Recurrent corneal erosion is not an uncommon disorder. It is characterized by the repeated disintegration of the epithelial layer of the cornea and its basement membrane. This leads to excessive lacrimation, photophobia, pain with subsequent scarring of the cornea and visual dysfunction. It could be associated with corneal dystrophies or could be secondary to corneal injuries. Diagnosis is based on a thorough ophthalmologic examination with fluorescein staining of the cornea to detect the erosions.
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 . It is associated with corneal injuries   (with fingernails or paper) or with epithelial basement membrane dystrophy (EBMD)  . Patients present with repeated episodic eye pain typically in the morning, photophobia, excessive lacrimation    , redness and blurring of vision . In a majority of patients, an acute episode subsides with simple medical treatment    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) 
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.
Entire Body System
- Severe Pain
Upon awakening, patients often experience severe pain, blurred vision, and light sensitivity when the eyelid pulls the loosened epithelial cells off the cornea. [eyevertise.com]
Upon awakening, this loose tissue peels off when opening the eyelids, resulting in severe pain. The pain may last for a couple of hours or up to several days, with a recurrence rate of several times per year. [opto.ca]
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]
- 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]
The pain feels as if there is something in the eye; a foreign body sensation that is sharp and stabbing. The discharge from the eye is clear and thin, like water. The person can often cannot recall any injury to the eye within the prior 24 hours. [allaboutaesthetics.com]
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]
eye pruritus, stinging sensation in the eye, foreign body sensation, eye dryness, eyelid erythema, eye pain, photophobia, eye discharge, visual disturbance, eyelid pruritus fr Partie demandant la nullité de la marque communautaire: la requérante en [glosbe.com]
Signs and Symptoms • Severe pain (especially after awakening) • Blurred vision • Foreign body sensation • Dryness and irritation • Tearing • Red eye • Light sensitivity DIAGNOSIS AND DETECTION Using a slit lamp microscope, the doctor examines the corneal [eyevertise.com]
- 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]
Patients present with repeated episodic eye pain typically in the morning, photophobia, excessive lacrimation, redness and blurring of vision. [symptoma.com]
Recurrent erosion syndrome (RES) refers to repeated episodes of superficial spontaneous abrasions leading to eye pain. Erosions are "scratches" on the surface of the cornea, the clear portion of the eye overlying the iris and the pupil. [djo.harvard.edu]
[…] en Eye disorders Common: eye pain, eye irritation, dry eye, abnormal sensation in eyes Uncommon: corneal erosion, corneal epithelium defect, corneal epithelium disorder, punctate keratitis, keratitis, corneal staining, eye discharge, photophobia, vision [glosbe.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]
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]
The workup in RCE includes a detailed history and a thorough corneal and ophthalmic examination to find underlying causes for the corneal erosion . 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 . 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.
Soft Contact Lenses Used in the Treatment of Recurrent Corneal Erosion Syndrome. ( 25230080 ) Park Y.M....Lee J.S. 2014 16 Anterior stromal puncture for the treatment of recurrent corneal erosion syndrome: patient clinical features and outcomes. ( 24439438 [malacards.org]
We have devised a management algorithm for the treatment of RCES (see “ Treatment Algorithm for RCES ”). Medical. Medical treatment options should be explored before resorting to more invasive surgical alternatives. Lubrication. [aao.org]
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]
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]
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]
[…] n J.A. 2015 10 Phototherapeutic keratectomy (PTK) for treatment of recurrent corneal erosion: Correlation between etiology and prognosis - prospective longitudinal study. ( 25900814 ) Dedes W....Thiel M.A. 2015 11 Authors' response: A randomised controlled [malacards.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]
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]
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;19:767-771. 3. Brown N, Bron A. Recurrent erosion of the cornea. Br J Ophthalmol. 1976;60:84-96. 4. Hope-Ross MW, Chell PB, Kervick GN, McDonnell PJ. [ophthalmologymanagement.com]
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]
Etiology and Pathophysiology RCE is commonly associated with prior corneal trauma or underlying corneal disease. [reviewofoptometry.com]
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 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]
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]
For recovering patients whose epithelium is healing, we recommend bland ointment to prevent surface aggravation. Antibiotics and pain relievers. [aao.org]
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- 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.
- 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
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