Recurrent Corneal Erosion Workup

  • Author: Arun Verma, MD; Chief Editor: Hampton Roy Sr, MD   more...
 
Updated: Feb 14, 2012
 

Other Tests

Lesions, such as corneal erosions, are stained mainly by fluorescein, whereas devitalized but intact epithelium is stained exclusively by rose bengal. One drop of 1% rose bengal placed on the upper bulbar conjunctiva, while the patient looks down, is generally sufficient.

See the images below.

Recurrent erosion with fluorescein in an area of sRecurrent erosion with fluorescein in an area of staining. Stromal puncture seen with fluorescein. Stromal puncture seen with fluorescein.

A careful slit lamp examination often reveals corneal erosions. Many times, there may be associated generalized or localized patches of corneal edema. In some cases, there may be associated microbial keratitis, which can be diagnosed with bacterial cultures of these corneas.

See the image below.

Direct view with a slit lamp. Direct view with a slit lamp.

Corneal topographic analysis (using computerized videokeratography) often reveals focal areas of corneal flattening (called corneal topographic lagoons) in eyes with RCE syndrome. This finding is important, as the identification of areas of focal abnormality in RCE syndrome remains a significant clinical problem in those patients with frank symptoms but no evident epithelial abnormalities.

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Histologic Findings

Fingerprint lines and maplike patterns are histologically similar. Both have an aberrant or a multilaminar basement membrane produced by the basal epithelial cells of the corneal epithelium.

The literature suggests that, especially in spontaneous (nontraumatic) recurrent erosions, there may be an inherent structural weakness of the corneal basement membrane with respect to the synthesis and deposition of type 4 collagen.

Even when frank epithelial defects or opaque microcysts are absent or undetectable with biomicroscopy, computed videokeratography may reveal the presence of corneal epithelial lagoons or microdepressions, indicative of microscopic folding and redundancies in the basement membrane, especially in posttraumatic recurrent erosions.

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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  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Christopher J Rapuano, MD  Professor, Department of Ophthalmology, Jefferson Medical College of Thomas Jefferson University; Director of the Cornea Service, Co-Director 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; RPS Ownership interest Other; EyeGate Pharma Consulting fee Consulting; Bausch & Lomb Honoraria Speaking and teaching; Bausch & Lomb Consulting; Merck 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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