How can I permanently resolve recurrent corneal erosions?

Hi there

Recurrent corneal erosions can be a very frustrating condition to have. They may occur after the cornea got scratched (eg with a fingernail or paper cut), or sometimes they happen out of the blue in some people with a genetic condition called 'epithelial basement membrane dystrophy/EBM dystrophy).

In this condition, the superficial layer of the cornea (the epithelium) does not stick properly to the underlying corneal layer (the stroma). When the eye gets a bit dry while sleeping, the eyelid tends to stick a bit to the epithelium. Then when the person awakes and the eyelid opens, it pulls and disturbs the loose corneal epithelium to which it is stuck, sometimes tearing it open again and again.

The most basic way of treating recurrent corneal erosions is to use a very thick eye ointment like Duratears at night before sleeping, and in fact before any naps too. This is more effective than water based gels like Vidisic/Genteal/Solcoseryl, because Duratears is oil based and will not evaporate during sleep. When the person awakes, the Duratears film should hopefully allow the eyelid to slide over the loose corneal epithelium instead of tearing or pulling it.

The longer the person can go without an attack, the better. That means there is a chance that the epithelium is beginning to stick a bit better again.

In some cases, the corneal epithelium refuses to stick and recurrences keep happening despite the use of Duratears. Or in some other cases, the person doesn't get an attack for a while and then all of a sudden it starts happening again.

In such cases, especially if the loose epithelium is in the centre of the cornea, laser phototherapeutic keratectomy (PTK) is a very effective way of 'curing' the problem. PTK removes a very thin layer of corneal stroma, and the new layer of epithelium that grows back usually sticks very firmly, thereby preventing further attacks of recurrent erosions.

Sometimes if the area of loose corneal epithelium is very peripheral on the cornea and the area is small, a very simple treatment called anterior stromal puncture can also solve the problem. In this method, a fine needle is used to make very small marks in the affected area, and again the new epithelium that grows over will stick better. However, this is not done for large areas affecting the centre of the cornea because the marks left by the needle can affect vision.

With regards to corneal erosions, its management has to include finding its potential causes. Common causes include a history of eye trauma, dry eyes, diabetes or underlying corneal dystrophies etc. Each cause needs to be managed in order for the frequency of corneal erosion to reduce.

Options of managing an acute episode of corneal erosion include a combination of various eye lubricants and sometimes topical antibiotic to reduce the risk of a secondary infection. In the event conservative or medical treatment is not effective, surgical options may be considered which include anterior corneal puncture or photottherapeutic keratectomy.

You should discuss options that would best suit you based on your ophthalmologist's understanding of your eye condition as each option has its own set of advantages and limitations.

Regular use of a preservative-free lubricant during the day, before bedtime and first thing in the morning before opening your eyes is important for patients with recurrent corneal erosions.

Many patients have considered re-surfacing the eye in order to facilitate the corneal epithelium adhering to the basement membrane. This can either be performed manually using a blade or needle at the slit-lamp, alternatively many patients are now opting to use laser resurfacing methods (this is the same laser that is used to perform Epi-lasik).

You should discuss your findings with your attending ophthalmologist to determine what your suitable options are.

Best of luck!

ESG