Managing Recurrent Corneal Erosion: Challenges and Treatment Options

Q: Managing Recurrent Corneal Erosion: Challenges and Treatment Options

Hello： First, your wife's medication regimen already includes artificial tears and a tear film ointment, which are standard treatments for dry eye syndrome. <br>However, if her eyelids are still sticking together during sleep and exacerbating her symptoms, it may be necessary to

Recurrent corneal erosion, but no preventive measures can be identified?

Hello, Doctor! My wife experienced her first corneal abrasion in February of last year.
She received treatment from a cornea specialist, who prescribed artificial tears and a tear film ointment, but she still frequently experiences her eyelids sticking together, causing pulling and abrasion.
Subsequently, she underwent further surgery to remove part of her cornea and was treated with contact lenses.
After the removal of the contact lenses, the doctor mentioned that her healing was progressing well.
However, after some time, her cornea again became stuck and was subjected to pulling and abrasion.

In the past few weeks, she has undergone numerous examinations.
Although she has dry eye syndrome, the severity is manageable, and the doctor indicated that the corneal damage is not severe.
The meibomian gland dysfunction test showed no issues.
The problem is that my wife always applies artificial tears before bed and even wakes up in the middle of the night to reapply the tears and ointment, yet she still experiences her eyelids sticking together and pulling.
Sometimes, this pulling can be painful enough to cause tears.
The tear film ointment, due to its higher viscosity, seems to exacerbate the situation.
Theoretically, the tear film ointment is supposed to create a protective barrier to prevent pulling, and the doctors have stated that only the ointment can help prevent this issue, with no definitive cure available.
However, it seems to be contributing to the pulling instead.

If the examination results are not severe, I cannot understand how to prevent the cornea from being pulled.
Could you please provide some preventive suggestions and whether there are other treatment options available? Thank you!

Jason, 30~39 year old female. Ask Date: 2024/01/17

Dr. Gao Pilin reply Ophthalmology

Hello: First, your wife's medication regimen already includes artificial tears and a tear film ointment, which are standard treatments for dry eye syndrome.
However, if her eyelids are still sticking together during sleep and exacerbating her symptoms, it may be necessary to reassess her treatment plan.
Here are some recommendations to consider:
1.
Change the tear film ointment: Discuss with her ophthalmologist whether there are alternative ointments available, as sometimes different brands or formulations may be more effective for individual patients.
2.
Adjust the timing of medication: Consider applying the ointment before bedtime, allowing sufficient time for a protective film to form before she falls asleep, thereby reducing the risk of her eyelids sticking together.
3.
Change sleeping position: It is advisable to avoid sleeping with her face buried in the pillow to minimize eye friction.
4.
Maintain a humid environment: Keeping the indoor air moist while she sleeps can be beneficial; using a humidifier may help reduce eye dryness.
5.
Contact lens therapy: Continuing contact lens wear may help ensure the health of the cornea and control of dry eye symptoms.
New lenses can be fitted, and once the cornea stabilizes, she can consider not wearing them.
Additionally, please consult with her ophthalmologist for a thorough discussion on potential further treatment options and personalized recommendations tailored to her specific situation.
I hope these suggestions will be helpful for your wife's condition.
If you have any other questions or need further guidance, please feel free to reach out to her ophthalmologist.
Wishing your wife a speedy recovery.

Reply Date: 2024/01/17

More Info

Managing recurrent corneal erosion (RCE) can indeed be a challenging situation, particularly when conventional treatments do not yield satisfactory results. RCE is characterized by the recurrent loss of the corneal epithelium, which can lead to significant discomfort and visual disturbances. The condition often arises from a history of trauma, dry eye syndrome, or underlying corneal dystrophies. Given your wife's ongoing issues despite treatment, it’s essential to explore both preventive measures and alternative treatment options.

Understanding the Condition
Recurrent corneal erosion typically occurs when the corneal epithelium does not adhere properly to the underlying basement membrane. This can be exacerbated by factors such as dry eyes, eyelid abnormalities, or even the use of contact lenses. In your wife's case, it appears that despite the use of artificial tears and ointments, she continues to experience episodes of adhesion between the eyelid and the cornea, leading to further erosion upon waking.

Current Treatment Options
1. Artificial Tears and Ointments: While your wife is already using these, it’s crucial to ensure that the formulations are appropriate. Some patients benefit from preservative-free artificial tears, which can be used more frequently without the risk of irritation.
2. Bandage Contact Lenses: These can provide a protective barrier over the cornea, allowing it to heal while minimizing discomfort. They can also help reduce the friction between the eyelid and the cornea during sleep.

3. Punctal Plugs: If dry eye is a contributing factor, punctal plugs can help retain tears on the surface of the eye, providing better lubrication and reducing the risk of erosion.

4. Topical Medications: In some cases, medications such as doxycycline or corticosteroids may be prescribed to reduce inflammation and promote healing.

5. Surgical Options: If conservative measures fail, surgical interventions such as anterior stromal puncture or phototherapeutic keratectomy (PTK) may be considered. These procedures aim to improve the adhesion of the epithelium to the underlying stroma.

Preventive Measures
1. Nighttime Regimen: Since your wife experiences issues primarily at night, it may be beneficial to adjust her nighttime routine. Applying a thicker ointment before bed may help create a more effective barrier against adhesion.
2. Humidity Control: Using a humidifier in the bedroom can help maintain moisture in the air, which may alleviate dry eye symptoms and reduce the likelihood of erosion.

3. Avoiding Eye Rubbing: Encourage her to avoid rubbing her eyes, as this can exacerbate the condition.

4. Regular Follow-ups: Continuous monitoring by an ophthalmologist is essential. They can assess the healing process and make adjustments to the treatment plan as necessary.

5. Lifestyle Adjustments: Staying hydrated and maintaining a balanced diet rich in omega-3 fatty acids can support overall eye health.

Exploring Further Treatment Options
If the current treatment plan is not effective, it may be worthwhile to seek a second opinion from a corneal specialist. They may offer additional insights or advanced therapies, such as:
- Amniotic Membrane Grafting: This procedure involves placing a piece of amniotic membrane over the cornea to promote healing and reduce inflammation.

- Scleral Lenses: These are larger-diameter contact lenses that vault over the cornea and can provide a stable tear film, protecting the cornea from the eyelid.

Conclusion
Managing recurrent corneal erosion requires a multifaceted approach tailored to the individual's specific circumstances. While your wife has already undergone several treatments, it’s crucial to continue exploring options and maintaining open communication with her healthcare providers. Regular follow-ups and adjustments to her treatment regimen can significantly improve her quality of life and reduce the frequency of erosions.

Similar Q&A

Understanding Recurrent Corneal Erosion: Causes and Management Strategies

Hello Doctor: I underwent a corneal epithelial debridement surgery (without laser) on my right eye on March 22 and wore therapeutic contact lenses for two weeks. After removing the lenses, I consistently used artificial tears and tear film ointment daily, but I still experience r...

Dr. Cai Wenyuan reply Ophthalmology
Hello: If it is indeed recurrent corneal erosion, it can be difficult to manage and prone to recurrence. It may be best to continue seeking medical treatment. Wishing you safety and health. Sincerely, Dr. Cai Wenyuan, Director of Ophthalmology, Taoyuan Hospital, Ministry of Healt...

Managing Recurrent Corneal Erosion: Effective Treatments and Concerns

Hello, doctor. For the past two years, I have been suffering from recurrent corneal abrasions due to dry eye. Initially, I was treated with eye drops, and I have now undergone two punctal occlusions. I also rely on single-dose artificial tears throughout the day (using about four...

Dr. Gao Pilin reply Ophthalmology
Hello: 1. For patients with dry eye syndrome, autologous serum eye drops are a common treatment method. Autologous serum eye drops are highly individualized, as they are derived from the patient's own blood, thus minimizing the risk of rejection and effectively alleviating d...

Managing Recurrent Corneal Erosion After Eye Injury: A Patient's Journey

Hello doctor, I accidentally fell in July and my nail scratched my cornea, resulting in a 3mm x 3mm wound that did not cover the pupil. At that time, the recovery was quite good and it healed in about a week without any discomfort. However, on November 8th, when I woke up, it see...

Dr. Gao Pilin reply Ophthalmology
Hello Alice: The simplest method is to apply the ointment every night before bed, and before opening your eyes in the morning, use artificial tears first, then slowly open your eyes to avoid sticking the newly formed epithelium. During the day, use preservative-free artificial te...

Persistent Corneal Erosion: Seeking Solutions for Ongoing Eye Pain

Hello, Doctor. When I was five months pregnant, I suddenly experienced eye pain. After an examination, I was diagnosed with a corneal abrasion. On average, I would experience pain once a month. Due to my pregnancy, I did not undergo any other treatments at that time, only using e...

Dr. Gao Pilin reply Ophthalmology
Hello: Based on your description of the condition, it appears to be recurrent corneal erosion. This occurs when the epithelium of the cornea is damaged (corneal abrasion), and the regeneration of the epithelium does not adhere tightly enough to the basement membrane and Bowman&#x...