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The Eye Practice
The Eye Practice

Recurrent corneal erosion

When opening your eyes can ruin your day.

Dry eyes can be the underlying trigger for a painful and recurring condition called Recurrent Corneal Erosion Syndrome (or RCES).

What is RCES?

In this condition, the delicate surface of your cornea adheres to your closed eyelids during sleep. When you wake up and open your eyes, the surface is ruptured, leading to a very uncomfortable eye for the next few days or longer.

Causes

Recurrent corneal erosion is often caused by an underlying condition called Epithelial Basement Membrane Dystrophy (or EBMD), which means the top layer of the cornea is more loosely attached than normal and can dislodge more easily. This can lead to RCES occurring in both eyes, although not necessarily at the same time.

The condition can also be triggered by trauma or recent eye surgery, in which case it tends to only affect the eye that had surgery or sustained the injury.

Contact lens wear can also lead to this condition.

Dry eye syndrome dehydrates the eyes and allows the cornea to make direct contact with the eyelids, especially during sleep. This causes the corneal surface to pull away on waking.

The result? Misery.

Symptoms

The symptoms of this disorder are:

  • Sharp pain in the eye (especially on waking)
  • Feeling like there is something in your eye (foreign body sensation)
  • Watery eyes
  • Red eyes
  • Blurred vision
  • Inability to keep the eye open
  • Light sensitivity (photophobia)

Management and treatment options

Managing dry eye effectively is one of the best ways to ultimately get rid of Recurrent Corneal Erosion Syndrome. Talk to your dry eye expert about ways to treat the underlying causes of your condition.  Often, dietary changes or a course of antibiotics pills may be the best therapy.

Night-time lubrication is one of the keys to successful management of this condition. Usually an oil based ointment works best as it does not evaporate and lubricates the eyes all night.

Whatever you choose, make sure it’s preservative-free, as preservatives can further aggravate the condition.

Overnight eye-masks can also be helpful, by protecting your eyes from the drying effects of air-conditioning and fans and also by keeping the eyes closed during sleep.

The treatment algorithm for recurrent corneal erosion should go something like:

1. Blinking exercises
2. Vita Pos or Lacrilube minimal ointment at night
3. Probiotics
4. Omega 3 supplements
5. Manuka honey
5. IPL (intense pulse light)
6. Prednisolone preservative drops
7. Oral Doxycycline
8. Sleep in extended contact lenses for 3 months
9. Basement membrane debridement
10. Stromal puncture
11. Therapeutic PRK

When do you need a referral?

If your recurrent corneal erosion is not resolving with the first 8 treatment options, you may need more aggressive treatment. Referral to an ophthalmologist may be required in persistent cases that do not respond to other therapies. What is imperative is to see someone that performs all treatments as they are experienced in recurrent corneal erosion treatment.  Leave the referral to us, as we know all the anterior segment specialists that are proficient in this area.

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