The diagnosis and management of recurrent corneal erosion syndrome

Abstract

Recurrent corneal erosion syndrome is a condition characterized by recurrent attacks of mild to severe eye pain, redness, tearing, blurred or distorted vision, and light sensitivity. The underlying mechanism is a disturbance at the level of the corneal epithelial basement membrane, resulting in defective adhesions and recurrent breakdowns of the corneal epithelium. Trauma and anterior corneal dystrophy are the two most important causes. Although the diagnosis is easy, treatment is often frustrating. Management of an acute attack is easy but prevention of recurrences is the real challenge. This article reviews the literature on diagnosis and treatment approaches of recurrent corneal erosion syndrome with a special focus on advances over the last decade.

Keywords:

• alcohol delamination
• anterior basement membrane dystrophy
• anterior stromal puncture
• corneal epithelium
• diamond burr
• epithelial debridement
• photo therapeutic keratectomy
• recurrent corneal erosion
• therapeutic contact lens

Financial & competing interests disclosure

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

No writing assistance was utilized in the production of this manuscript.

Key issues

• Newer investigation modalities such as anterior segment optical coherence tomography and in vivo confocal microscopy are helpful in clinically suspicious cases of recurrent corneal erosion syndrome. More so with understanding the pathology than with the diagnosis.

• Lubricants and ointments are the preferred modalities in an acute attack of recurrent corneal erosion syndrome.

• Inhibitors of Gelatinase such as matrix metalloproteinase-2 and matrix metalloproteinase-9 can be useful in preventing recurrences.

• Therapeutic contact lenses can lead to early symptomatic relief in an acute attack of corneal erosion.

• Epithelial debridement should never be performed alone. Additional procedures such as phototherapeutic keratectomy or Diamond burr superficial keratectomy must be combined with epithelial debridement to prevent recurrences.

• Diamond burr superficial keratectomy is simple and does not require expensive equipment like in the case of excimer laser phototherapeutic keratectomy.

• Alcohol delamination is a simple and cost-effective treatment modality.

• Umbilical cord serum is as useful as autologous serum and it has the advantage of greater quantity of growth factor and ease of preparation compared to autologous serum.

• Patient counseling is an important part of management of recurrent corneal erosion syndrome.