The Patient's Guide to Recurrent Corneal Erosion

Do you sometimes feel a sharp pain in your eye, and then experience watering and light sensitivity? Do you frequently wake up with a sore, tender eye and blurry vision?  Do your eyes frequently water or even matter when you wake up in the morning?  If these are symptoms that brought your to this blog, I highly recommend that you schedule a visit with your optometrist because you may have a chronic and recurrent condition called corneal erosion.

Understanding the Basics of Recurrent Corneal Erosion

The easiest way to see a corneal abrasion or recurrent erosion is to use NaFl dye.  In this picture the person has a large abrasion right in the center of the cornea which would have a huge impact on vision.  An abrasion this size could take several days to a week to fully heal; and if you get recurrent breaks in this area it could cause a huge toll on your life -- constantly battling a week of pain, light sensitivity, and blur.  This is why Recurrent Corneal Erosion is such a difficult problem to have to deal with.  via

Recurrent corneal erosion is a relatively common issue for people with dry eyes or those with a history of previous corneal abrasion.  Finger nail scratches or paper cuts to the cornea are common initial injuries -- the abrasion you suffer from such a small and thin corneal scratch may have difficulty healing properly.  As the cornea heals itself from that injury, the junctions that hold your epithelial cells together may never fuse with the same strength, leading to areas that are susceptible to re-breaking.  From that moment of your initial injury onward, if your eye gets too dry or irritated, the tissue may break open again causing the same terrible symptoms of pain, watering, light sensitivity, and blurry vision that you experienced when you first had the abrasion.  Overnight dryness is the most common culprit for these recurrences -- your eyes will get too dry overnight, causing the surface epithelial tissue to stick to your eyelid.  When you open your eyes in the morning, those sticky areas will break right open where the junctions are permanently weakened from your prior abrasion.  The result is severe pain, and a fresh new abrasion to battle.

Treatment Options

GenTeal Gel is a go-to product for me in cases of
overnight dryness via

Typically the best way to prevent recurrent erosions is to prevent your eye from getting too dried out, especially overnight when our eyes are more prone to getting dry anyway.  That means using moisturizing drops, gels, or ointments on a routine basis.  For many of my patients, just using a rewetting gel drop or ointment at bedtime is enough to prevent a morning recurrence.  Drops like Refresh Liquigel, Systane gel, or GenTeal gel or ointment are excellent products.  It is also best (if possible) to avoid any direct airflow to your eyes overnight.  That means no ceiling fans or vents blowing at your face.  If you use a CPAP machine it can also cause direct "wind" blowing on your face, so a good quality eye ointment is essential to prevent excessive overnight corneal dryness in this case.

If you are still getting a few corneal erosions a year, over the counter drops may not be enough to solve your problem.  There are several surgical treatments that have been effective for treating and preventing future recurrent erosions, and your doctor will work with you to find a plan right for your eye.  Options include lesser invasive procedures like using a bandage contact lens or doing a month long pulse of steroid drops and doxycycline, to more advanced surgical options. Anterior stromal puncture is a common method that surgeons will use to prevent future erosions where they purposefully cause multiple pinpoint breaks in a circular ring around the cornea to try to stimulate a full healing attack from your body to reset all of those problematic weak epithelial junctions.

ProKera amniotic membrane lens is a large disc placed
on your eye to help heal the epithelial junctions permanently.
The lens itself is not comfortable, and will cause blurry vision
while you wear it, but for many this is worth the results.  via

A new treatment on the market that has been showing great success is the use of ProKera, The concept is simple: a contact lens that is made out of amniotic tissue is applied to the eye that bathes your cornea in natural anti-inflammatories and healing mediators.  The hope is that this membrane can help fully regenerate your cornea with its full epithelial junctions intact, meaning a strong new cornea of your own that is resistant to future breaks. Optometrists and ophthalmologists can both use this membrane contact lens to help your eye heal, but since this is amniotic membrane tissue, the expense can be high if your medical insurance does not have full coverage. Another thing to note is that the ProKera lens is definitely not for everyone -- it is bulky and uncomfortable while it is on your eye, and you will have blurry vision for the entire time you are wearing the lens (typically a week or more).  For most wearers, it is worth a week of discomfort if you could possibly have a lifetime without another corneal break.  Again, your doctor can help you decide which approach to your recurrent erosions is right for you, and hopefully prevent another painful recurrence.