Recurrent corneal erosion is a painful disorder of the eyes involving the outermost corneal layer. Whilst direct trauma to the eye (such as the introduction of a foreign body) will scratch the cornea causing an ulcer, in this disorder there is a failure of the cornea to attach to the underlying basement membrane, and it is therefore liable to become detached.
Etiology
There is usually a history of previous corneal injury (corneal abrasion or ulcer), but also may be due to corneal dystrophy or corneal disease.
Symptoms and signs
Symptoms include recurring attacks of acute ocular pain, foreign-body sensation, photophobia (i.e. sensitivity to bright lights), 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 microcyts, or fingerprint patterns.
Diagnosis
The erosion may be seen by a doctor using the magnification of an ophthalmoscope, although usually fluorescein stain must be applied first and a blue-light used. Opticians and Ophthalmologists have use of slit lamp microscopes that allow for more thorough evaluation under the higher magnification.
Management of episodes
With the eye generally profusely watering, the type of tears being produced have little adhesive property. Water or saline eye drops tend therefore to be ineffective. Rather a 'better quality' of tear is required with higher 'wetting ability' (ie greater amount of glycoproteins) and so artificial tears (eg viscotears) are applied frequently.
Whilst individual episodes may settle within a few hours or days, they will as the names suggests recur at intervals.
Prevention
Given that episodes tend to occur on awakening and are sometimes managed by use of good 'wetting agents', approaches to be taken to help prevent episodes include:
wear extended wear (thirty day) contact lenses during sleep. Obtain a sample of the various extended wear lenses in the market to see which works best for you. Insert the lenses before going to sleep and put a few drops of saline into each eye upon waking. Repeat this saline hydration again a few minutes later and then remove the lenses. Do not wear the lenses during the day. Maintain your lenses properly, and ensure that your fingers are well cleaned before touching lenses. Obtain the lowest prescription lens available, to allow greatest oxygen flow through the lens. Do not get lenses that will improve your visual acuity, as they may be too thick. Long time daily sufferers have been 100% "episode free" for years utilizing this method, so have some patience when getting used to the lenses. Whether patients have had a corneal ablation or not, the corneal surface will very likely show no signs of erosions, even within a few months of the last episode.
avoiding dry or irritating environments (eg cigarette smoke)
drinking plenty fluids to help prevent drying of the eyes. This may also involve limiting alcohol intake in the evenings.
not sleeping-in late, as corneal hydration from lid closure may be a factor affecting epithelial adhesion.[1]
use of long-lasting eye ointments (eg lacrilube) applied before going to bed.
learn to wake with eyes closed and still. Keep high quality artificial tears within reach at bedtime. If eyes feel 'stuck shut' upon awakening, insert the tip of tears bottle slightly into inner corner of eye, gently squirting the tears, which will seep under the eyelid, often allowing opening of eyes without an erosion episode. Several repeated applications of tears may be necessary, but with patience, eyes will very likely become 'unstuck' allowing painfree opening of eyes and erosion avoidance. (personal experience)[citation needed]
control air quality and humidity while sleeping. Avoid having an over ventilated room while you sleep. Having air flowing over your face, even with your eyes closed, can and will increase eye dryness. Cool, moist and still air is the best environment to prevent unnecessary evaporation of eye moisture. (personal experience)[citation needed]
Treatment
Where episodes frequently occur, or there is an underlying disorder, curative procedures may be attempted. These all essential try to remove the affected part of the cornea with the intention that new, healthier, epithelium grows back. Under local anaesthetic, the corneal layer may be gently removed with a fine needle, cauterised (heat or laser) or 'spot welding' attempted (again with lasers). The procedures are not guaranteed to work, and in a minority may exacerbate the problem.
