Recurrent Corneal Erosion Syndrome

Recurrent corneal erosions (a common finding in most corneal dystrophies) refer to the process by which the corneal epithelium (the thin, outer protective layer of the cornea) tends to breakdown repeatedly, causing anything from mild irritation to more sever pain, watering and photophobia.

In most individuals, a breakdown of the corneal epithelium is a shortlived occurrence, often referred to as a corneal abrasion. These abrasions tend to respond very quickly to conservative measures such as a short course of lubricant eye drops. The corneal epithelium cells regenerate and the layer becomes complete once again and also adherent to the underlying (Bowman’s) supportive membrane.

Some patients, such as those with certain corneal epithelial dystrophies, are prone to frequent epithelial breakdowns. Although the epithelial cells may regenerate, they are not sufficiently adherent to the underlying Bowman’s membrane. When the eyelid subsequently moves over the surface of the cornea, it may drag this layer of new epithelium and tear it from the underlying membrane. This typically occurs during the night or on waking in the morning.

Patients may develop RCES following a seemingly innocuous injury such as a scratch caused by an infant’s fingernail, or when bending down whilst gardening, onto a leaf or bamboo cane.

Patients may be treated with lubricating eye drops, ointments, antibiotics or specialized (bandage) soft contact lenses. Punctal occlusion can also be of additional benefit.

If recurrent erosions persist,  then additional measures such as corneal scraping or the use of excimer laser therapy (phototherapeutic keratectomy), may be required.

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