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Eye and Vision Condition Education from Dr's Doug & Lisa Cook

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Recurrent Corneal Erosion

May 16th, 2009 · 24 Comments · Ocular Disease

Recurrent Corneal Erosion can be best described as a healing disorder of the epithelium or the “skin” that covers the cornea of the eye.

The epithelium doesn’t attach to the cornea after an injury.  It is loose and easily torn off.  Normally the epithelium should attach back to the cornea.  When this part of the eye is injured as from a scratch, an abrasion or a foreign body, the epithelium should grow back, seal down to the cornea and heal in a quick manner.  The epithelium of the cornea is one of the quickest healing tissues of the body in fact.  The presumably healed epithelium may cover the injury site and even appear normal  even with a microscopic view.

This condition is considered a dystrophy which means the tissue doesn’t work the way it should.  In this case, it doesn’t heal properly.

This can be a very frustrating condition for patients to endure.  They will report a sensation that a foreign body must still be present even though it was completely removed earlier.  This feeling of pain can be quite intense.  Extreme sensitivity to bright light can occur also when this problem is at it’s worst.  The patient swears something is still there and will even doubt that the doctor got the foreign body out – suspecting that another must be present or that the doctor must have missed something.

What is happening is that the epithelium moves with each blink.  The blink moves the loose epithelium, healed but not attached over the cornea. The epithelium rubs against raw nerve endings giving the sensation of a persistent foreign body with each blink.  Doubt about the health care provider’s competency may enter the patient’s mind especially if previous foreign bodies never produced such a problem.  “This used to always get better,” or “I’ve had these injuries before and they healed up quite quickly in the past,” are common statements made by some.

Patients with Recurrent Corneal Erosion may often seek several opinions for their condition if they feel their current doctor does not appear to be efficiently healing their problem.  They can move from doctor to doctor in frustration.

RCE can be difficult to treat because it recurs.  A patient may carefully follow the correct treatment and suddenly lose all their success upon awakening one morning in pain – the epithelium rubbed off because of dryness of the eye causing the upper lid to adhere to the epithelium, ripping it when the eyes are first opened upon awakening.  The can occur over weeks – even months.

We find that the treatment needs to be customized to each patient.  A strategy for one patient may not necessarily work for another.  The treatments we try include:

Artificial tears: Many times a day.  Usually more is needed than the patient can attend.  One drop even once an hour or more often may be necessary.

Nighttime Ointment:  A bland ophthalmic ointment such as Lacrilube or Refresh PM instilled into the eye helps to prevent nighttime drying – which may be the most common reason for recurrence.

Hypertonic saline solution such as Muro 128 5% by Bausch and Lomb is a salt water drop that is 5 times more salty than our natural tears.  The extra salt of these drops can draw fluid trapped between the epithelium and the cornea to help the epithelium adhere to the cornea.  This drop may be needed several times a day and can sting upon instilling.  An hypertonic ointment at night may also be prescribed.

Bandage contact lenses may help by fitting tight against the cornea preventing the epithelium from moving.  This can allow the epithelium to stay still long enough to adhere.  For some people, a bandage contact lens may not work or seem to worsen the condition.  Studies have demonstrated that snug to tight fittting lenses can work best.  However a dry eye condition itself can make a lens uncomfortable.

Patching of the eye can be used if a bandage contact lens does not work.  Patching for some people  however may feel worse in a way similar that the bandage contact lens didn’t work.

Debridement is a procedure that removes the loosened epithelium.  A very light scuffing of the cornea may roughen the surface enough to allow the epithelium to grow back attached to the eye.

Anterior stromal puncture accompanied with debridement places a grid of tiny anchor points for the epithelium to attach to the cornea as it grows back.

Ocular comfort drops is a recent development.  A formulation of dilute anesthetic was recently discussed at an ocular disease conference.  Only 10% the strength of normal anesthetic, it’s weak enough to prevent toxic effects but allow patient comfort until healed.  This requires careful follow up to prevent complications and can only be used for a very select few conditions.  We have had excellent results with this option.

Restasis and Doxycycline are each considered experimental and off label treatments.  Restasis, an eyedrop,  is normally used for the treatment of dry eye.  Most folks with RCE have this problem anyway but it is theorized that the active ingrediant, (cyclosporine) may inhibit inflammatory factors that are involved in preventing the attachment of the epithelium back to the cornea.  Doxycycline, a capsule or tablet taken orally, has been shown to help patients with meibomian gland dysfunction in producing a normal sebaceous gland product.  It may also help inhibit the inflammatory factors the prevent efficient and normal tear production.

Time is a critical component of any treatment of this condition.  Days may run into weeks which run into months.  Setbacks may occur frequently requiring we begin from the beginning all over again.  The good news is that most patients do get the upper hand in successfully managing this condition and achieving a complete healing – although it took longer than they wish.

If you suffer from this condition you have our sincere empathy and understanding.  Persistence on your part will pay off in overcoming this often painful and nagging healing problem.  We dedicate ourselves to staying with you during thick and thin in helping you achieve a normal life.

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24 Comments so far ↓

  • FrancescaNo Gravatar

    Thank you for the most empathetic description I’ve read. I’m still suffering three years after my initial injury…which was treated with agressive antibiotics every 30 minutes for 48 hours.

    I am post menapausal and the incidents occur exclusively between 2-6 am.

    I had episodes within an hour of getting up and applying ointment at 2 am, with a tear-duct blocker installed, and my worst attack (5 day recovery) was with the contact patch.

    I’m now trying nightly applications of sesame oil on the lid, 0mega-3 supplements, increased water consumption, a humidifyer and a EyeEco patch. My theory is to enhance lipid in my lid and retain moisture at night.

    I’d love to learn what HAS worked for other sufferers. I understand success rates for surgeries are very low and would love to see those data.

  • CarrieNo Gravatar

    Hoping Francesca has recovered from her RCE. My sistuation is VERY similar having had this for nearly 4 years now. Doing daytime drops, Restasis, tear duct plug, Muro 128 at night, fish oil, plenty of fluids, etc. Very, very frustrating. Have gone many, many weeks without and occurance only to have it happen again. I just want to wake up one day and have it be gone forever. I appreciated this very caring explanation and feel for anybody else suffering from this.

  • TerriNo Gravatar

    Thank you for this article/blog. This was very informative. I too am an RCE suffer. I was diagnosed 2 years ago. Approximatly 1 year ago, I had both eyes “scraped”. Where the first layer of your cornea is scraped away with the hope that the new cornea would heal correctly. My doctor new this wasn’t a complete fix, however figured I’d have about 5 years before it happened again. NOT! It lasted 1 year for both my eyes. I am being fitted tomorrow for contact bandages that I will wear 24/7. I wear the bandages now while the cornea heals, but we are hoping this will work to stop future tears. I am currently on Doxycycline, Lotemax eye drops, Refresh PM ointment for night time. My doctor thinks my corneas recent tearing was due to the fact I went off the Doxy for a couple months. So back on I go to try again. It is frustrating that there isn’t much help out there. I do appreciate finding this site and seeing I’m not the only sufferer.

  • SwapnaNo Gravatar

    Thank you so much for the detailed explanation. I was having serious doubts about my eye specialists competancy when the prescription he gave did not provide the required result. I was sure he did not check my eye properly and didn’t remove the foreign particle. The when I went to the mirror and rubbed mty left eye I noticed the cornea felt looser than the right. I am so thankful for this information. I was going to stop using the tear drops and night ointment .. but now I know the background for the same. I wish my doc explained the reason.. it would have alleviated my fears and made me stick to the regime more dedicatedly. I now know that this needs to be treated with patience and understand the need to lubricate my eye. Thanks a lot.

  • SistersueNo Gravatar

    Thank you for this blog…as all before me have said this is more informative then I have found so far. I to was thinking about going to see another eye doctor (for a 2nd opinion). What I don’t understand is I saw my doctor in December and in March my eye felt like there was something in there but I could never get it out. But, it didn’t do it all the time; weeks or even months would go by before it would happen again. Finally in September it happened for 2 days in a row and that is when I decided to go see the eye doctor. The doc tells me I have dry eyes and that is why this happened. I have never had dry eyes before and if I really have dry eyes then why didn’t the doctor spot that when I saw him in December?
    I like wearing the Contact lense bandage because I have no pain while I have it in my eye. But I don’t feel that the drops or gel drops are doing me any good. Only relief I get if from the contact len bandage or with a medicated ointment. So now instead of using the drops that do no good, I just use the ointment 3 or 4 times a day.

  • Dr Doug CookNo Gravatar

    A dry eye can be intermittent. It may have appeared just fine on the day of that visit.

    A dry eye can begin as we get older. I have seen cases develop in age late 20’s but it typically would be later. Contact lens intolerance can be a symptom as the eye needs to produce more tears to keep a lens hydrated. Paradoxically, a contact lens could act as a lid to prevent tears from evaporating as well as serve as a bandage to prevent discomfort which occurs with blinks.

    Increasing need of the ointment over the drops because it works better has me wondering if your dry eye symptoms are worsening. Treatments such as Restasis or punctal plugs can be considered if over the counter drops and ointments are failing. Dry eye can be a chronic problem. Recurrent corneal erosion can develop secondary to the dry eye.

  • September 14 « Bear Lodge Farm

    [...] the eye surgeon wants to do surgery because I have anterior basal cell disease, otherwise known as recurrent corneal erosion. Then once healed, I can get an exam and new contacts. Hopefully, then I will be able to drive [...]

  • David from ArizonaNo Gravatar

    I woke up Oct 18th at 2:00am from a dead to what I can describe only as feeling like there was splinters of wood or glass in my eye poking and scratching along the surface with each blink.

    I did everything possible, thinking fore sure something got stuck behind or inside my eye (I couldnt figure out what/how) I RUBBED my eyes (probably) making things worse, ran water in them, til 5:00am when I finally succumbed to the excruciating pain causing me to run around like a headless chicken bumping into walls and falling over and forced my eye shut holding my hand over it. Got into an eye do at 9:00am.

    Luckily before the appointment I was able to look at a web site with my right eye and I found one on RCE.

    I showed up at the eye doc in severe pain with streams of tears involuntarily flowing from my eye…they did the vision test etc, and I told them “PLEASE do something to make the eye pain stop.” so they did a numbing drop…thank god. Anyway first doc looked to make sure no foreign bodies. None. She kept looking and looking. “When was your last eye appt” – I say “Never”, she says well your vision is 20/20 so that explains why (I was becoming impatient knowing the pain would return) Finally I said “Seeing anything” she said “Looks like you make have scratched the cornea a little” – I said “Is it possible its RCE” she gave me the “Hmmm Look” and said “Dr Kootman is our corneal specialist, let me have him take a look. 30 minutes later he comes in, and puts some Die in my eye and uses a blue slit light and said “Oh, you have a Corneal Erosion David.”…Any way, turns out almost 50% of my Cornea skin was completely gone. He put a patch contact lense in, which Ive been wearing 24/7 taking out every week to clean since. Last time I went in he said it needs to stay in, may take a few months, maybe longer.

    Glad I came across this site because it provides more technical info than I got out of him…I NEVER was given the impression this was MONTHS/Years to repair, now I know.

    Patience and Dilligence. Thank you all.

  • BrittneyNo Gravatar

    I have been suffering with RCE for over 18 months now and have been frustrated with the doctor that diagnosed me. I am going for a 2nd opinion and hope to find some relief. My pain typically occurs during the day, not when I wake up. And it gets worse throughout the day. If anymore ideas are out there for how to fix this, please let me know. Thanks everyone for all the great information!

  • RichardNo Gravatar

    I’ve been suffering with this since May, 2012 and it SUCKS. Eye drops all day long, ointment at night, fish oil, flax seed oil, wet towels on eye, etc. Despite this vigilance, more erosions without rhyme or reason. Think I’m going to finally bite the bullet and try the laser surgery despite the massive deductible of my insurance coverage. To those who suffer this-God Bless and yes, I really do understand your nightmare.

  • RichardNo Gravatar

    Had PTK done yesterday. My eye hurts like hell, basically like a bad erosion. There is massive tearing going on and of course the foreign body sensation is constant. However, the pain meds help a bit and sleeping helps. My vision really isn’t that bad either. I feel safe going to sleep for the first time in a year. I’ve had 3 long naps and an eight hour night sleep without awakening and with no erosions. All without loading globs of ointment in my eye. I’ll keep anyone whoever reads this updated. My God, I hope this ends my 15 months of hell.

  • DesireeNo Gravatar

    Oh, I can’t say enough that this condition is frustrating like NO OTHER AILMENT I can think of! When it comes to eye problems, who knew they can really debilitate you this much! Well, I have had RCE for 1997. I stuck notebook’s spiral wire end into my eye and it was a deep stab. I was getting into a car, holding the notebook, and my elbow hit the car and with force the end spiral went all the way down all layers of my cornea. WHAT PAIN! But the pain that comes with the erosion flare ups is right at exactly the same as the original injury. I was flare up free for a number of years and I guess with age, it has really amped up. I live in the south and thank God for humidity. When the air gets drier in winter months, I am in trouble. Or when I travel to drier climates. I sleep with a mask that keeps my eye patted down so that when I wake up, my eye doesn’t automatically open. I can ease my eye open myself. I use Refresh PM, as needed. I have had Anterior Stromal Puncture and that helped about 2 years ago when my flare ups were beginning to get out of control. I had to have it twice, two days in a row and where a bandage contact lens for a week or so. My RCE is back, though. It lasted for a couple years with only minor flare ups. Now I need to figure out what to do again. I’ll probably have it done one more time and see how long it lasts again. The ophthalmologist literally stabbed me over 1000 times with a needle in the eye. I could have never imagined such horror! I also cannot touch my closed eyelid with my hands/fingers unless my eye is in a certain position. It is now my natural reflex to keep my eye aligned in gaze in such a way when I got to wash my eye make up off, for instance. Otherwise, I would be in a world of pain. And beware if you decide to have alcohol. This will DRY YOUR EYE OUT! Boost the Refresh PM if you do.
    So much else I could comment on, but I’ll keep it at this much info for now. I was very happy to find this website. It really offered lots of info and in such a way that was interesting and empathetic! Kudos!

  • RichardNo Gravatar

    So far so good after PTK. Life getting back to normal.

  • RichardNo Gravatar

    Had another erosion. Doctors are quacks, at least mine.

  • LesleeNo Gravatar

    I feel grateful to all of you who share your frustration & pain of RCE. I have had it for 6 months now. I started accupuncture (3 months ago)& it was working really well (no burning, no feeling of something in my eye…) The eye specialist was amazed at how the cysts had almost disappeared. I was supposed to have a lazer treatment, which was cancelled because I was doing so well…..then I caught a bad cold & the virus hit my eye. Now I am getting some burning & tearing again (soooo frustrating).
    My cold is over now & I am doubling up on the accupuncture & chinese herbs.
    I also tape my eye shut at night, take muro 128 & lots of tears in day.

    When is this EVER going to heal???

    frustrated, but not hopeless,
    Leslee

  • Margaret StephensNo Gravatar

    So good to read what others have been through. I was ‘whipped’ on the left cornea with a fir tree branch back in early Sept 2013 and abrasion healed well at first. Healing broke down about 5 weeks ago and it has been a nightmare of pain, redness and tears ever since, especially in the mornings. Going back to eye clinic tomorrow to plead for something to be done. I use gel tears in the day, Lacri-lube every night, have no heat on in the night and a humidifier by the bed yet every morning the pain at about 6 am is terrible. I dare not drive until after lunch and just dread waking up. Will try taping my eye shut tonight to control eyelids when I wake. Good to know I am not the only one in pain. Bless you all.

  • Lisa KNo Gravatar

    I keep a bottle of Refesh Tears under my pillow. When I wake up at night and my eyes are stuck shut I grab the Refesh and flood my closed eyes until I can get enough moisture in to open my eyes. If I do have a corneal errosion I get a soft washcloth and get it wet with very cold water and then go back to bed with this on my eye until the pain subsides. I have had this problem for about three years now. I use Restasis which only seems to help during the day and I use Muro 128 at night which I feel allows my eyes to go a few hours before they dry out.

  • BriNo Gravatar

    I injured my eye in January and have been dealing with RCE for four months now. This website made me feel like someone actually understands how painful this is. I tried telling others that I would rather have stitches in my hand or anything else but an issue with my eye. In January, I had to wear a contact lens bandage for ten days to allow my corneal abrasion to heal, and continued antibiotics and pain eye drops for a couple of weeks. Next thing I know I ended up going to the eye doctors two more times over the next few months for severe pain in the same eye and he gave me gel eye drops for night time before bed and lubricating eye drops for daytime. I thought I was finally doing well and healed up until yesterday. I woke up with slight irritation in my eye and it became 10 times worse throughout the day. I almost went to the emergency room because the pain was so unbearable but I waited it out to go to my ophthalmologist. I guess my eye was scratched in the same area, but slightly healed over. My eye doctor gave me more lubricating eye drops but nothing for the pain. It is still very painful, swollen, and my eye keeps tearing a lot. I look like I in a fight and punched in the eye. Does this happen to anyone else? Any suggestions? It’s been about 35 hours since the initial irritation. I am glad that I have found others who can understand how frustrating this is.

  • Shaun AllportNo Gravatar

    Hi all I have been reading these posts with great interest, I have had RCE for the last 6 months, in that time it has ruined holidays and work life…it is sooooooooo delibetating ? I have recently (2 days ag)o had an eye bandaged fitted not sure if it will work as since had repeat erosions and vision is poor too poor for me to drive i feel?
    I wouldn’t wish this ailment on my worst enemy if I even knew who they were??

    keep talking

    just have to percivere buy the looks

  • Stella SterlingNo Gravatar

    It’s so reassuring to hear other experiences. I have had RCE for over 25 years. It took two years to heal the first time. The eye specialist scrapped the eye I think? which made it worse. They didnt tell you treatment they did in those days. I have managed it over the years and it did heal but never fully. I recently underwent laser surgery. The specialist new I had RCE but went ahead anyway. Now I have it in both eyes and the pain is excruciating. It comes back when I stop using Steriod ointment. I am going to try Restasis Im desparate. Im too scared to fall asleep I wake up crying its soo painful. I am applying loads of ointment in the meant time. It’s very depressing as you know before it happens that its going to tear. Fingers XXX this will work

  • CaroleNo Gravatar

    I’ve had RCE since last August, I’ve had three removal of the epithelium three times since then, the latest last week with the stromal puncture as well. I have the bandage contact lens in now. The first procedure was done by an opthamologist using a surgical monocle and a shot in my eye to deaded the pain of the procedure – this was very traumatizing and unsucessful. The Dr. sent me to a cornea specialist who did the procedure using pain drops and holding my eyelids open – very little pain. Two months later the healing failed and I had the same cornea specialist do the procedure again last week, same method but this time excrutiatingly painful – I broke down in his office, crying and I could not be consoled. The pain continued after leaving despite two vicodin and today (4 days later) just now starting to feel normal. Dr. put a bandage contact in on both occasions. I am so traumitized by the procedures I feel like I have PTSD, not to mention the episodes of pain of the condition itself. It was initially torn and I had the foreign object sensation. Now it’s not a torn or foreign object sensation but a searing, throbbing pain where my eye actually feels like it’s enlarged. Has anyone here ever had the procedure under a general anethesia? I don’t think I can have it done while awake again, I would rather die. I have a very strong character but this condition is turning me into a sniveling, scared, paranoid, pathetic person.

  • Dr Doug CookNo Gravatar

    Talk to your latest corneal specialist. Read to him the words you composed today to give him/her a sense of the state you are in. The cornea has so many nerve endings and they really create pain management issues in severe cases of this disorder.

  • CaroleNo Gravatar

    Ok, yes, I’m going to see him today. I’ll let you know the outcome. I forgot to mention I’m a diabetic and I feel the healing is impeded by that as well. Although I have been working very hard to rid my self of type 2 diabetes, one of the problems with it is you don’t heal very well.

  • CaterinaNo Gravatar

    Like Stella says, so reassuring to hear other experiences. I have been suffering with RCE for over 10 years. Thankfully, the eye doctor I was referred to diagnosed me at first glance. I am very reluctant to undergo PTK and manage my episodes with Systane gel drops. I also flood my eyes with Refresh before I open my eyes in the morning and apply Muro 128 ointment in each eye before falling asleep. My worst episode kept me in my dark apartment for an entire weekend with a cold washcloth over my eyes – unable to read, watch TV or do anything. Unless you have experienced RCE, its hard to imagine how debilitating the condition can be.

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