Recurrent corneal erosion (RCE) is a condition where the outermost layer of the eye’s clear front surface, the cornea, repeatedly peels away. This can cause significant discomfort and disrupt daily life. Understanding and managing this condition is important for alleviating symptoms and preventing future episodes.
Understanding Recurrent Corneal Erosion
Recurrent corneal erosion occurs when the superficial layer of the cornea, the epithelium, detaches from the underlying Bowman’s layer. This detachment often happens due to a weakened adhesion between these layers. The condition is characterized by symptoms such as sudden, sharp eye pain, particularly upon waking or opening the eyes, light sensitivity, excessive tearing, and blurred vision.
Common causes and predisposing factors for RCE include previous corneal abrasions or injuries, which can disrupt the corneal surface’s integrity. Certain corneal dystrophies, such as epithelial basement membrane dystrophy (EBMD), can also weaken epithelial adhesion. Additionally, dry eye syndrome can contribute to the development of recurrent erosions.
Acute Treatment for Symptoms
Immediate treatment for an acute episode of recurrent corneal erosion focuses on pain relief, promoting healing of the corneal surface, and preventing infection. Lubricating eye drops or ointments are frequently used to reduce friction between the eyelid and the compromised corneal surface, aiding healing and comfort. Ointments are often recommended for use at night to create a protective barrier while sleeping.
Cycloplegic drops can be prescribed to reduce pain caused by spasms of the iris. Topical antibiotic drops or ointments are applied to the eye to prevent bacterial infections. A bandage contact lens may be placed on the eye for protection, pain reduction, and to facilitate epithelial healing. Oral pain relievers like ibuprofen or paracetamol can also help manage discomfort.
Preventative and Long-Term Strategies
Preventing future episodes of recurrent corneal erosion and promoting long-term corneal health involves several strategies aimed at strengthening the adhesion of the corneal epithelium. A common preventative measure is the continued use of hyperosmotic saline drops or ointments, which help to draw excess fluid out of the cornea and promote epithelial attachment. Consistent application, especially at bedtime, can prevent the eyelid from sticking to the cornea and causing further erosions upon awakening.
For individuals with co-existing dry eye syndrome, punctal occlusion may be considered to retain natural tears, improving lubrication. When medical treatments are not sufficient to prevent recurrences, several medical procedures can be performed to strengthen the corneal adhesion. Anterior stromal puncture (ASP) involves creating tiny, superficial punctures in the Bowman’s layer using a fine needle, which encourages new adhesion complexes between the epithelium and the underlying stroma.
Another procedure is excimer laser phototherapeutic keratectomy (PTK), where an excimer laser is used to remove a thin layer of Bowman’s layer after the damaged epithelium is debrided. This process allows the cornea to re-epithelialize with stronger attachments to the basement membrane, reducing the likelihood of future erosions. Superficial keratectomy, or manual debridement, involves carefully removing the loose or abnormal epithelial tissue, allowing for regrowth of a more adherent epithelial layer. After such procedures, a bandage contact lens along with topical antibiotics and corticosteroids may be used to aid healing.
When to Consult an Eye Doctor
It is important to consult an eye doctor when experiencing symptoms suggestive of recurrent corneal erosion or if existing symptoms worsen. Seek professional medical attention if you experience severe eye pain, a significant decrease in vision, persistent redness of the eye, or any discharge from the eye. These symptoms could indicate a more serious underlying issue or the development of an infection.
While some home care measures can help alleviate acute symptoms, a proper diagnosis and management plan from an ophthalmologist are necessary. An eye care professional can accurately diagnose recurrent corneal erosion through examinations, including a slit lamp exam, and determine the most appropriate long-term treatment strategy. Early and consistent professional care is important to prevent complications and ensure effective management.