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Recurrent corneal erosions (RCE)
 
IN BRIEF

A pattern of spontaneously occurring corneal erosions.

 
background

RCEs are typically associated with one of the following:

(1) ABMD (also called EBMD or map dot fingerprint dystrophy), a corneal abnormality where the top layer of the cornea does not adhere fully to the rest of the cornea, or

(2) An injury to the cornea. Often what happens in this situation is that the cornea heals after the injury but RCEs start several weeks or months afterwards. Some research suggests this may result from limbal stem cell deficiency.

We've had many reports of people suffering RCEs after LASIK, PRK and similar surgeries, with symptoms starting anywhere from immediately to one year after surgery. It seems likely that many of these had undiagnosed ABMD before surgery.

If there is no other dry eye disease present, people with RCEs will typically be fine all day and have problems only at night or first thing in the morning. However, RCEs will often overlap with other conditions that can present similar symptoms, for example, lagophthalmos (incomplete lid closure, which also results in morning eye pain and can result in erosions), meibomian gland dysfunction, or even undiagnosed general dry eye symptoms. This 'mixture' can sometimes complicate diagnosis and treatment of RCEs.

 
TREATMENT

The challenge with RCEs is how to get the cycle under control, reliably protect the cornea against new erosions, and if possible heal and compact the epithelium to the point where with reasonable care recurrence can be avoided. Here are some of the methods that are employed to discourage recurrence:

LUBRICANTS:

  • Hypertonic ointment (Muro 128).
  • Dwelle®. [NOTE: Dwelle is not a prescription drug, its classification for FDA purposes is "just" an OTC lubricant eyedrop, but we have had extensive reports over the years from people who have used it to control erosions and some well-known corneal specialists regularly prescribe it for this use. We highly recommend reading materials by formulator Dr. Frank Holly about high oncotic pressure eyedrops and their mechanism of action.]

PHYSICAL BARRIER PROTECTION:

  • Tranquileyes moisture goggle.
  • "Bandage" contact lens. These are often used to treat an individual abrasion/erosion but in severe cases are also used nightly as a protection against future erosions.

SURGICAL:

  • De-epithelialization (removal of the epithelium), either manual debridement or with a laser (called PTK or phototherapeutic keratectomy).
  • Stromal puncture

REBECCA'S THOUGHTS:

Great big huge disclaimer, don't do anything I suggest without consulting your doctor, follow your doctor's instructions and not mine, please don't sue me, etc. etc.

(1) The following strategy, faithfully employed over a period of months, seems to have worked quite well for a lot of people that I know with RCEs - subject to many variations on the theme of course! (a) Rice baggy compress before bed. (b) Dwelle drops applied night (reapplied during the night if necessary), morning, and - especially in the first several weeks - two to three times during the day. (c) Tranquileyes moisture goggle or similar (if necessary, tape).

(2) Taking pains to prevent sudden eyelid opening during the night or on waking can make a real difference to the occurrence of erosions, as sudden lid opening can trigger an erosion. Please visit DryEyeTalk for tips about this - patients have various strategies for it. Some wear moisture goggles or a sleep mask, others moisten their lids and wait awhile before opening their lids.

(3) I think that bandage soft contacts are under-employed in treating erosions when they're at an acute stage. If you haven't been offered this option, you may want to discuss it with your doctor.

(4) Be very cautious about considering invasive treatments - make sure you've really exhausted other options before going the surgery route and make sure you understand the limitations and risks.

 

 
more information

Please visit DryEyeTalk, our discussion forums where many people with RCES participate. Connecting with other patients experiencing this, and discussing potential treatments with experienced doctors, can help you quickly get up to speed on what seems to help (or not) the most patients. In particular check out the RCE topical archive and popular Blogs started by fellow RCE patients.

 

last updated 7 August 2008

 
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