Recurrent Corneal Erosions

What is recurrent corneal erosion (RCE)?

The cornea is the clear, dome-shaped covering of the eye. RCE occurs when the outer layer of the cornea, known as the epithelium, loosens or peels off. Normally the epithelium is tightly adhered to the layer of the cornea beneath it. The eye becomes very painful with RCE since the cornea is very sensitive to any disruption of cells. The pain frequently is worse upon awakening. When the eyelids are closed during sleep, the reduced oxygen supply causes mild swelling of the epithelium. This swelling can cause the epithelium to become stuck to the under surface of the eyelid. Upon awakening, this loose tissue peels off when opening the eyelids, resulting in severe pain. The pain may last for a couple of hours or up to several days, with a recurrence rate of several times per year. Frequently, if they resolve quickly, the symptoms of a RCE are often ignored. A doctor of optometry should be consulted to properly diagnose and treat a recurrent corneal erosion to minimize the discomfort experienced and provide solutions to prevent recurrence.

What causes RCE?

Most cases of RCE are associated with prior corneal trauma, such as a previous scratch. Other cases are associated with underlying epithelial dystrophies. As mentioned earlier, normally the epithelium is tightly adhered to the underlying layer. Sometimes after an injury there are insufficient or defective connections to anchor the epithelium to the rest of the cornea, leaving the epithelium susceptible to peeling. Patients who have an underlying corneal dystrophy naturally have loose epithelium. This is usually present at birth but does not manifest itself until early adulthood. It is important to note that patients rarely experience permanent vision loss from a RCE.

How do you treat RCE?

Treatment of RCE involves a Doctor of Optometry patching the affected eye with an oxygen permeable bandage contact lens along with the use of antibiotic and anti-inflammatory eye drops. Artificial teardrops are also used to lubricate the eye. Depending on the severity of the RCE, topical ointments are sometimes used in the eye nightly prior to going to bed, to reduce the chance of the epithelium peeling off in the morning. In some cases patients experience repeated episodes of erosions. Treatment may involve either a bandage contact lens for several months or possible surgical intervention by an ophthalmologist in extreme cases. Where corneal trauma has occurred, it is important to have the eye treated properly by an optometrist to reduce the chance of experiencing a RCE.

Image by James Heilman, MD (Own work) [CC BY-SA 3.0 (http://creativecommons.org/licenses/by-sa/3.0) or GFDL (http://www.gnu.org/copyleft/fdl.html)], via Wikimedia Commons

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