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Recurrent Corneal Erosions

Recurrent Corneal Erosions are a process where blisters form at the surface of the cornea, which can cause blisters that may eventually break. This exposes corneal nerves. Generally, there is a sharp pain and tearing immediately afterwards. It may wake on up from sleep, or it may occur early in the morning when waking up. Frequently the tearing will stop, and it may feel as though there is a piece of foreign material on the eye. The process can occur in one or both eyes. It may be because of a hereditary disease or be localized to one eye in which some previous accident has occurred, such as a very  minor corneal abrasion (scratch).

Treatment:

1. Lubrication at night is generally given in the form of a lubricant ointment such as Lacrilube, Refresh PM, HypoTears ointment or AKWA Tears ointment. Approximately a 1/4" of material is placed in the trough formed by stretching away the lower lid, the lower lid is then released and the ointment is allowed to cover the cornea during blinking. This is used immediately prior to bedtime in the affected eye(s). Lubricant drops such as Refresh, Genteal, HypoTears PF, Cellufresh or similar non-preserved tears are used frequently during the day (every 1-2 hours). Ann attempt should be made for someone to check your eyes while you sleep to see that the lids close completely.

2. If the eye has a large area of corneal abrasion, treatment with a bandage contact lens (BCL) and antibiotics may be attempted. This may allow the surface to heal in mild cases. This type of treatment requires returning for frequents visits to monitor the eye for infection.

3. Muro 128 drops and ointment may be used to remove fluid from the blister-like areas. This will help the surface cells stick down and facilitate healing. This can help in mild to moderate cases.

4. If the erosions are severe and recurrent, the epithelium (surface cells) may be removed. This may cause discomfort similar to the original abrasion. Pain medication will be given to you if this is done. The eye can be patched or a BCL will be placed over the area to assist in helping with comfort. It may not be realistic to return to work for approximately 48 hours after the procedure. Light sensitivity and the discomfort are frequently noted. it is important to keep dust and water out of the eye as it heals.

Removal of the epithelium to allow for regrowth

5. If other therapies have failed, diamond burr therapy is frequently needed. In this process, the cells are removed much like scraping peeling paint from the wall. A diamond dusted round-tip burr is used to make micro-scratches in the cornea. It has a very high level of success, but also may cause night glare, which may subside over a period of several months or a small amount of residual glare may remain permanently. While it can be done in the visual axis, peripheral treatment has less of a risk. It is generally performed with the use of a BCL and scraping of the cornea at the same time. Similarly, it may cause discomfort and light sensitivity. The procedure is performed with local anesthetics and patients are given drops and pills for comfort post-operatively. A visit two weeks later allows us to assess the healing and remove the BCL. 

 

 

Diamond Burr Therapy involves a diamond dusted round-tip burr used to make micro-scratches on the cornea


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