Recurrent corneal erosion (RCE)

What is recurrent corneal erosion (RCE)?

The cornea is the clear, dome-shaped layer that covers the eye. Recurrent corneal erosion (RCE) occurs when the outer layer of the cornea, called the epithelium, becomes detached or dislodged. Since the cornea is extremely sensitive to any cellular disruption, RCE is associated with severe pain, which is often worse on waking. When the eyelids are closed during sleep, the decrease in oxygen supply causes the epithelium to swell slightly and adhere to the inner surface of the eyelid. The detached tissue falls away when the person opens the eyes upon awakening, causing moderate to severe pain that lasts from two to three hours to several days, and may recur several times a year. As CRT often disappears quickly, its symptoms are usually ignored. However, it is recommended that a doctor of optometry be consulted so that recurrent corneal erosion can be diagnosed and treated appropriately to minimize discomfort and prevent recurrence.

What causes recurrent corneal erosion?

In most cases, RCE is associated with previous trauma to the cornea, such as a scratch, but it can also result from epithelial dystrophy. As previously mentioned, the epithelium is normally firmly attached to the underlying layer of the cornea. Sometimes a lesion results in reduced contact between the epithelium and the rest of the cornea, making it vulnerable to detachment. Patients with corneal dystrophy naturally have a loose epithelium and are therefore more susceptible to CTE. This problem is usually present at birth, but does not usually become apparent until adulthood. It is important to note that CRA rarely leads to permanent vision loss.

How is recurrent corneal erosion treated?

There are several treatments for RCE and each case should be assessed on an individual basis. The simplest treatment involves frequent use of preservative-free eye drops during the day and application of an ointment before bed. In the event of an acute attack, the application of anti-inflammatory eye drops and the use of antibiotics and analgesics may be necessary. Large erosions should be treated with a protective oxygen permeable contact lens. Due to the recurrent nature of CRT, prolonged use of eye drops may be required. In extreme cases, surgery by an ophthalmologist may be required. Where there has been trauma to the cornea, it is important to have the eye properly treated by a doctor of optometry to reduce the risk of CRA in the future.

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