Recurrent corneal erosion (RCE) is a disorder of the corneal epithelium and the epithelial basement membrane with repeated breakdown of the corneal surface leading to disabling ocular symptoms and predisposes the cornea to infections [1]. It is associated with corneal injuries [2] [3] (with fingernails or paper) or with epithelial basement membrane dystrophy (EBMD) [4] [5]. Patients present with repeated episodic eye pain typically in the morning, photophobia, excessive lacrimation [4] [6] [7] [8], redness and blurring of vision [9]. In a majority of patients, an acute episode subsides with simple medical treatment [1] [5] [7] but a few patients may suffer from painful recurrences. Acquired recurrent corneal erosions can be secondary to ocular foreign bodies, burns due to alkalis, herpes simplex infection, soft contact lens use, vitrectomy or may be associated with other corneal dystrophies. In patients with dry eyes, adhesions develop between the corneal epithelium and the palpebral conjunctiva leading to recurrent corneal erosion syndrome (RCES) [10]

A majority of RCE patients with EBMD are asymptomatic. In RCES, the epithelial layer is poorly attached to the underlying stroma and the main clinical feature is the ocular pain of varying severity. The pain is worse on waking up in the morning due to adherence between the eyelid and the cornea. Other symptoms include blurring of vision, loss of visual acuity, astigmatism, foreign body sensation in the eyes when recurrent corneal erosion leads to epithelial loosening. Recurrence is common as it takes between 8 to 12 weeks for the corneal basal epithelial cells to regenerate.

• Foreign Body Sensation

  Six of eight patients (75%) are now symptom free; 2/8 (25%) have an occasional foreign body sensation relieved by lubricants. Follow up ranged from 9-60 months with a mean of 25.5 months. [ncbi.nlm.nih.gov]

  RCES causes pain, foreign body sensation, sensitivity to light and watering of the eye. This is often worst first thing in the morning, and settles over 15 to 30 minutes. [berkshireeyesurgery.co.uk]

  Clinical features: Symptoms: Early morning awakening with painful eye Foreign body sensation Tearing Decreased vision Photophobia. Signs: epithelial slippage, edema, bullae, or epithelial loss during the acute episode of erosion. [dro.hs.columbia.edu]

  Other symptoms include blurring of vision, loss of visual acuity, astigmatism, foreign body sensation in the eyes when recurrent corneal erosion leads to epithelial loosening. [symptoma.com]

  Symptoms Mild foreign body sensation to severe pain which can be fleeting or last for days, typically occurring during sleep or upon awakening. Causes Poorly adherent corneal epithelium. [willseye.org]

• Eye Pain

  They got poked in the eye and it hurt and they showed up to the doc complaining of eye pain. That's an abrasion. An EROSION happens when the patient WOKE UP with eye pain. [myeyepod.blogspot.com]

  In all seven eyes, pain resolved and epithelial defects healed within 2 to 10 days after initiation of therapy. No recurrence was observed during an average follow-up period of 21.9 months (range, 1.5 to 60 months). [ncbi.nlm.nih.gov]

  Patients present with repeated episodic eye pain typically in the morning, photophobia, excessive lacrimation, redness and blurring of vision. [symptoma.com]

  Definition Recurrent episodes of eye pain from loose (or missing) corneal epithelium. Symptoms Mild foreign body sensation to severe pain which can be fleeting or last for days, typically occurring during sleep or upon awakening. [willseye.org]

• Corneal Edema

  Similar treatment of ten patients with corneal edema due to endothelial decompensation did not significantly reduce symptoms or improve vision, but such a solution may have significant dehydrating effect when edema results solely from epithelial abnormalities [ncbi.nlm.nih.gov]

  They frequently are seen in conditions involving corneal edema, such as near a healing cataract surgery incision, or in the center of the cornea associated with Fuchs corneal dystrophy. [emedicine.com]

  Sodium chloride solutions and ointments (Muro 128) create an osmotic gradient that is useful in reducing corneal edema. These hypertonic agents also promote epithelial adherence. Tetracyclines. [goodvisionohio.wordpress.com]

• Neglect

  It is often regarded as one of the most common and neglected ocular disorders and symptoms are similar to those of a corneal abrasion: the feeling of something in your eye, pain and soreness of the eye, redness of the eye, sensitivity to light, tearing [londonvisionclinic.com]

  Recurrent Corneal Erosion Classification and external resources DiseasesDB 31285 Recurrent Corneal Erosion (RCE) is a chronic relapsing condition caused by a breakdown of the corneal epithelium; this pathology could be mostly neglected among ocular disorders [eyewiki.aao.org]

  Corneal erosions are perhaps one of the most common and neglected ocular disorders. Some of these cases occur after ocular trauma, but most of them occur spontaneously. [emedicine.com]

The workup in RCE includes a detailed history and a thorough corneal and ophthalmic examination to find underlying causes for the corneal erosion [11]. The diagnosis of RCE depends more on a history of early morning orbital pain rather than any specific findings on examination of the cornea as many times it may appear normal. Slit-lamp examination after fluorescein staining may reveal epithelial bullae, microcysts, or loss of corneal epithelium in acute episodes [12]. Brawny edema may involve the anterior stroma underlying the cornea. The centrally located corneal erosion with the edema results in diminished visual acuity.

Computerized videokeratography is used to assess the corneal topography. It helps to detect focal abnormal areas such as microdepressions in symptomatic patients with RCE syndrome who do not manifest epithelial anomalies.

Histological examination of the corneal epithelium reveals lines which resemble fingerprints or maps with a multilaminar basement membrane.

All patients were treated for both their primary treatment and re-treatment by the same surgeon. Retrospective analysis of case records of all patients requiring re-treatment was supplemented with a telephone interview. [ncbi.nlm.nih.gov]

Recurrences requiring further treatment Hykin 1994 had five participants requiring further treatment. [doi.org]

Individuals with mild signs and symptoms have better prognosis than those with severe conditions The prognosis is generally good, when each recurrence of Corneal Erosion is promptly diagnosed and treated The long-term prognosis of RCE varies due to the [dovemed.com]

Prognosis RCES may resolve spontaneously but most cases require treatment. The prognosis is generally good but approximately 5% of patients continue to have painful erosions despite appropriate management. [drmalcolmmckellar.co.nz]

IL6 gene -174C allele may be considered as genetic marker of corneal erosion risk in patients with hereditary stromal corneal dystrophies, whereas IL8 -781TT genotype is associated with negative recurrent erosion prognosis in such patients. [ncbi.nlm.nih.gov]

Complications Corneal haze and scarring Infectious keratitis Decreased vision Prognosis With adequate treatment and prompt diagnosis, prognosis is excellent, the healing process is an important part and it may take years. [eyewiki.aao.org]

PURPOSE: To study the clinical features and etiology of recurrent corneal erosion syndrome (RCES). [ncbi.nlm.nih.gov]

PURPOSE: To evaluate the epidemiologic characteristics of a large clinical population of patients with recurrent erosions of the cornea. The efficacy of different modalities of treatment was also evaluated. [ncbi.nlm.nih.gov]

Epidemiology There are no accurate statistics relating to the exact incidence and prevalence of this condition, as it often goes undiagnosed or misdiagnosed. [patient.info]

Recurrent erosions of the cornea: epidemiology and treatment. Cornea. 2000; 19 (6) 767-771 25 Seitz B, Langenbucher A, Hafner A. et al. Phototherapeutic keratectomy for recurrent corneal erosion syndrome (e-PTK). [doi.org]

Reidy JJ, Paulus MP, Gona S (2000) Recurrent erosions of the cornea: epidemiology and treatment. Cornea 19: 767-771. [omicsonline.org]

Verity Frances Oliver and Andrea Louise Vincent, The Genetics and Pathophysiology of IC3D Category 1 Corneal Dystrophies, Asia-Pacific Journal of Ophthalmology, 5, 4, (272), (2016). Achilleas D. Theocharis, Dimitra Manou and Nikos K. [doi.org]

Pathophysiology The 2 categories of corneal abrasions are as follows: superficial (those not involving the Bowman layer) and deep (those that penetrate the Bowman layer but do not rupture the Descemet membrane). [emedicine.com]

A combination of PRK and PTK is effective in the alleviation of symptoms and prevention of recurrences of corneal erosion. [ncbi.nlm.nih.gov]

It is thought that the natural regrowth of cells in the following days are better able to attach to the basement membrane to prevent recurrence of the condition. [en.wikipedia.org]

The preventive methods for Recurrent Corneal Erosion could include: Any of the aforementioned surgical procedures may help prevent RCE Frequent use of preservative-free artificial tears to prevent the previously damaged area of the cornea from becoming [dovemed.com]

A secondary goal is to prevent future occurrences of erosion. 3 Medical therapy typically results in resolution of the epithelial defect. 1 Frequent nonpreserved artificial tears help re-epithelialization, but do not seem to help in the prevention of [reviewofoptometry.com]

1. Watson SL, Lee MH, Barker NH.Interventions for recurrent corneal erosions.Cochrane Database Syst Rev. 2012 Sep 12;(9): CD001861.
2. Waring GO, Rodrigues MM, Laibson PR. Corneal dystrophies. 1.Dystrophies of the epithelium, Bowman's layer and stroma. Surv Ophthalmol. 1978;23:71-122.
3. Messer G, Isakow I, Dabush S. Post-traumatic recurrent corneal erosion. Metabolic Paediatr Syst Ophthalmol. 1983;7: 59-63.
4. Dohlman CN. Healing problems in the corneal epithelium. Jpn J Ophthalmol. 1981;25: 131-4.
5. Findley FM. Recurrent corneal erosions. J Am Optom. Assoc. 1986;57:392-6.
6. Wood TO, McLaughlin. Recurrent erosion. Int Ophthalmol Clin. 1988;28:83-93.
7. Bron AJ, Brown N. Recurrent erosion of the cornea. Br J Ophthalmol. 1976;60:84 -91.
8. Mindel J. Therapeutic uses of contact lenses. Surv Ophthalmol 1989;33:381-94.
9. Lee JH, Kim MJ, Ha SW, Kim HK. Autologous Platelet-rich Plasma Eye Drops in the Treatment of Recurrent Corneal Erosions.Korean J Ophthalmol. 2016 Apr; 30(2):101–107.
10. Thakrar R, Hemmati HD. Treatment of recurrent corneal erosions. Available at: https://www.aao.org/Assets/13db5b59-2b18-4489-909b-42ddbf557fe0/635570315256730000/march-2013-ophthalmic-pearls-pdf. Accessed 6th May 2017
11. Moutray TN, Frazer DG, Jackson AJ. Recurrent erosion syndrome--the patient's perspective. Cont Lens Anterior Eye. 2011 Jun; 34(3):139-43.
12. Laibson PR. Epithelial basement membrane dystrophy and recurrent erosions. Current Ocular Therapy. 5th ed. 2000; 355-357.