Study: Recurrent Corneal Erosions in Epithelial Corneal Dystrophies
The abstract below is an excellent reminder of the subtlety of clinical signs in many patients who experience erosions from mild dystrophies.
Recurrent corneal erosions and ABMD (EBMD, MDFD, map dot fingerprint dystrophy, and all its other names...) continue to be a serious area of concern for me in terms of patients not getting diagnosed promptly enough to get on to the most appropriate treatment.
Too often, people with RCE are simply told they have dry eye based on reported symptoms, because they're experiencing 'mini' erosions periodically which simply heal so quickly that the signs aren't obvious by the time they see the doctor. Sometimes they see multiple doctors. Sometimes they even see multiple corneal specialists before they are properly diagnosed.
Patients, if you experience sharp pains, blurred vision, and/or a sudden rush of tears in the middle of the night or immediately on waking, or if you feel like your eyelids are sticking down and "tearing" the surface of your eye, please describe your symptoms as specifically as possible to your doctor. And ask them specifically about the possibility of RCE.
Doctors, here's what you need to be listening carefully for: Not just symptoms, but time of day - when they occur and exactly under what circumstances. When I'm talking to someone who is describing a classic overnight RCE pattern, and I ask them how they are during the day, and they say they are absolutely fine - it's just a nighttime thing, I get really puzzled as to why they have been diagnosed and treated with "just dry eye". How many dry eyes really behave that way? Symptoms that occur exclusively at night are often evidence of either lagophthalmos or RCE or both. Of course the trouble with a lot of this ocular surface stuff is comorbidities galore! But RCE is a really, really important comorbidity to pick out of the mix.
As regards treatments, I would like to respectfully highlight two important management approaches that are often ignored:
augmenting lubricants with specialty moisture chamber products such as NITEYE, Ortolux, Eyeseals or Quartz, and
immobilizing eyelids with medical tape, specialty strips such as EyeLocc, or specially designed moisture chambers such as Tranquileyes.
Klin Monbl Augenheilkd. 2018 Jun;235(6):697-701. doi: 10.1055/a-0611-5783.
Geerling G, Lisch W, Finis D.
The corneal epithelium is the most important structure of the ocular optical system. Recurrent corneal erosions can result from inflammation, trauma, degeneration and dystrophies. Epithelial basement membrane dystrophy (EBMD), epithelial recurrent erosion dystrophy (ERED) and Francheschetti and Meesmann's epithelial corneal dystrophy (MECD) can all - besides other signs and symptoms - result in more or less frequent corneal erosions. The pathomechanisms involved however are different. In EBMD, corneal erosions are facultative and clinical signs are often subtle. Aberrant basement membrane structures are associated with thinning of the epithelium and can be clinically identified as maps or fingerprints. In ERED, recurrent corneal erosions are - predominantly in the first decades of life - always present. A defect in the COL17A1 gene results in a dysfunctional hemidesmosome. In MECD, punctate corneal erosions are less frequent and result from intraepithelial microcysts which open spontaneously onto the ocular surface. Usually lubricants, therapeutic contact lenses and sometimes epithelial debridement and phototherapeutic keratectomy are the mainstay for treating corneal erosions in these three dystrophies.