Recurrent Corneal Erosion
Recurrent corneal erosion is the recurrent breakdown of the outermost layer (epithelium) of the cornea. In recurrent corneal erosions, the outermost layer of the cornea fails to glue in tightly to its underlying membrane (basement membrane), making it possible for the epithelium to break off too easily with little effort.
Causes
There are 3 major causes of recurrent corneal erosion, which are:
- Previous corneal injury (corneal abrasion) such paper cut
- Corneal dystrophy (map dot fingerprint dystrophy) – (abnormal structure changes of the cornea)
- Underlying corneal disease
Signs and Symptoms
In recurrent corneal erosion, the patient can remember having had a corneal abrasion relatively recently (but sometimes can be as long as months to years earlier) and then, most often when first opening the eye in the morning, feels a sudden burst of pain accompanied by symptoms of a corneal abrasion, which are:
- Lots of watery tearing
- Sensitivity to light (especially bright light)
- Blurry vision
- Redness of the eye
- Spasm of the muscles surrounding the eye resulting in squinting
- Feeling that something is in the eye
- Pain
Self-Care Guidelines
The self-care for recurrent corneal erosion is:
- Keep the eye shut
- Never rub the involved eye at any time (even if it feels fine)
- Immediately remove a contact lens. Contact lens wearers should always have a back-up pair of glasses for when contact lenses shouldn’t be worn
- Use artificial tears to bathe the eye
- Use clean water to rinse the eye
- Use sunglasses to reduce the light sensitivity
What is very important in self-care is learning how to open your eyes when awakening. The friction of the lid against the sick cornea is enough to rip off a piece of the corneal epithelium, as noted above. So, if you suspect you have recurrent corneal erosion, keep the eye closed firmly and only open the good eye. Look around a little to lubricate the sick eye, so that when you do open it, there is hopefully no friction and, thus, no repeat of the abrasion.
When to Seek Medical Care
You should seek medical advice for recurrent corneal erosions when:
- The pain is persisting beyond the first day, or the pain is increasing despite self-care
- There is no improvement with self-care after 24 hours
- There is progressive vision loss
- It is more than once that the abrasion has recurred
- You develop a mucoid or pus-like discharge from the eye
Treatments Your Physician May Prescribe
Treatment can take up to several weeks or months.
- Instillation of an antibiotic ointment along with frequent eye lubrication.
- If there is an underlying corneal disease requiring treatment, that too will be addressed.
- Often, you will be given a salt-like drop for day use and salt-like ointment for nighttime use. The salt pulls fluid out of the corneal epithelium, allowing it to lay down tighter to the underlying basement membrane and, hence, heal better.
- Bandage contact lenses are sometimes used and kept in place for several weeks along with antibiotic/steroid drops.
- Anterior stromal puncture is used to treat persistent situation with fair success. A bent needle is used to make shallow punctures in the deeper layer of the cornea to allow the surface layer (epithelial layer) to anchor in place.
- If these rather simple procedures are not successful, your eye surgeon may re-scrape the area to create a more irregular abrasion followed by 1–3 days of patching in hopes of getting the tissues to heal better.
- Finally, if all this fails to work, the eye care professional may recommend laser treatment to the involved site, called phototherapeutic keratectomy (PTK).
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