Recurrent corneal erosion

Recurrent Corneal Erosion (RCE) is a chronic condition characterized by the repeated breakdown of the cornea's outermost layer, known as the epithelium. This condition can result in significant discomfort, pain, and visual disturbance. It is often a consequence of a previous corneal injury, though it may also arise in association with corneal dystrophies or without any apparent preceding cause.

Etiology

Recurrent corneal erosion may occur following a minor trauma to the cornea, such as a scratch from a fingernail or a contact with a piece of paper. It is also associated with certain corneal dystrophies, such as Epithelial Basement Membrane Dystrophy (EBMD), which affects the adhesion of the epithelial cells to the underlying basement membrane. In some cases, no clear precipitating factor is identified, suggesting a possible genetic predisposition or an underlying weakness in the corneal epithelium.

Symptoms

Patients with RCE typically report episodes of acute eye pain, especially upon awakening, which is attributed to the eyelid reopening the partially healed erosion. Other common symptoms include:

• Photophobia (sensitivity to light)
• Tearing
• Blurred vision
• Foreign body sensation in the eye

Diagnosis

Diagnosis of RCE is primarily clinical, based on the patient's history and symptoms. A thorough eye examination, including slit-lamp biomicroscopy, is essential. Special staining of the cornea with fluorescein dye can highlight areas of epithelial breakdown. In cases where corneal dystrophy is suspected, genetic testing or corneal microscopy may be utilized for a more definitive diagnosis.

Treatment

The treatment of RCE focuses on promoting healing of the cornea, preventing recurrence, and managing pain. Initial management often includes:

• Lubricating eye drops and ointments to keep the eye moist and support healing
• Antibiotic drops or ointments to prevent infection
• Bandage contact lenses to protect the cornea and relieve pain

For patients with frequent recurrences or those who do not respond to conservative treatment, more advanced therapies may be considered, such as:

• Anterior stromal puncture, which promotes adhesion of the epithelium to the underlying tissue
• Phototherapeutic keratectomy (PTK), a type of laser eye surgery that removes irregularities on the corneal surface and encourages proper healing

Prevention

Preventive measures for RCE include the use of lubricating eye drops or ointments, especially at night, to minimize the risk of the eyelid disturbing the corneal surface. Patients with known corneal dystrophies may benefit from regular follow-up with an ophthalmologist to monitor their condition and manage any complications promptly.

Prognosis

With appropriate treatment, most patients experience a significant reduction in the frequency and severity of RCE episodes. However, some individuals may continue to have recurrences, necessitating ongoing management.