Corneal Erosions (Recurrent)

Corneal Erosion at the 5 O'Clock Position

Basic Understanding

Recurrent corneal erosion is a disorder of the eyes characterized by the failure of the cornea's outermost layer of epithelial cells to stay attached to the underlying basement membrane (Bowman's layer). The cornea is the clear front of the eye which is covered by a layer of protective cells much like the outer protective layer of the skin.  When this layer is disturbed the pain is often extremely severe. The condition can be very painful because the loss of these cells results in the exposure of sensitive corneal nerves. This condition can often leave patients with temporary reduced vision due to strong light sensitivity (photophobia) and the irregular corneal surface makes light blurry.  Symptoms include recurring attacks of severe acute ocular pain, foreign-body sensation, photophobia, and tearing often at the time of awakening or during sleep when the eyelids are rubbed or opened. Signs of the condition include corneal abrasion or localized roughening of the corneal epithelium, sometimes with map-like lines, epithelial dots or microcysts, or fingerprint patterns. An epithelial defect may be present, usually in the inferior interpalpebral zone.

Recurrent attacks of sudden eye pain often noted upon opening the eyes in the morning. This often follows a corneal abrasion, especially after a fingernail injury, or may related to an abnormal corneal surface which is predisposed to spontaneous abrasions of the surface

Advanced Treatments

Treatment is aimed at improving patient comfort, healing the acute condition and then prevention of future recurrences. Initial management is often with a bandage contact lens placed over the eroded cornea in order to provide a barrier between the injured cornea and the blinking eyelid.  A special membrane, called an Amniotic Membrane, is frequently placed over the erosion then covered by the bandage contact lens.  This state of the art therapy which we provide at Palm Beach Eye Center is not available at many local ophthalmologist's offices.  The membrane provides proteins that enhance healing and decrease inflammation.  Sometimes the eye may be patched for a short time to allow healing.  Antibiotic drops or ointments are frequents used.  If the frequency of the condition is excessive the surface of the cornea may require reconstruction.  This may be done as an in-office procedure. Sometimes a special fine needle is used to promote adherence of the corneal surface to the underlying corneal tissue. A special diamond burr or a laser may be used to smooth the irregular surface.  Special drops called autologous serum or ointments are often prescribed on a long-term basis to prevent further episodes.

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Research and Layman's Interpretation

Clinical presentation and causes of recurrent corneal erosion syndrome: review of 100 patients.

Cornea. 2014 Jun;33(6):571-5. doi: 10.1097/ICO.0000000000000111.

Diez-Feijoo E1, Grau AE, Abusleme EI, Durán JA.

Purpose- To study the clinical features and etiology of recurrent corneal erosion syndrome (RCES).
Conclusion-RCES has various etiologies, which explains the variety in the clinical presentation of the disorder. Interestingly, a significant number of RCES patients begin to manifest the syndrome after keratorefractive surgery, and a high percentage of patients also present with MGD.

Layman's interpretation- There are many possible causes of recurrent corneal erosions and your ophthalmologist can perform an appropriate evaluation to determine the specific cause of your erosion in order to provide the best treatment.

Demographic patterns and treatment outcomes of patients with recurrent corneal erosions related to trauma and epithelial and bowman layer disorders.

Am J Ophthalmol. 2013 Dec;156(6):1082-1087.e2. doi: 10.1016/j.ajo.2013.07.022. Epub 2013 Sep 25.

Suri K1, Kosker M, Duman F, Rapuano CJ, Nagra PK, Hammersmith KM.
Purpose-To evaluate demographics and outcomes of patients with recurrent corneal erosions related to trauma and epithelial and Bowman layer disorders.
Conclusion-Recurrent corneal erosions are most commonly associated with epithelial basement membrane dystrophy. Patients are generally initially managed conservatively, with recurrence in more than half of eyes. Diamond burr polishing is the most common surgical intervention and is effective in a majority of eyes.
Layman's interpretation-The use of a special diamond burr to sand down an irregular corneal surface is an effective and safe surgical technique to manage recurrent corneal erosions.

Anterior stromal puncture for the treatment of recurrent corneal erosion syndrome: patient clinical features and outcomes.

Am J Ophthalmol. 2014 Feb;157(2):273-279.e1. doi: 10.1016/j.ajo.2013.10.005. Epub 2013 Oct 22.

Avni Zauberman N1, Artornsombudh P1, Elbaz U1, Goldich Y1, Rootman DS1, Chan CC2.
Purpose-To evaluate the clinical features and outcomes of patients with recurrent corneal erosion syndrome who underwent anterior stromal puncture.
Conclusion- Anterior stromal puncture using a short (5/8 inch) 25 gauge bent needle is a simple, safe, and cost-effective procedure for symptomatic relief in patients with recurrent corneal erosion syndrome refractive to conservative measures. Repeat treatment may be performed prior to additional surgical intervention.
Layman's interpretation-Microscopic treatment with a fine needle can be effective to prevent future corneal erosions.

Application of umbilical cord serum eye drops for recurrent corneal erosions.

Cornea. 2011 Jul;30(7):744-8. doi: 10.1097/ICO.0b013e31820d850f.

Yoon KC1, Choi W, You IC, Choi J.
Purpose-To investigate the efficacy of umbilical cord serum eyedrops for the treatment of patients with recurrent corneal erosions.
Conclusion-In the treatment of recurrent corneal erosions, umbilical cord serum eye drops may be effective in reducing the number of recurrences.
Layman's interpretation-Eye drops made from umbilical cord serum are useful in decreasing the recurrences of corneal erosions. At Palm Beach Eye Center we harmlessly use the patient's own serum to make the eye drops rather than use serum from a donor.  We can typically make this in less than 4 hours.

Small spot phototherapeutic keratectomy for recurrent corneal erosion.

J Refract Surg. 2007 Sep;23(7):721-4.

van Westenbrugge JA 1.
Purpose-To describe small spot phototherapeutic keratectomy (PTK) using the NIDEK EC-5000 excimer laser for the treatment of recurrent corneal erosion.
Conclusion-Small spot PTK is a safe and effective alternative to traditional PTK and to corneal micropuncture in the treatment of recurrent corneal erosion.

Layman's interpretation-Laser can be safely used to treat recurrent corneal erosions.

Single and multilayer amniotic membrane transplantation for persistent corneal epithelial defect with and without stromal thinning and perforation.

Br J Ophthalmol. 2001 Dec;85(12):1455-63.

Prabhasawat P1, Tesavibul N, Komolsuradej W.
Purpose-To evaluate the efficacy of amniotic membrane transplantation (AMT) in persistent corneal epithelial defect with or without stromal thinning and corneal perforation.
Conclusion-Amniotic membrane can successfully treat refractory corneal epithelial defect by promoting epithelial healing and thus prevent corneal perforation. It can be used as a treatment for corneal perforation by restoring corneal stromal thickness so that emergency penetrating keratoplasty can be avoided.
Layman's interpretation-Amniotic Membrane promotes corneal healing.  In our experience, it is a mainstay of treatment for recurrent erosions that reduces discomfort and accelerates healing time.

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