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Recurrent Corneal Erosion

Last updated Jan. 10, 2019

Approved by: Maulik P. Purohit MD, MPH

Recurrent Corneal Erosion (RCE) is a chronic, recurring condition in which the top (first) layer of the cornea, the epithelium, gets peeled-off from the cornea in any given area.

What are the other Names for this Condition? (Also known as/Synonyms)

  • Corneal Erosion
  • RCE (Recurrent Corneal Erosion)

What is Recurrent Corneal Erosion? (Definition/Background Information)

  • Recurrent Corneal Erosion (RCE) is a chronic, recurring condition in which the top (first) layer of the cornea, the epithelium, gets peeled-off from the cornea in any given area
  • Corneal erosions usually occur due to previous trauma to the cornea; most due to commonly corneal abrasions that affect the corneal epithelium
    • When new epithelial cells migrate to the injured area of the cornea during the healing process of corneal abrasions, their attachments to the second layer of the cornea, called Bowman’s layer, via attachment sites, called hemidesmosomes, become weak
    • These weak attachments make the corneal epithelium in the areas of prior trauma more prone to detachment from the cornea
  • Detachment of the corneal epithelium from an area of the cornea creates an erosion, or small divot, which exposes the corneal nerves and results in severe pain
  • Recurrent Corneal Erosions can be difficult to treat due to the recurrent nature of the condition

Who gets Recurrent Corneal Erosions? (Age and Sex Distribution)

  • Individuals with history of superficial trauma to the cornea, most commonly corneal abrasions, are seen to be affected by Recurrent Corneal Erosion
  • No age predilection is noted, although elderly individuals may have weaker hemidesmosome attachments and age-related corneal thickening; these factors can make them more prone to developing Corneal Erosion
  • Both males and females are affected
  • No racial, ethnic group, or geographical predilection is observed

What are the Risk Factors for Recurrent Corneal Erosion? (Predisposing Factors)

The risk factors for developing Recurrent Corneal Erosion include:

  • History of corneal abrasion
  • Epithelial basement membrane dystrophy: It is a corneal condition in which the basement membrane of the cornea thickens, which can cause abnormalities in the attachment of the epithelial cells
  • Diabetes: Diabetics, sometimes, have poor hemidesmosome attachments. Hemidesmosomes are structures in the eye that keep the corneal layers together

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases one’s chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.

What are the Causes of Recurrent Corneal Erosion? (Etiology)

  • Corneal abrasions from matter/materials, such as wood or fingernails, lead to weakened attachments of new epithelial cells to the rest of the cornea
  • Because newer epithelial cells are not strongly attached to the rest of the cornea, they are more prone to peeling-off (tearing or breaking)
  • Recurrent Corneal Erosions most commonly occur when the lids open upon awakening in the morning, after the closed lids disrupt the epithelial cells while sleeping
  • The blinking process of opening and closing the eyelids in the morning will cause the top epithelial layers to rip-off. Due to this process, an erosion or a divot, in an area of the cornea (at site of prior trauma) takes place

What are the Signs and Symptoms of Recurrent Corneal Erosion?

The signs and symptoms of Recurrent Corneal Erosion may include:

  • Pain upon awakening (due to the lid-corneal interaction while sleeping)
  • Recurrence of sudden pain that lasts until the cornea heals
  • Tearing
  • Light-sensitivity
  • Blurred vision
  • Area of the cornea that is abraded like a divot, which can be observed on eye examination

How is Recurrent Corneal Erosion Diagnosed?

The diagnosis of Recurrent Corneal Erosion may include the following tests and exams:

  • Obtaining a thorough history of the condition, including previous trauma to the cornea, such as corneal abrasion
  • Observation of corneal abrasion upon examination with a slit lamp
  • The physician will usually be able to observe a pool of fluorescein dye that accumulates in the abraded or eroded area of the cornea, after instillation of the dye

Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis.

What are the possible Complications of Recurrent Corneal Erosion?

Complications due to Recurrent Corneal Erosion could include:

  • Recurrence of episodes of pain
  • Decreased vision
  • Chronic inflammation
  • Poor corneal healing capability
  • Corneal scarring
  • Infection
  • Recurrence of the condition resulting in more severe signs and symptoms

How is Recurrent Corneal Erosion Treated?

The treatment measures for Recurrent Corneal Erosion may include:

  • Administration of artificial tears, lubricating gels, and lubricating ointments
  • Contact lens used as a bandage: Contact lenses can be used to cover the damaged cornea and prevent further worsening of the condition. The lens also helps as a protective layer during the healing process
  • Topical corticosteroids
  • Amniotic membrane grafts applied, via a ring or large-diameter contact lens, to reduce inflammation and help repair the damaged cornea
  • Anterior stromal micropuncture: A procedure in which a needle is used to puncture the cornea up to the beginning of the third layer of the cornea, called the stroma, to induce scar tissue, which can enhance epithelial adherence
  • Diamond burr polishing: A surgical instrument is used to remove any loose epithelial cells and polish the Bowman’s layer (the second layer of the cornea), to increase the likelihood of better adherence of new epithelial cells to Bowman’s layer
  • Excimer laser phototherapeutic keratectomy (PTK): This procedure is sometimes used, if a large area of the cornea is compromised. In this procedure, the damaged layers of cornea are removed to provide a clean slate for new epithelium to form with better adherence

How can Recurrent Corneal Erosion be Prevented?

The preventive methods for Recurrent Corneal Erosion could include:

  • Any of the aforementioned surgical procedures may help prevent RCE
  • Frequent use of preservative-free artificial tears to prevent the previously damaged area of the cornea from becoming dry and inflamed
  • Lubricating ointment at bedtime to prevent lid-cornea interaction while sleeping
  • Adequate control of diabetes through lifestyle modification
  • Eye injuries in sports and due to occupations/industrial work may be prevented by using suitable protective eye wear

What is the Prognosis of Recurrent Corneal Erosion? (Outcomes/Resolutions)

  • The prognosis of Recurrent Corneal Erosion depends upon the severity of the signs and symptoms. Individuals with mild signs and symptoms have better prognosis than those with severe conditions
  • The prognosis is generally good, when each recurrence of Corneal Erosion is promptly diagnosed and treated
  • The long-term prognosis of RCE varies due to the recurrent nature of the condition. Individuals, who have frequent recurrences generally have worse prognosis than individuals without such regular recurrences
  • However, with adequate treatment, RCE can be well-managed long-term, even though it can take several years before the episodes are completely stopped

Additional and Relevant Useful Information for Recurrent Corneal Erosion:

  • Treatment for Recurrent Corneal Erosion typically varies between physicians and healthcare institutions
  • Autologous serum drops have gained popularity for treatment of severe Recurrent Corneal Erosions. Serum is derived from an affected individual’s blood and used as eye drops to protect the damaged area of the cornea with its lubricating properties. Blood serum has a similar composition to natural eye tears

What are some Useful Resources for Additional Information?

References and Information Sources used for the Article:

Helpful Peer-Reviewed Medical Articles:

Reviewed and Approved by a member of the DoveMed Editorial Board
First uploaded: Sept. 7, 2016
Last updated: Jan. 10, 2019