Recurrent Corneal Erosion

A repeated breakdown of the surface of the eye causing severe eye pain, light-sensitivity, tearing, and corneal scarring leading to visual changes
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What is recurrent corneal erosion

A common clinical eye disorder involving a repeated breakdown of the eye’s clear front surface layer (that is, the cornea)
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Who gets recurrent corneal erosion?

This is one of the most common and neglected ocular disorders, usually occurring after eye trauma, but mostly occurring spontaneously. More common in women than men, it usually occurs after 40 years of age[footnote]Medscape: Recurrent Corneal Erosion[/footnote]

YOU HAVE AN EYE CONDITION THAT COULD TAKE YEARS TO HEAL

As you sleep, a portion of your eye’s surface sticks to your eyelid and rips away when you open your eyes in the morning. Typically, the prognosis is very good to excellent with proper medical attention. However, the healing process may take years. You should, therefore, do all you can to take good care of your eyes. Always wear protective sunglasses when the sun is out and always use lubricating eye drops. You must also take care when opening your eyes upon awakening.

YOUR EYES CAN FEEL VERY UNCOMFORTABLE

You might feel mild to severe pain, particularly upon awakening – like someone is putting their finger on your eye. You can feel a foreign body sensation in your eye – like a piece of sand right in the centre. It can last for an hour, or the entire day. Your eyes may be excessively sensitive to light and you might experience blurred vision. You may also find your eyes tear up more than usual.

AN AVERAGE DAY WITH RECURRENT CORNEAL EROSION

Every few weeks, or perhaps every few months, you might awaken to intense pain when you open your eyes. Blinking throughout the day may also lead to pain. When looking in the mirror, your eyes might appear very red. Getting dressed, walking to work, or driving into the light can all be much harder than they need to be. You might experience blurred vision if it happens right over the pupil.

A CONDITION THAT CAN PROFOUNDLY AFFECT YOUR RELATIONSHIPS

An episode of recurrent corneal erosion can significantly affect your professional and social life. You may need to miss work. Social events become the lowest priority in your life. The pain, photosensitivity, and reduced vision can affect your relationships which can lead to significant emotional distress.

HELP IS AT HAND

If you feel stuck in the cycle of extremely painful erosions followed by slow healing, it can feel that there is no end in sight and that you will never recover. In reality, it is rare for this condition not to resolve itself following appropriate expert treatment. Let me guide you through this condition so you can get back to a normal life.

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Supplementary information about recurrent corneal erosion

In my expert hands, you certainly don’t need to know all of the information I’ve included in the toggles below. If you’d like to know how it all works, however, open them and learn more.

Recurrent corneal erosion is a painful eye condition where there are episodes of severe pain on waking which resolve over a few days to a week only to reoccur again in the future. The first scratch is usually caused by trauma to the eye with a fingernail, branch or another sharp object. This scratch damages the skin and superficial layer of the cornea on the surface of the eye.

Although the skin on the surface of the eye heals after a few days and covers the area of the wound, this new skin is not fully mature and does not stick well to the underlying and damaged corneal bed. For this reason, you may tear the fresh skin again, or it can erode. This classically happens at night time if the eye dries out and the surface sticks to the eyelid.

On waking, you tear the skin from the surface of the eye and feel a tearing sensation immediately followed by severe pain. This heralds the start of another cycle of erosion and healing.

Trauma usually causes the first scratch to the eye. It might be a fingernail, a branch or other sharp object which damages the skin and superficial layer of the cornea on the surface of the eye.

Another cause of recurrent erosion is map dot fingerprint dystrophy, also known as epithelial basement membrane dystrophy. This is a rare genetic condition where a faulty gene results in weakness of the skin on the surface of the cornea. Corneal erosions can develop even in the absence of any damage to the eye.

Symptoms and lifestyle impacts

Typically, the condition starts when you scratch the surface of the eye. The cornea (front of the eye) has many nerves, and this injury can feel really painful. The corneal abrasion (scratch) heals and the pain goes away. Then without warning your eye starts to feel pain again just like the first injury. The outer layer of the cornea (corneal epithelium) heals, and your eye starts to feel comfortable again.

Can you see the pattern?

If the patch of the cornea with the recurrent pain is small, your eye can heal after a short amount of time. A larger spot will take days to recover. You might not remember the original injury, yet suddenly you find yourself with a developing condition. If this describes you, please do not hesitate to book in to see me. I am academically and medically experienced to manage this sub-speciality condition of the eye. I have years of experience in high-volume specialist eye units, across the UK, dealing with precisely this type of patient experience.

Examination in London

Diagnosing recurrent corneal erosion syndrome can be difficult and requires examination by a corneal specialist under a slit lamp. We use a special dye called fluorescein in an eyedrop. The dye in this drop reveals the characteristic signs in the cornea due to the way the dye interacts with the erosion.

In acute attacks where the pain is severe, I prescribe antibiotic ointment and painkillers. Limited amounts of anaesthetic eye drops and a bandage contact lens can also relieve the pain. Once healing is complete, then I recommend you frequently instil eye drops during the day and use lots of ointment to prevent the eyelid from sticking at night.

If the cycle of erosion and healing continues despite intensive lubrication, then I recommend treatment of recurrent corneal erosion with:

  • an extended period of 24/7 contact lens wear,
  • mechanical removal of the abnormal tissue by hand or
  • an automated PTK laser procedure

If you feel stuck in the cycle of long term, extremely painful erosions followed by slow healing, it can feel that there is no end in sight and that you will never recover. In reality, it is rare for this condition not to resolve following appropriate expert treatment.

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About the author

Mr Alex J. Shortt | Consultant Ophthalmic Surgeon

MB BCh MSc PhD FRCOphth PGDipCatRef

I’m Alex Shortt, a highly trained academic researcher and Consultant Ophthalmic Surgeon based in London’s famous Harley Street medical district. I trained and worked as a consultant for 14 years at London’s Moorfields Eye Hospital. I specialise in advanced technologies for correcting vision, including cataract surgery, implantable contact lenses and laser vision correction.

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