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Thread: Recurrent corneal erosion syndrome (RCES)

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    Default Recurrent corneal erosion syndrome (RCES)

    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.

    Recurrent corneal erosion syndrome (RCES) attachment.php?attachmentid=3461&d=1512899126

    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

    ✍️ 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.











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