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.

Recurrent erosion with fluorescein in an area of staining.

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Stromal puncture seen with fluorescein.

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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.

Direct view with a slit lamp.

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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.

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.

Treatment & Management

Laibson PR. Epithelial basement membrane dystrophy and recurrent erosions. Current Ocular Therapy. 5th ed. 2000. 355-357.
Moutray TN, Frazer DG, Jackson AJ. Recurrent erosion syndrome--the patient's perspective. Cont Lens Anterior Eye. 2011 Jun. 34(3):139-43. [QxMD MEDLINE Link].
Reeves SW, Kang PC, Zlogar DF, Gupta PK, Stinnett S, Afshari NA. Recurrent Corneal Erosion Syndrome: A Study of 364 Episodes. Ophthalmic Surg Lasers Imaging. 2010 Mar 9. 1-2. [QxMD MEDLINE Link].
Hykin PG, Foss AE, Pavesio C, Dart JK. The natural history and management of recurrent corneal erosion: a prospective randomised trial. Eye. 1994. 8 (Pt 1):35-40. [QxMD MEDLINE Link].
Lopez Bernal D, Ubels JL. Artificial tear composition and promotion of recovery of the damaged corneal epithelium. Cornea. 1993 Mar. 12(2):115-20. [QxMD MEDLINE Link].
Fraunfelder FW, Cabezas M. Treatment of recurrent corneal erosion by extended-wear bandage contact lens. Cornea. 2011 Feb. 30(2):164-6. [QxMD MEDLINE Link].
Mencucci R, Paladini I, Brahimi B, Menchini U, Dua HS, Romagnoli P. Alcohol delamination in the treatment of recurrent corneal erosion: an electron microscopic study. Br J Ophthalmol. 2010 Jul. 94(7):933-9. [QxMD MEDLINE Link].
Maréchal-Courtois C, Duchesne B. [Recurrent corneal erosion]. Bull Soc Belge Ophtalmol. 1993. 247(1):13-5. [QxMD MEDLINE Link].
Gyldenkerne GJ, Ehlers N. [Excimer laser therapy of recurrent corneal erosions]. Ugeskr Laeger. 1994 Sep 12. 156(37):5282-4. [QxMD MEDLINE Link].
John ME, Van der Karr MA, Noblitt RL, Boleyn KL. Excimer laser phototherapeutic keratectomy for treatment of recurrent corneal erosion. J Cataract Refract Surg. 1994 Mar. 20(2):179-81. [QxMD MEDLINE Link].
Katz HR, Snyder ME, Green WR, Kaplan HJ, Abrams DA. Nd:YAG laser photo-induced adhesion of the corneal epithelium. Am J Ophthalmol. 1994 Nov 15. 118(5):612-22. [QxMD MEDLINE Link].
Rogers C, Cohen P, Lawless M. Phototherapeutic keratectomy for Reis Bucklers' corneal dystrophy. Aust N Z J Ophthalmol. 1993 Nov. 21(4):247-50. [QxMD MEDLINE Link].
Soong HK, Farjo Q, Meyer RF, Sugar A. Diamond burr superficial keratectomy for recurrent corneal erosions. Br J Ophthalmol. 2002 Mar. 86(3):296-8. [QxMD MEDLINE Link].
Aitken DA, Beirouty ZA, Lee WR. Ultrastructural study of the corneal epithelium in the recurrent erosion syndrome. Br J Ophthalmol. 1995 Mar. 79(3):282-9. [QxMD MEDLINE Link].
Arbour JD, Brunette I, Boisjoly HM, Shi ZH, Dumas J, Guertin MC. Should we patch corneal erosions?. Arch Ophthalmol. 1997 Mar. 115(3):313-7. [QxMD MEDLINE Link].
Baum JL. The Castroviejo Lecture. Prolonged eyelid closure is a risk to the cornea. Cornea. 1997 Nov. 16(6):602-11. [QxMD MEDLINE Link].
Ben Osman N, Jeddi A, Mtimet S, Marrakchi S, Ayed S. [Recurrent corneal erosion. Apropos of a case]. J Fr Ophtalmol. 1994. 17(5):358-60. [QxMD MEDLINE Link].
Brennan NA, Coles ML. Extended wear in perspective. Optom Vis Sci. 1997 Aug. 74(8):609-23. [QxMD MEDLINE Link].
Brown N, Bron A. Recurrent erosion of the cornea. Br J Ophthalmol. 1976 Feb. 60(2):84-96. [QxMD MEDLINE Link].
Bruce AS, Brennan NA. Corneal pathophysiology with contact lens wear. Surv Ophthalmol. 1990 Jul-Aug. 35(1):25-58. [QxMD MEDLINE Link].
Buxton JN, Constad WH. Superficial epithelial keratectomy in the treatment of epithelial basement membrane dystrophy. Ann Ophthalmol. 1987 Mar. 19(3):92-6. [QxMD MEDLINE Link].
Campos M, Nielsen S, Szerenyi K, Garbus JJ, McDonnell PJ. Clinical follow-up of phototherapeutic keratectomy for treatment of corneal opacities. Am J Ophthalmol. 1993 Apr 15. 115(4):433-40. [QxMD MEDLINE Link].
Catania L. Primary Care of the Anterior Segment. 2nd ed. Norwalk, Conn: Appleton & Lange; 1994. 237-241.
Cavanaugh TB, Lind DM, Cutarelli PE, Mack RJ, Durrie DS, Hassanein KM, et al. Phototherapeutic keratectomy for recurrent erosion syndrome in anterior basement membrane dystrophy. Ophthalmology. 1999 May. 106(5):971-6. [QxMD MEDLINE Link].
Chandler PA. Recurrent erosion of the cornea. Am J Ophthalmol. 1945. 28:355-367.
Dausch D, Landesz M, Klein R, Schroder E. Phototherapeutic keratectomy in recurrent corneal epithelial erosion. Refract Corneal Surg. 1993 Nov-Dec. 9(6):419-24. [QxMD MEDLINE Link].
Dursun D, Kim MC, Solomon A, Pflugfelder SC. Treatment of recalcitrant recurrent corneal erosions with inhibitors of matrix metalloproteinase-9, doxycycline and corticosteroids. Am J Ophthalmol. 2001 Jul. 132(1):8-13. [QxMD MEDLINE Link].
Forstot SL, Damiano RE, Witters R, et al. Diamond burr keratectomy for the treatment of recurrent corneal erosion syndrome. Ophthalmology (suppl). 1994. 101:103.
Foulks GN. Treatment of recurrent corneal erosion and corneal edema with topical osmotic colloidal solution. Ophthalmology. 1981 Aug. 88(8):801-3. [QxMD MEDLINE Link].
Friedman NJ, Kaiser PK, Trattler WB. Review of Ophthalmology. Elsevier Saunders; 221.
Förster W, Grewe S, Atzler U, Lunecke C, Busse H. Phototherapeutic keratectomy in corneal diseases. Refract Corneal Surg. 1993 Mar-Apr. 9(2 Suppl):S85-90. [QxMD MEDLINE Link].
Galbavy EJ, Mobilia EF, Kenyon KR. Recurrent corneal erosions. Int Ophthalmol Clin. 1984 Summer. 24(2):107-31. [QxMD MEDLINE Link].
Geggel HS. Successful treatment of recurrent corneal erosion with Nd:YAG anterior stromal puncture. Am J Ophthalmol. 1990 Oct 15. 110(4):404-7. [QxMD MEDLINE Link].
Harkins T. The excimer laser and phototherapeutic keratectomy. Clin Eye Vis Care. 1995. 7:103-6.
Heyworth P, Morlet N, Rayner S, Hykin P, Dart J. Natural history of recurrent erosion syndrome--a 4 year review of 117 patients. Br J Ophthalmol. 1998 Jan. 82(1):26-8. [QxMD MEDLINE Link].
Hope-Ross MW, Chell PB, Kervick GN, McDonnell PJ, Jones HS. Oral tetracycline in the treatment of recurrent corneal erosions. Eye. 1994. 8 (Pt 4):384-8. [QxMD MEDLINE Link].
Hsu JK, Rubinfeld RS, Barry P, Jester JV. Anterior stromal puncture. Immunohistochemical studies in human corneas. Arch Ophthalmol. 1993 Aug. 111(8):1057-63. [QxMD MEDLINE Link].
Ionides AC, Tuft SJ, Ferguson VM, Matheson MM, Hykin PG. Corneal infiltration after recurrent corneal epithelial erosion. Br J Ophthalmol. 1997 Jul. 81(7):537-40. [QxMD MEDLINE Link].
Kanski J. Clinical Ophthalmology. 3rd ed. London: Butterworths; 1994. 135-6.
Katsev DA, Kincaid MC, Fouraker BD, Dresner MS, Schanzlin DJ. Recurrent corneal erosion: pathology of corneal puncture. Cornea. 1991 Sep. 10(5):418-23. [QxMD MEDLINE Link].
Kenyon KR. Recurrent corneal erosion: pathogenesis and therapy. Int Ophthalmol Clin. 1979 Summer. 19(2):169-95. [QxMD MEDLINE Link].
Kremer I, Blumenthal M. Combined PRK and PTK in myopic patients with recurrent corneal erosion. Br J Ophthalmol. 1997 Jul. 81(7):551-4. [QxMD MEDLINE Link].
Laibson PR. Microcystic corneal dystrophy. Trans Am Ophthalmol Soc. 1976. 74:488-531. [QxMD MEDLINE Link].
Lawless MA, Cohen P, Rogers C. Phototherapeutic keratectomy for Reis-Bückler's dystrophy. Refract Corneal Surg. 1993 Mar-Apr. 9(2 Suppl):S96-8. [QxMD MEDLINE Link].
Liu C, Buckley R. The role of the therapeutic contact lens in the management of recurrent corneal erosions: a review of treatment strategies. CLAO J. 1996 Jan. 22(1):79-82. [QxMD MEDLINE Link].
Mackie IA. Successful management of three consecutive cases of recurrent corneal erosion with botulinum toxin injections. Eye. 2004 Jul. 18(7):734-7. [QxMD MEDLINE Link].
Malecha MA. Anterior stromal puncture for recurrent corneal erosion after laser in situ keratomileusis. J Cataract Refract Surg. 2004 Feb. 30(2):496-8. [QxMD MEDLINE Link].
McDonnell PJ, Seiler T. Phototherapeutic keratectomy with excimer laser for Reis-Buckler's corneal dystrophy. Refract Corneal Surg. 1992 Jul-Aug. 8(4):306-10. [QxMD MEDLINE Link].
McGhee CN, Bryce IG, Anastas CN, Webber SK, Burvill M, Murray AT. Corneal topographic lagoons: a potential new marker for post-traumatic recurrent corneal erosion syndrome. Aust N Z J Ophthalmol. 1996 Feb. 24(1):27-31. [QxMD MEDLINE Link].
McLean EN, MacRae SM, Rich LF. Recurrent erosion. Treatment by anterior stromal puncture. Ophthalmology. 1986 Jun. 93(6):784-8. [QxMD MEDLINE Link].
Ramamurthi S, Rahman MQ, Dutton GN, Ramaesh K. Pathogenesis, clinical features and management of recurrent corneal erosions. Eye. 2006 Jun. 20(6):635-44. [QxMD MEDLINE Link].
Ramamurthi S, Ramaesh K. Anterior stromal puncture for recurrent corneal erosion after laser in situ keratomileusis. J Cataract Refract Surg. 2005 Jan. 31(1):9-10; author reply 10. [QxMD MEDLINE Link].
Rapuano CJ. Excimer laser phototherapeutic keratectomy: long-term results and practical considerations. Cornea. 1997 Mar. 16(2):151-7. [QxMD MEDLINE Link].
Reinhard T, Sundmacher R, Strunck-Kortenbusch B. [Corneal puncture in recurrent corneal erosion]. Ophthalmologe. 1993 Dec. 90(6):694-7. [QxMD MEDLINE Link].
Rhys C, Snyers B, Pirson Y. Recurrent corneal erosion associated with Alport's syndrome. Rapid communication. Kidney Int. 1997 Jul. 52(1):208-11. [QxMD MEDLINE Link].
Rodrigues MM, Laibson PR. Recurrent corneal erosions. Trans Pa Acad Ophthalmol Otolaryngol. 1976 Fall. 29(2):171-3. [QxMD MEDLINE Link].
Thygeson P. Observations on recurrent erosion of the cornea. Am J Ophthalmol. 1959 May. 47(5, Part 2):48-52. [QxMD MEDLINE Link].
Trobe JD, Laibson PR. Dystrophic changes in the anterior cornea. Arch Ophthalmol. 1972 Apr. 87(4):378-82. [QxMD MEDLINE Link].
Udell IJ, Ormerod LD, Boniuk V, Abelson MB. Treatment of contact lens-associated corneal erosions. Am J Ophthalmol. 1987 Sep 15. 104(3):306-7. [QxMD MEDLINE Link].
Waring GO 3rd, Rodrigues MM, Laibson PR. Corneal dystrophies. I. Dystrophies of the epithelium, Bowman's layer and stroma. Surv Ophthalmol. 1978 Sep-Oct. 23(2):71-122. [QxMD MEDLINE Link].
Wood TO. Recurrent erosion. Trans Am Ophthalmol Soc. 1984. 82:850-98. [QxMD MEDLINE Link].

Media Gallery

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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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, Contact Lens Association of Ophthalmologists

Disclosure: Nothing to disclose.

Specialty Editor Board

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

Disclosure: Received salary from Medscape for employment. for: Medscape.

Christopher J Rapuano, MD Professor, Department of Ophthalmology, Sidney Kimmel Medical College of Thomas Jefferson University; Director of the Cornea Service, Wills Eye Hospital

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

Disclosure: Serve(d) as a director, officer, partner, employee, advisor, consultant or trustee for: AAO; OMIC; American Society of Ophthalmic Trauma (ASOT); Avellino, Baxis; Bio-Tissue; Celularity; Dompe; Emmecell; Glaukos; Kala; Oyster Point; Sun Ophthalmics; Tarsus; TearLab<br/>Serve(d) as a speaker or a member of a speakers bureau for: Glaukos; Dompe; Bio-Tissue<br/>Received research grant from: Glaukos<br/>Received income in an amount equal to or greater than $250 from: AAO; OMIC; Baxis; Bio-Tissue; Cellularity; Dompe; Glaukos; Kala; Sun Ophthalmics; TearLab<br/>stock options for: RPS, Fount Bio.

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, Pan-American Association of Ophthalmology

Disclosure: Nothing to disclose.

Additional Contributors

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.

Sections Recurrent Corneal Erosion
Overview
Presentation
- History
- Physical
- Causes
- Complications
- Show All
DDx
Workup
Treatment
Media Gallery
References

Recurrent Corneal Erosion Workup

Other Tests

Histologic Findings

References

Tables

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