Recurrent erosion syndrome is a chronic eye condition characterized by repeated damage to the cornea’s outermost layer. This disorder involves the failure of the epithelial cells to properly adhere to the underlying basement membrane. When these cells detach, it exposes sensitive nerve endings in the cornea, leading to significant pain and vision disturbance. Episodes can occur repeatedly over time.
What is Recurrent Erosion Syndrome?
The cornea is the transparent, dome-shaped front part of the eye, responsible for focusing light to provide clear vision. Its outermost layer, the corneal epithelium, is a thin, multicellular tissue composed of several layers of rapidly regenerating cells. This epithelial layer is normally well-attached to the underlying Bowman’s layer and basement membrane.
An erosion occurs when this delicate epithelial layer breaks down or separates from its foundation. During an acute episode, individuals commonly experience sudden, severe eye pain, often upon waking or during sleep. Other symptoms include light sensitivity (photophobia), blurred vision, and excessive tearing. Unlike a single corneal abrasion, recurrent erosion syndrome is defined by these repeated episodes.
Why Recurrent Erosion Syndrome Occurs
Recurrent erosion syndrome often develops following an initial corneal injury, such as a scratch, foreign body, or abrasion. The healing process may be incomplete or flawed, resulting in poor adhesion of newly formed epithelial cells to the underlying basement membrane. This weak attachment makes the epithelium vulnerable to being torn off by eyelid movement, particularly during sleep when eyelids are closed and mild epithelial swelling can occur.
Certain underlying conditions also contribute to recurrent erosions. Corneal dystrophies, such as Epithelial Basement Membrane Dystrophy (Cogan’s Dystrophy or map-dot-fingerprint dystrophy), are contributing factors. Dry eye syndrome, diabetes mellitus, and previous corneal infections can also increase the risk. These factors disrupt the integrity of the corneal surface and its adhesive structures, making it prone to recurrence.
Diagnosis and Treatment Approaches
An ophthalmologist diagnoses recurrent erosion syndrome through a comprehensive eye examination using a slit lamp. This specialized microscope allows the doctor to visualize the corneal surface in detail, identifying irregularities, loose epithelium, or areas of damage. Fluorescein dye, an orange stain, is often applied to the eye. This highlights any areas where the epithelial layer is compromised, making the erosion visible under blue light.
For an active erosion, immediate treatment focuses on pain relief and preventing infection. This involves lubricating eye drops or ointments to keep the eye moist and promote healing. Antibiotic drops may be prescribed to prevent bacterial infection in the exposed corneal tissue. A therapeutic bandage contact lens may also be applied to protect the corneal surface, reduce pain, and facilitate healing.
Long-term management aims to strengthen the corneal surface and reduce future episodes. Continued use of hypertonic saline drops or ointments helps reduce corneal swelling and improve epithelial adhesion. Oral tetracycline derivatives, like doxycycline, are sometimes prescribed. They can reduce the activity of enzymes that degrade the corneal basement membrane, promoting healing. Topical corticosteroids may also be used to reduce inflammation and promote proper healing.
Strategies for Preventing Recurrence
Proactive measures minimize the risk of future recurrent erosion episodes. Consistent use of prescribed lubricating eye drops, especially at night, helps prevent the eyelid from sticking to the fragile epithelium and tearing it upon waking. Thicker, more viscous eye ointments applied before bed can offer additional protection.
Avoiding eye rubbing is also advised, as mechanical trauma can easily disrupt the weakened corneal surface. Managing underlying dry eye syndrome through appropriate treatments further supports corneal health. Using protective eyewear in dusty, windy, or irritating environments can shield the eyes from potential triggers. For persistent cases that do not respond to conservative treatments, more advanced procedures may be considered. These include anterior stromal puncture (ASP), which creates tiny punctures in the corneal surface to promote stronger epithelial adhesion, or excimer laser phototherapeutic keratectomy (PTK), which reshapes the corneal surface to improve adhesion.