Corneal Erosion, Recurrent Follow-up

  • Author: Arun Verma, MD; Chief Editor: Hampton Roy Sr, MD   more...
 
Updated: Jun 17, 2009
 

Further Outpatient Care

  • Regular follow-up care for many months to even years is required for proper evaluation of the condition.
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Deterrence/Prevention

Preventative measures for patients with recurrent corneal erosion include the following:

  • Avoid dry or irritating environments (eg, cigarette smoke).
  • Drink plenty of fluids to help prevent drying of the eyes. This may also involve limiting alcohol intake in the evenings. Drinking heavily may cause an erosion episode the following morning, sometimes referred to as "drinker's eye."
  • Avoid sleeping in late, as corneal hydration from lid closure may be a factor affecting epithelial adhesion.
  • Apply long-lasting eye ointments (eg, Lacri-Lube) at bedtime. Many patients use a lubricating ointment at night for months or even years to prevent a recurrence.
  • Learn to wake with the eyes closed and still.
    • Keep high-quality artificial tears within reach of the bed; if the eyes feel “stuck shut” upon awakening, insert the bottle tip slightly into the inner corner of the eye and gently squirt in the artificial tears. The artificial tears will seep under the eyelid, often allowing the opening of the eyes without an erosion episode. Several repeated applications of artificial tears may be necessary, but with patience, the eyes will likely become “unstuck” and allow the pain-free opening of the eyes and erosion avoidance.
    • Another method, after waking with the eyes closed and still, is to use the fingers to gently rub the closed eyelids in a circular motion before attempting to open them.
    • The friction of the eyelid against the cornea may be enough to rip off a piece of the corneal epithelium. If a recurrent corneal erosion is suspected, the affected eye should be kept firmly closed, and only the unaffected eye should be opened. Looking around will help lubricate the affected eye so that, when it is opened, there is no friction and, thus, no repeat of the abrasion.
  • Control the air quality and the humidity of the room while sleeping. Avoid having an overventilated room. Air flowing over the face, even with the eyes closed, can increase eye dryness. Cool, moist, still air is the best environment to prevent unnecessary evaporation of eye moisture.
  • Limit exposure to viruses (eg, annual flu shot). Viruses, such as the flu (and associated gastrointestinal symptoms like diarrhea), seem to cause the eyes to dry out and can help cause an erosion episode.
  • Wear protective glasses (eg, sunglasses, prescription glasses, even "fake" glasses), especially when engaging in activities like gardening or playing with children.
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Complications

  • Complications include corneal haze, corneal scarring, infectious keratitis, and permanently decreased vision.
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Prognosis

  • Overall, the prognosis is very good to excellent with proper attention. Unless there is an ongoing underlying corneal disease, most patients will ultimately heal completely and not have any more episodes; however, the healing process may take years.
  • While most patients respond to medical treatment, surgical treatment in the form of anterior stromal puncture (especially in localized posttraumatic erosions), epithelial debridement, diamond burr polishing of the Bowman layer, or excimer laser phototherapeutic keratectomy have excellent success rates, and they should not be used as last resort but rather a next step in the treatment regimen.
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Patient Education

  • Precautionary measures for patients with recurrent corneal erosion associated with epithelial basement membrane dystrophy include the following:
    • Avoidance of rubbing the eyes through the eyelids
    • Liberal use of ointment medications at bedtime during an erosion episode
    • Sometimes these measures must be performed for several months after resolution of the episode.
  • Educate patients on how to open the eyes upon awakening (see Deterrence/Prevention).
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Contributor Information and Disclosures
Author

Arun Verma, MD  Senior Consultant, Department of Ophthalmology, Dr Daljit Singh Eye Hospital, India

Disclosure: Nothing to disclose.

Coauthor(s)

Michael P Ehrenhaus, MD  Director, Department of Cornea, External Disease & Refractive Surgery, Assistant Professor, Department of Ophthalmology, State University of New York Downstate Medical Center

Michael P Ehrenhaus, MD is a member of the following medical societies: American Academy of Ophthalmology, American College of Surgeons, American Medical Association, American Society of Cataract and Refractive Surgery, and Contact Lens Association of Ophthalmologists

Disclosure: Nothing to disclose.

Specialty Editor Board

Fernando H Murillo-Lopez, MD  Senior Surgeon, Unidad Privada de Oftalmologia CEMES

Fernando H Murillo-Lopez, MD is a member of the following medical societies: American Academy of Ophthalmology

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Senior Pharmacy Editor, eMedicine

Disclosure: Nothing to disclose.

Christopher J Rapuano, MD  Professor, Department of Ophthalmology, Jefferson Medical College of Thomas Jefferson University; Co-Chairman of the Cornea Service, Co-Chairman of Refractive Surgery Department, Wills Eye Institute

Christopher J Rapuano, MD is a member of the following medical societies: American Academy of Ophthalmology, American Society of Cataract and Refractive Surgery, Contact Lens Association of Ophthalmologists, Cornea Society, Eye Bank Association of America, International Society of Refractive Surgery, and Pan-American Association of Ophthalmology

Disclosure: Allergan Honoraria Speaking and teaching; Allergan Consulting fee Consulting; Alcon Honoraria Speaking and teaching; Inspire Honoraria Speaking and teaching; RPS Ownership interest Other; Vistakon Honoraria Speaking and teaching

Lance L Brown, OD, MD  Ophthalmologist, Affiliated With Freeman Hospital and St John's Hospital, Regional Eye Center, Joplin, Missouri

Disclosure: Nothing to disclose.

Chief Editor

Hampton Roy Sr, MD  Associate Clinical Professor, Department of Ophthalmology, University of Arkansas for Medical Sciences

Hampton Roy Sr, MD is a member of the following medical societies: American Academy of Ophthalmology, American College of Surgeons, and Pan-American Association of Ophthalmology

Disclosure: Nothing to disclose.

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Corneal abrasion.
Recurrent corneal erosion.
Recurrent erosion with fluorescein in an area of staining.
Map-dot-fingerprint dystrophy.
Stromal puncture seen with fluorescein.
Direct view with a slit lamp.
Debriding of the epithelium. Poorly adherent epithelium with a second layer of basement membrane.
Granular dystrophy before phototherapeutic keratectomy.
Granular dystrophy after photorefractive keratectomy.
 
 
 
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