Recurrent Corneal Erosion
What is recurrent corneal erosion?
Recurrent corneal erosion (RCE) affects the outer surface layer of the cornea (corneal epithelium). The corneal epithelium protects the cornea from foreign objects (things that shouldn’t be there). In RCE, this outer layer is weak and loose due to poor adhesion to the rest of the cornea. The loose epithelium ‘rips open’ at the points of weakness, especially when waking up, resulting in severe pain.
People with RCE usually experience pain after waking up, which can range from mild to severe. Other symptoms include:
- Watery eyes
- Blurred vision
- Irritated, dry eyes
- Pain – moderate to severe
- Photophobia (light sensitivity)
- Feeling as if something is scratching your eye
Your symptoms may lessen throughout the day and recur the next morning.
When should I visit emergency care?
If you experience pain that continues to increase, you may require immediate attention. Other signs include progressive vision loss and pus-like discharge. If you think something is in your eye (a foreign object) and cannot flush it out, speak to a medical professional. Foreign objects in the eye can lead to corneal abrasions and infections.
Learn more about eye emergencies here: Urgent care for eye problems.
The most common cause is a previous injury (trauma) to the eye that hasn’t healed completely. This leaves your epithelial cells unsettled so they can dislodge easily and stick to your eyelids. The corneal epithelium is more likely to stick while you’re sleeping. This is why the pain is often worse after you have woken up and opened your eyes for the first time.
As the epithelium fails to heal, the erosion of your cornea can continue. A change in the cornea caused by an eye condition can also result in epithelial weakening, such as a corneal dystrophy. Common types of dystrophy that can cause RCE include map-dot fingerprint, Reis-Buckler, and lattice dystrophy.
Long-term complications are rare. You may experience an infection, infectious keratitis, or corneal scarring, which can lead to poor vision.
You are more likely to experience RCE if you’ve had an eye injury or wear your contacts incorrectly. Other risk factors include diabetes, dry eye syndrome, ocular rosacea, and meibomian gland dysfunction. Women and people over 40 are also more likely to experience RCE.
Certain surgeries for eye conditions can also increase the risk, including:
To prevent it, you should avoid dusty, dry environments that could irritate your eyes. We recommend that you avoid rubbing your eyes as well.
When you visit our clinic, we will discuss your symptoms, including how long you’ve had them and how severe they are. You should tell our ophthalmologist (eye specialist) if your symptoms are worse at any time of day. Asking questions, such as if you have previously hurt your eye, will help us make a diagnosis.
We can also perform a slit lamp examination to diagnose RCE. A slit lamp exam involves using a microscope with a light source to look for corneal injuries, such as abrasion. We may use a yellow dye (fluorescein) in an eye drop to highlight specific areas of the eye. If you have a severe case, we may also use corneal topography to map the surface of your cornea.
Many eye conditions may have similar symptoms. Other possible causes include corneal ulcers, dry eye syndrome, herpes simplex virus (HSV), and exposure keratopathy.
Treatment is usually non-invasive, but your treatment plan may evolve to a more invasive approach if your condition is persistent. Our specialists will discuss your circumstances with you.
The initial treatment for RCE involves using a long-term lubricant ointment each night and lubricant eye drops during the day as required. We can combine this with epithelial debridement (removing your loose epithelium) and contact lens fitting to allow better epithelial healing. You may also need an antibiotic eye drop to avoid infection.
To remove damaged corneal epithelium and allow new tissue to grow, we may perform alcohol delamination or phototherapeutic keratectomy (PTK). At Oculase, we prefer PTK if medical therapy fails as it is a definitive treatment. During laser PTK treatment, we can correct your refractive errors, such as myopia (short-sightedness) and astigmatism.
Other surgical options include anterior stromal micropuncture and diamond burr polishing. However, these aren’t commonly used as other interventions, described above, provide better results.
Additionally, we must manage any other eye conditions, such as blepharitis. If you experience dry eyes, we might perform punctual occlusion. Punctual occlusion can slow your tears and any artificial lubrication from draining.
Book an appointment
If you are experiencing symptoms of recurrent corneal erosion, get in touch today to organise diagnostic tests. After a thorough examination and diagnostic process, our ophthalmologists will determine the most appropriate treatment option for you.