Recurrent Corneal Erosion
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.
Presentation
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.
Entire Body System
Short Stature
- Short stature and mental retardation have also been noted. The hearing loss is neurosensory in type. Epidermal glycogen deposition has been found in one patient with the presumed recessive disorder.[disorders.eyes.arizona.edu]
Eyes
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]
- 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]
- 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]
- 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]
- 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]
Workup
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.
Treatment
- 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]
Prognosis
- 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]
- Prognosis Overall, the prognosis is very good to excellent with proper attention.[emedicine.com]
Etiology
- PURPOSE: To study the clinical features and etiology of recurrent corneal erosion syndrome (RCES).[ncbi.nlm.nih.gov]
Epidemiology
- 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]
- Epidemiology Frequency United States Recurrent corneal erosions are quite frequent in developing countries where lack of proper nutrition plays a significant role in the health of the cornea.[emedicine.com]
Pathophysiology
- 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]
- Pathophysiology Injury to the corneal surface results in an epithelial defect and repair of epithelial defects occurs in three distinct phases characterized by epithelial cell migration, proliferation, and differentiation, resulting in restoration of[eyewiki.aao.org]
Prevention
- 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]
References
Article
- Watson SL, Lee MH, Barker NH.Interventions for recurrent corneal erosions.Cochrane Database Syst Rev. 2012 Sep 12;(9): CD001861.
- Waring GO, Rodrigues MM, Laibson PR. Corneal dystrophies. 1.Dystrophies of the epithelium, Bowman's layer and stroma. Surv Ophthalmol. 1978;23:71-122.
- Messer G, Isakow I, Dabush S. Post-traumatic recurrent corneal erosion. Metabolic Paediatr Syst Ophthalmol. 1983;7: 59-63.
- Dohlman CN. Healing problems in the corneal epithelium. Jpn J Ophthalmol. 1981;25: 131-4.
- Findley FM. Recurrent corneal erosions. J Am Optom. Assoc. 1986;57:392-6.
- Wood TO, McLaughlin. Recurrent erosion. Int Ophthalmol Clin. 1988;28:83-93.
- Bron AJ, Brown N. Recurrent erosion of the cornea. Br J Ophthalmol. 1976;60:84 -91.
- Mindel J. Therapeutic uses of contact lenses. Surv Ophthalmol 1989;33:381-94.
- 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
- Moutray TN, Frazer DG, Jackson AJ. Recurrent erosion syndrome--the patient's perspective. Cont Lens Anterior Eye. 2011 Jun; 34(3):139-43.
- Laibson PR. Epithelial basement membrane dystrophy and recurrent erosions. Current Ocular Therapy. 5th ed. 2000; 355-357.