Recurrent Corneal Erosion Syndrome, Corneal Abrasion - A State of Sight #16

Corneal erosions can recur frequently causing pain and irritation. Isaac Porter, MD explains the causes of recurrent corneal erosion syndrome and possible treatment options including lubrication, drops, and surgical procedures.

Do you suffer from recurrent corneal erosions? Please share your comments and questions below!

Welcome to A State of Sight, I’m Isaac Porter from Raleigh, NC and this is your weekly update in ophthalmology and eye care. In this episode, I’m going to give you the details about recurrent corneal erosion syndrome, which is a problem that can cause a significant amount of pain and irritation.

To better understand this, let’s look at the eye model. The cornea is the clear shield that covers the front of the eye. The epithelium is the layer on the surface of the cornea.

It is a thin layer, a little bit like the skin, that covers the eye. This layer is always replaced and changes over to help provide a nice smooth surface for the eye.

If the eye is scratched or hit, it’s very easy for this thin layer of epithelium to be removed in what we call a corneal abrasion. This is very painful but it heals very quickly (it can heal the distance of one millimeter over ten hours).

After an abrasion, once it heals back from all directions, the epithelium smooths the surface of the eye and patients then feel better. However, if this happens and there is not a good attachment between the surface layer of the epithelium and the underlying layers of the cornea, patients can be prone to recurrent corneal erosions.

Patients with recurrent corneal erosion syndrome (RCES) may notice after waking in the morning or in the middle of the night that they have a lot of pain, redness, and tearing. This is due to poor adhesion between the epithelium and the underlying layers. The surface can easily break off again and cause an erosion that’s similar to the initial abrasion.

Other reasons that can cause RCES include an inherited disease where the epithelium does not stick down properly, or it can be caused from have diabetes.

Initially, we can treat conservatively with lubrication or a strong saline ointment or solution that can help smooth the surface and allow better adhesion of the epithelium.

When these treatments do not work, we have to go to more advanced treatments, such as using a specialized contact lens that can help keep the surface intact and prevent any brushing or disturbance from the eyelid with a blink or when people are sleeping.

After this treatment if patients are still having trouble and have erosions frequently, or if the erosions are very bad and bothersome, we may consider eye surgery.

One type of procedure that we can do is take a needle to make fine impressions in the area of the erosion to create a small scar to create a better adhesion. This operation is called anterior corneal stromal micropuncture.

We can also do a treatment called PTK, which stands for phototherapeutic keratectomy, which is basically using the laser that we use to perform LASIK with to remove some layers from the surface of the cornea. Then once the eye heals afterwards, we can see a better adhesion and a decrease in the corneal erosions.

Next week I would like to give you some more details about PTK because it’s a great procedure for the right people, but that’s all the time we have for today so as always, please post below if you have comments or questions and until next time, good health and good sight.