Recurrent corneal erosion (RCE) is a painful eye condition where the cornea’s outermost layer, the epithelium, repeatedly detaches from the underlying layers. This weak attachment is often caused by a previous injury or an underlying corneal dystrophy. Patients typically experience sudden, sharp eye pain, often upon waking or during sleep, accompanied by blurred vision, tearing, and light sensitivity. The recurring nature of RCE stems from the incomplete healing of the epithelial layer to its basement membrane, requiring treatment to restore the cornea’s structural integrity.
Non-Surgical and Medical Management
The initial approach to managing RCE focuses on stabilizing the corneal surface and promoting healthy adhesion. During an active erosion event, the primary goal is pain management and infection prevention. This is typically achieved with lubricating drops, antibiotic ointments, and oral non-steroidal anti-inflammatory drugs (NSAIDs). Cycloplegic drops may also be employed to help ease pain by relaxing the internal eye muscles.
For daily and preventative care, frequent application of preservative-free artificial tears and lubricating ointments, especially at bedtime, is recommended to reduce friction between the eyelid and the cornea. Hyperosmotic agents, such as hypertonic saline drops or ointments like Muro 128, are sometimes prescribed to help draw excess fluid out of the cornea, which can strengthen the epithelial bond.
A therapeutic bandage contact lens (BCL) acts as a physical shield over the cornea while it heals, providing immediate relief from pain and protecting the newly forming epithelial cells. The BCL is typically worn for several weeks or months and is often used alongside prophylactic antibiotic drops to minimize the risk of infection.
When topical treatments are insufficient, systemic medications may be employed to address the underlying cause of poor healing. Oral doxycycline, a tetracycline antibiotic, is often prescribed because it inhibits matrix metalloproteinase (MMP) enzymes, which break down the proteins needed for epithelial adhesion. Doxycycline is often paired with a topical corticosteroid, such as prednisolone, which also reduces inflammation and MMP activity. This combination creates a more stable environment for the cornea to repair itself over several months.
Targeted In-Office Procedures
When medical management proves ineffective or RCE episodes remain frequent, the ophthalmologist may recommend in-office procedures to encourage a stronger epithelial bond. Epithelial debridement involves the gentle removal of the loose, poorly adhering epithelial layer using a surgical sponge or cotton swab under local anesthesia. This technique allows a new, healthy layer of epithelial cells to grow back and establish better adhesion to the underlying basement membrane.
Anterior Stromal Puncture (ASP) is a technique used for erosions located away from the central visual axis. A fine needle is used to create tiny, shallow punctures through the epithelium and Bowman’s layer into the anterior stroma. These micro-punctures induce a localized healing response that results in the formation of micro-scars, which serve as new anchoring points to secure the regrowing epithelium more firmly.
Another approach is alcohol delamination, which utilizes a dilute alcohol solution applied to the corneal surface for a short period, typically around 30 seconds. The alcohol chemically loosens the damaged epithelium and underlying debris, allowing the surgeon to gently peel it away. Similar to debridement, this process aims to leave a smooth surface that encourages the new epithelial layer to grow back with stronger, more persistent attachments.
Advanced Laser and Surgical Treatments
For chronic RCE that does not respond to medical or in-office procedures, advanced treatments are used to achieve a definitive, long-term solution. Phototherapeutic Keratectomy (PTK) is considered the gold standard for refractory RCE, particularly when the erosion is located in the center of the cornea. PTK uses an excimer laser to precisely remove a microscopic layer of the abnormal tissue, including the superficial portion of Bowman’s membrane and potentially the anterior stroma.
The excimer laser treatment effectively polishes the corneal surface, eliminating the defective basement membrane that was preventing proper adhesion. This creates a smooth, healthy foundation upon which the new epithelial cells can re-adhere with a significantly improved and permanent bond. After the procedure, a bandage contact lens is placed on the eye to promote comfortable healing while the new epithelium regrows over the next few days.
PTK boasts a very high success rate in preventing recurrence, though patients should be aware of a potential temporary side effect of corneal haze during recovery. For severe cases complicated by significant corneal scarring or underlying disease extending deep into the tissue, other surgical options may be considered. These include a Superficial Keratectomy, or in rare circumstances, Deep Anterior Lamellar Keratectomy (DALK), which involves a partial-thickness corneal transplant.