Recurrent corneal erosion syndrome (RCES)
✍️ a provisional diagnosis of RCES may be made on history alone.
✍️ failure of epithelial to BM re-adhesion with recurrent episodes of spontaneous breakdown of the corneal epithelium.
✅ Risk factors
✍️ Sharp trauma.
✍️ Corneal dystrophies
☝️ epithelial BM dystrophy and
Reis–Bucklers dystrophy)
☝️ stromal dystrophies.( anterior stromal )
✍️ Post-keratoplasty.
✍️ Diabetes
✍️ dry eye
✍️ ocular rosacea.
✅ Clinical features
✍️ Recurrent episodes of severe pain and photophobia
✍️ starting on opening eyes after sleep
✍️ aggravated by blinking
✍️ resolves within hours
✍️ history of corneal trauma (often forgotten).
✍️ Variable degree of epithelial irregularities
☝️ loose epithelium without staining
☝️ frank epithelial defects
☝️ signs of underlying disease
• microcysts
• maps
• dots
• fingerprints
• stromal changes.
☝️ When severe, may last for several days, with pain accompanied by lid oedema, ciliary injection, extreme photophobia, and reduced vision.
☝️ May predispose to infection.
✅ Pathology
✍️ Abnormalities of epithelial adhesion
✍️ defects in hemidesmosomes
✍️ BM which may exhibit thinning and reduplication.
✍️ Excessive MMPs result in enzymatic degradation of adhesion complexes.
✅ Treatment of Recurrent corneal erosion syndrome (RCES)
✍️ Conservative
☝️ Topical:
• lubricants (carmellose hourly during the day and
Lacri-Lube OC at night
• ± cycloplegia (cyclopentolate 2×/d)
• NSAID (ketorolac 3×/d) for comfort.
☝️ Therapeutic CL
• extended wear silicone hydrogel
• high water content hydrogel.
☝️ Tetracyclines
• doxycyline 50–100mg 1×/d for 3mo
• oxytetracycline 250mg 2×/d for 3mo
• inhibit MMP activity and promote epithelial stability
• contraindicated in children under , in pregnant/breastfeeding women, or in hepatic or renal impairment).
☝️ erythromycin 250mg ( alternative to tetracycline)
✍️ Surgical
☝️ Mechanical debridement
• consider mechanical debridement if heaped
up, devitalized epithelium.
• Anaesthetize cornea
• gently break away non-adherent grey epithelium with moistened cotton bud or sponge
• use post-procedure therapeutic CL with topical non-preserved antibiotic eye drops to prevent 2ry infection).
☝️ Alcohol delamination of the epithelium
• promotes smoothing of the stromal bed to improve epithelial adhesion.
• involves 4–5 drops of 18% alcohol applied within a circular corneal well placed on top of the cornea for 30–40s.
• This is then drained from the well (by a surgical sponge)
• followed by epithelial debridement of entire corneal epithelium with a cotton-tipped applicator.
☝️ Excimer laser phototherapeutic keratectomy
• for refractory or severe cases of RCES.
☝️ anterior stromal micropuncture
• considered for RCES outside the visual axis.
• performed at the slit-lamp (if cooperative patient) or in theatre with topical anaesthesia
• using a bent 25g needle to cover the defective area
• closely packed micropunctures through epithelium and Bowman’s layer.