Recurrent Corneal Erosion

What is recurrent corneal erosion?

Recurrent corneal erosion (RCE) happens when the outer layer of the cornea, the transparent membrane at the front of your eye, separates and lifts away from underlying layers. It’s a painful condition that causes your eyes to tear and water, and it makes bright light painful. RCE can cause short-term vision issues and long-term eye damage when not treated.

The cornea is like the windshield of your eye. It’s there to keep the inside of your eye safe and separate from the outside world. The cornea has five layers. Recurrent corneal erosions affect the outermost two. Those layers are:

• The epithelium. This is the cornea’s outermost layer. It’s densely packed with nerve endings and is hundreds of times more sensitive than the surface of your skin.
• Bowman’s membrane. This layer is mostly collagen, a protein similar to those that allow gelatin (like in desserts) to hold its shape once it sets. It’s there to firmly link the layers above and below.

When you have RCE, the epithelium and Bowman’s membrane don’t stick together as they should. That can cause the epithelium to erode, exposing vulnerable layers underneath. And corneal erosions are very painful because the epithelium is packed with nerve endings.

How common are recurrent corneal erosions?

RCEs are common, but experts aren’t sure exactly how often they happen. One study in London, England found they affect just under 1% of that city’s population in a year. But that probably underestimates the true number because people may not seek medical care for minor erosions. That’s because your cornea repairs itself very quickly, so minor erosions may be gone within minutes or hours.

What are the symptoms of recurrent corneal erosions?

If you have RCE, it’s common to experience symptoms when you first wake up. Opening your eyes can lift away the outer cornea layer if the bonds that join it to the underlying layer aren’t strong enough. That can lead to any of the following eye symptoms:

• Pain.
• Redness.
• Light sensitivity (photophobia).
• Watery or very teary eyes (epiphora).
• Feeling like something is stuck in your eye, even if you can’t see anything in it.

What causes recurrent corneal erosions?

RCE is similar to what happens if you apply a fresh coat of paint over a layer of damaged, peeling paint. The damaged underlying paint keeps the new paint from sticking correctly. Even lightly passing your hand across the newly painted surface can cause the new layer to lift and peel off.

The most common cause of RCE is an earlier eye injury. Those injuries are usually from things like your fingernails, paper or contact with some part of a plant (like a tree or shrub). They also don’t have to be recent. Some people will have an RCE related to an eye injury that happened years earlier. The symptoms of injury-related RCEs usually affect only one eye.

Corneal diseases and chronic conditions that affect your eyes are also common causes or contributing factors to RCEs. These often affect just one eye, but some people will have symptoms in both eyes.

These conditions include:

• Corneal degeneration conditions like epithelial basement membrane dystrophy (EBMD), also known as map-dot-fingerprint dystrophy.
• Dry eye syndrome.
• Type 2 diabetes.
• Eyelid swelling and irritation (blepharitis).
• Ocular rosacea.

What are the complications of recurrent corneal erosion?

RCE complications are usually not life-threatening, but they’re still disruptive and serious. They include:

• Increased risk of future RCE. Having RCE now increases the risk of cornea damage in the future.
• Corneal haze. Repeated damage from RCEs can make your corneas less transparent. When that happens, less light can pass through them, making it harder for you to see.
• Increased chance of infection. Your cornea is a physical barrier. Damage to it exposes more vulnerable layers underneath. That can allow germs to enter and cause an eye infection, which can be serious.

How are recurrent corneal erosions diagnosed?

RCEs are generally easy to diagnose. A healthcare provider, such as an optometrist or ophthalmologist, can diagnose it by asking questions about your symptoms, medical history and any previous issues or injuries affecting your eye.

Providers can then confirm the diagnosis using certain tests. That stops the pain from RCE and prevents discomfort during tests. The possible tests include:

• Slit lamp exam. For this exam, a provider uses a slit lamp to look at your eye. This exam also often involves fluorescein, a dye that glows under blue light. Adding dye (either in drops or a special strip) to the surface of your eye can highlight areas of corneal erosion.
• Adhesion test. This test involves touching the surface of your eye with a surgical sponge. If you have RCE, your cornea’s outermost layer should move with the sponge rather than staying firmly in place. This is especially helpful if other tests don’t show an eroded area.

How are recurrent corneal erosions treated?

Providers use a stepped approach to treat RCE. They’ll generally start with simpler medical treatments and move to more advanced surgical treatments if simpler ones don’t help. They may also skip to more advanced treatments if you have a more severe RCE.

Medical management

Medical management aims to make it as easy as possible for your eye to heal on its own. Many of the treatments are ones you can give to yourself. Your provider will give you specific instructions on what you’ll need to do.

Some of these treatments will need to continue for days or weeks. You may need to do others for months, depending on the severity of your RCE.

Medical management can involve one or more of the following treatments:

• Pain management. RCE is often a painful condition. Treating your pain with nonsteroidal anti-inflammatory drugs (NSAIDs) may help reduce the pain. Ointment, as well as bandage contact lenses, can also be especially useful in relieving pain.
• Eye lubrication. Eye lubricants include artificial tears, saline drops, gels or ointments you apply to the surface of your eye(s). Providers often prescribe them for you to apply them at night before you go to sleep. That’s meant to help avoid RCE that starts or worsens when you open your eyes in the morning.
• Hypertonic saline. This is a liquid that boosts the absorption of fluid through the surface of your eye. That improves the bonding of the epithelium to underlying layers. Providers often recommend using this during the day in combination with ointments you apply at night.
• Antibiotic drops or ointment. These can help with eye infections contributing to RCE, or prevent infections while your eye heals.
• Patching or bandage contact lenses. Both of these options provide an extra protective layer for your eye while it heals. A bandage contact lens is exactly like it sounds: a bandage that attaches to your eye like a contact lens. It helps your eye repair itself by providing a support structure.
• Cycloplegia. Muscles connected to your eye can make tiny adjustments to your eye shape. That helps you focus on things at varying distances. Cycloplegia involves temporarily paralyzing those muscles in the affected eye. That keeps the eye’s shape constant, making healing easier.
• Serum drops. These special drops contain immune proteins and other components that help your eye(s) heal. They can be autologous, meaning the components come from your own blood, or from donor blood.
• Specialized medications. These can be medications (like corticosteroids or doxycycline) that block proteins that might interfere with how your cornea repairs itself, or that contain growth factors that stimulate repair.

Surgical treatments

Surgical treatments involve removing damaged sections of epithelium so it can regrow uniformly instead of in uneven patches. These procedures usually happen under topical anesthesia, which numbs the surface of your eye to prevent pain or discomfort.

After these treatments, your healthcare provider may also treat you with medicines like those listed above. The epithelium usually regrows within a few days, but medical treatments may need to continue for weeks or months to ensure the epithelium bonds securely to underlying layers.

Surgical treatments can involve one or more of the following:

• Debridement. This involves removing damaged sections of epithelium with special tools.
• Diamond burr polishing. A provider uses a special tool to buff and remove epithelium tissue from the affected corneal area. That allows it to regrow uniformly across that area of your cornea.
• Stromal punctures. A provider uses a very small needle or a laser to make tiny holes into the stroma, the layer of your eye underneath Bowman’s membrane. Placing these holes precisely causes your eye to repair itself at specific points. That strengthens the bonding of the layers above.
• Amniotic membrane placement. This works like a bandage contact lens, but uses tissue taken from a placenta. The placenta is from a cesarean section delivery and goes through intensive processing to make sure it’s sterile. A provider places it directly on your eye over the affected area. The placental tissue protects the eye and promotes the regrowth of your cornea’s outer layers.

Complications/side effects of the treatments

The complications or side effects of the treatments vary depending on many factors, especially the specific treatment(s) you receive. Your healthcare provider is the best person to tell you about the side effects or complications you’re most likely to experience and what you can do to limit or prevent them.

How soon after treatment will I feel better?

The recovery time after treatment varies depending on several factors. The epithelium layer of your cornea can regrow and repair itself very quickly. But it can take weeks or months for the underlying layers to repair and bond to each other fully. Your provider can tell you about the likely recovery time, and when you should notice changes in symptoms, vision or how your eye feels.

Can recurrent corneal erosions be prevented, or can I lower my risk of them?

RCEs can happen unpredictably. You can’t prevent them for certain, but you can do things to make them less likely to happen.

The most important way to prevent RCEs is to prevent eye injuries. Wear eye protection like goggles, masks or safety glasses whenever there’s a chance of injury to your eye. That’s particularly the case if you’re working with tools or around objects that could impact your eyes.

Lubricating the eyes with artificial tears, gel or ointment at bedtime can be especially useful, especially if you have eye pain when you wake up. The lubrication between the corneal surface and the eyelid can help prevent the sticking that contributes to erosions.

What can I expect if I have recurrent corneal erosion?

If you have RCE, the main symptom is pain. Other symptoms are common, unpleasant and disruptive, but minor erosions usually heal rapidly. It’s common for people only to seek medical care when erosions are moderate to severe.

The main issue you may deal with is that they can happen repeatedly. And the more they happen, the more likely it is to cause complications that affect your vision.

Because of that, the best thing to do is see an eye specialist if you notice RCE symptoms, especially when you wake up and open your eyes in the morning. Early treatment can limit damage from an RCE and reduce the risk of future ones.

How long do recurrent corneal erosions last?

Your cornea has tremendous regenerative ability. It can repair minor damage within hours and more severe damage within days.

But it’s also important to remember that RCEs occur when healing doesn’t happen correctly. When that’s the case, you may need to consistently apply medications or other treatments to your eyes as prescribed for weeks or even months. While that might seem tedious and troublesome, it’s also the best way to ensure that your eyes heal properly and you avoid future RCEs.

What’s the outlook for recurrent corneal erosion?

RCEs are painful, unpleasant and sometimes serious, but they aren’t life-threatening. Sometimes they recur, but recurrences are usually treatable. And fortunately, complications that might affect your vision long-term or permanently are rare.

How do I take care of myself?

If you think you have an RCE, getting treatment early is the best plan of action. That way, you get treatment and relief for your symptoms and reduce the odds of future issues.

If you have an RCE, your provider will guide you on managing it. It’s important to follow their instructions exactly. The closer you follow the instructions and take medications or treatments as prescribed, the more likely you’ll recover without complications.

When should I see my healthcare provider, or when should I seek care?

If you have an RCE, you should see your healthcare provider as recommended for follow-up visits. Doing so will let them track the healing of your cornea and adjust your treatments if necessary. You should also call or see them if you notice changes in your symptoms, your vision or the effectiveness of the treatment(s) you take.

When should I go to the ER?

RCE is usually not an emergency condition, but it can be painful and extremely disruptive. If you have RCE symptoms, calling your primary care provider’s office for guidance is a good idea. You may also choose to go to an urgent care-type clinic.

While RCE is usually not an emergency, it does have similarities to more severe eye injuries, like corneal lacerations. When in doubt, get emergency care. Doing so without delay may make a big difference in treatment, recovery and preserving your eyesight.

If you have eye pain along with the following, you should get medical attention:

• A cut, scratch, scrape or puncture injury to your eye.
• Sudden vision loss (even if it’s temporary or only affects part of your vision).
• Irritation or redness that you can’t explain.
• Nausea and vomiting.
• Headache.
• Fever.
• Feeling like you have something stuck in your eye (regardless of whether you can see something that could cause that feeling).

A note from Cleveland Clinic

When your eyes work as expected, it’s easy not to think about how much you use them. But it can be particularly scary when your eyes hurt and you don’t know why. RCEs are serious and painful, but they’re also very treatable.

If you have RCE symptoms, especially if they’re new, talk to a healthcare provider or eye specialist. Early diagnosis and treatment will give you the best odds of a fast recovery and preventing future occurrences.