Recurrent Corneal Erosion Workup

Updated: Mar 20, 2023
  • Author: Arun Verma, MD; Chief Editor: Hampton Roy, Sr, MD  more...
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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 s Recurrent 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.

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.


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.