A recurrent corneal erosion is a very painful and often serious condition that occurs, in most cases, when a scratched cornea doesn’t heal properly. This can lead to recurring erosions – a scraping off of the improperly healed corneal epithelium – reopening the wounded area and causing varying degrees of pain.
What is a Recurrent Corneal Erosion?
When the corneal, the clear top layer of the eye, is scratched, it quite often heals well with treatments such as Muro 128 ointment, antibiotic drops and time. However, in some cases, the corneal epithelium will heal well to itself, appearing to be fine, but will not heal properly down to the basement layer below, thus making the healed area below less secure and prone to re-injury by the eyelid.
Think of it like building a house on a broken foundation – while the building may be strong (the apparent healing), the foundation isn’t, and it doesn’t take much to disrupt the structure or cause it to fail due to the poor foundation.
RCE Symptoms and Initial Treatments
Typically, patients who experience recurrent corneal erosions awaken during the night with a searing eye pain – often far greater than the original injury – and have the feeling of the corneal tissue tearing at the site of the injury. This is caused by the newly formed “scar tissue” adhering to the eyelid and being rubbed off during REM sleep. The patient awakens with pain, swelling of the eye and eyelids, a feeling of something in the eye, tearing and blurred vision.
Initial treatments include Muro 128 ointment at night to both promote healing and decrease the friction between the eye and the eyelid. As this is an open wound, at least for a time, antibiotics drops will be used. Patients may also be instructed to use artificial tears drops during the day to keep the eye moisturized.
Use of a Bandage Contact Lens
If the recurrences continue, ophthalmologists may use a bandage contact lens. This can immediately help with the pain, as the lens acts as a bandage by separating the eye and the eyelid. The contact decreases the constant irritation of the eyelid blinking over the injured area. The bandage contact is simply a clear, prescription free contact lens that the ophthalmologist places in the eye – whether the patient has ever worn contact lenses or not. This lens remains in place – 24 hours a day – for as long as the eye doctor feels necessary. Typically it is left in place for two weeks, but it can remain longer – with some studies reporting use of the bandage for eight to 26 weeks.
Once the eye has healed, the doctor may remove the lens to re-examine the eye with fluorescein dye under a slit lamp. The lens may be replaced at that time, or the eye may be given the chance to continue healing without the lens to see if the recurrences occur. Unfortunately, due to the nature and unpredictability of this type of injury, the erosion may happen again at any point – from the same day to even one year later.
Patients should be sure to follow their doctor’s advice when wearing a bandage contact lens. Insertion and removal should be done by the doctor, as the chances of re-injuring the eye are great, especially for those who aren’t contact lens wearers. Sleeping with contact lenses is also problematic, and while most contact lens wearers are told not to sleep in lenses – when used as a bandage, the lens is left in continually. Chance of infection from the constant wear means that use of an antibiotic eye drop such a Vigamox is critical, as is keeping the lens moist and floating, especially at night.
Recurrent corneal erosions are very frustrating, painful and difficult to treat. Standard treatments include application of Muro 128 at night to increase healing and reduce the friction between eye and eyelid. Bandage contact lenses can provide relief from pain, but come with their own problems and must be carefully managed. Surgical interventions may be needed to correct a resistant erosion that doesn’t respond to less invasive treatments.
Disclaimer: This article is intended for informational purposes only. Those with eye injuries should seek medical attention immediately and follow their doctor’s advice on treatment.
Sources:
Corneal Erosion, Recurrent: Treatment & Medication (accessed 5/31/10).
Corneal Abrasion (accessed 5/31/10).
Recurrent Corneal Erosion Fact Sheet (accessed 5/31/10).
