Recurrent Corneal Erosions

Waking up with eye pain

What are Recurrent Corneal Erosions?

A recurrent corneal erosion is the recurrent breakdown of the outermost layer (epithelium) of the cornea. In recurrent corneal erosions, the outermost layer of the cornea (the epithelium, or top-most layer of skin) fails to stick tightly to its underlying layer of the cornea (basement membrane), making it possible for the epithelium to break off too easily with little effort.

What are the Signs and Symptoms of a corneal erosion?

A corneal erosion may often be painful – and if it happens to you, you may feel an intense pain, often upon waking up first thing in the morning. You may also notice

·       Eye Pain

·       decreased vision

·       distortions, or a cloudiness/haziness to your vision

·       redness of the eye

·       sensitivity to bright lights

·       twitching/squinting of the eyelid muscles.

The eye pain may sometimes last for several hours. This may happen repeatedly (recurrent), sometimes once a week, or once a month.

What causes recurrent corneal erosions?

There are 3 major causes of recurrent corneal erosion, which are:

·       Previous corneal injury (corneal abrasion) such as a paper cut or fingernail scratch to the eye.

·       Corneal dystrophy (map dot fingerprint dystrophy) – abnormal structural changes to the cornea. This may be genetically inherited.

·       Underlying corneal disease

How do you treat recurrent corneal erosions?

Acutely, medical management of corneal erosions involves using antibiotic eyedrops and/or ointment, and your doctor may place a bandage contact lens in the eye. This contact lens may blur your vision, and during the healing process you may notice/feel fluctuations/distortions in your vision. Your doctor may have you wear this contact lens for several weeks at a time.

How do you prevent recurrent corneal erosions?

In general, keeping your eyes lubricated and moist are the easiest way to prevent recurrent corneal erosinos from occurring. Using a lubricating eye ointment at night time, or a hypertonic saline eye ointment at night time (muro 128) will also often help reduce the chance of developing erosions. However, many patients still have recurrent corneal erosions in spite of these preventative measures and will require long term treatment.  

What is the long term treatment for recurrent corneal erosions?

Medical treatment for recurrent corneal erosions

Treatment can take up to several weeks or months. This may involve:

·       Frequent eye lubrication and a night-time ointment.

·       If there is an underlying corneal disease requiring treatment, that too will be addressed.

·       Often, you will be given a salt-like drop for day use and salt-like ointment for nighttime use. The salt pulls fluid out of the corneal epithelium, allowing it to lay down tighter to the underlying basement membrane and, hence, heal better.

·       Bandage contact lenses are sometimes used and kept in place for several weeks along with antibiotic/steroid drops.

Surgical treatment for recurrent corneal erosions

·       Anterior stromal puncture is used to treat persistent situation with fair success. A bent needle is used to make shallow punctures in the deeper layer of the cornea to allow the surface layer (epithelial layer) to anchor in place.

·       If medical management or anterior stromal puncture is not successful, your eye surgeon may recommend a procedure called a superficial keratectomy, or phototherapeutic keratectomy (PTK). These procedures involve re-scraping the affected eye and either use a diamond polishing burr, or a laser treatment to the involved eye. These procedures have a >95% success rate, but they do involve a recovery time of approximately 1 week.

What is the recovery process after surgical treatment?

Note: recovery is the same after either a superficial keratectomy or phototherapeutic keratectomy.

Before surgery: Follow your surgeon’s pre-surgery instructions, and plan to take about a week off work to recover. Although you will get some clarity back in your vision in the first day or so after the procedure, you should not strain your eyes for several days, so that means minimizing any work on the computer, no driving, and little to no reading if possible.

Right after surgery: Make sure you have someone you trust drive you home right after the procedure. Although you will have only local anesthetic, so you will not be groggy, you will not be able to see very well and will need help getting around safely. You should also plan to take a nap once you arrive home, or find a way to relax without using your eyes, so no television or reading. You will get medicated eye drops that will help your cornea heal, and if you have any discomfort, over-the-counter pain medications (Tylenol, Ibuprofen) can be very helpful. Your doctor will prescribe you a prescription painkiller for any breakthrough pain that Tylenol or ibuprofen does not adequately help with.  You can take a shower the day after your surgery, but you may need to use a special shield on your eye to protect it from products like soap and shampoo. You will need to avoid anything that can get in your eye like lotion, hairspray, and makeup. A bandage contact lens will be placed in the operated eye which will then be removed in the office by your doctor at one of your follow-up visits.

Days 2 to 4 after surgery: You may still have some eye pain and discomfort during this time, but that is normal and should be relieved by over-the-counter painkillers. You will also continue wearing the bandage contact lens during this time, to protect your cornea as it grows back. During this period of time, you are most likely to experience side effects from the procedure.

·       Watering eyes

·       Sensitivity to light

·       Some blurry vision

·       A sense of burning or dryness

·       Itching

·       Feeling like a foreign object is constantly in your eye

The second and third days after the procedure are usually the most uncomfortable, but symptoms can be managed with rest and OTC painkillers. They will begin to go away by day four. You may have decreased vision or distortions in your vision, which is normal and will go away in a few days. If the pain or distortions do not go away within a week, or they get worse, contact your doctor.

You should avoid exercise during this time, partly because it can impact how your eye heals, but also because you want to avoid getting sweat in your eye. Even mild exercise can negatively impact your eye’s healing ability.

Day 5 after surgery: Most of the pain will have gone away, though the distortions in your vision may still be present. You will need to continue taking the prescribed post-operative eyedrops and follow-up at your scheduled appointments.  The bandage contact lens that is placed in the operated eye will be removed in the office by your doctor at one of your follow-up visits.

An eye exam is the best way to screen for, and evaluate any eye conditions affecting your health, comfort, and quality of vision.