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]

  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]

  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]

  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

  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]

  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]

  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]

  Symptoms Characterised by initially sudden eye pain at night or on waking, accompanied by reddening, light sensitivity and watery eyes. Each episode can vary in intensity and duration. [institutmacula.com]

• 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]

  In the second phase of the disease, blurred vision, glare, and halos around lights develop because of incipient corneal edema in the stroma and epithelium. [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]

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.

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