Persistent Corneal Erosion: Seeking Solutions for Ongoing Eye Pain

Q: Persistent Corneal Erosion: Seeking Solutions for Ongoing Eye Pain

Hello： Based on your description of the condition, it appears to be recurrent corneal erosion. <br>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 Bowma

Recurrent corneal erosion?

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 eye drops and ointments.
After giving birth, I consulted a doctor at National Taiwan University and underwent phototherapeutic keratectomy (PTK), but the cornea still experienced abrasions.
Another doctor at NTU suggested surgery, and I had my first PTK procedure at the end of February 2012.
After the surgery, I wore a protective contact lens for nearly two months.
The doctor said the recovery was satisfactory before removing the lens.
However, by the end of April, the cornea had still suffered another abrasion, leading the doctor to perform a second PTK.
Since then, the cornea has not improved, and I have been experiencing ongoing pain.
I later tried traditional Chinese medicine treatments, including herbal solutions and powders, but the cornea continues to have abrasions.
Are there any other methods that can provide a permanent solution? I have tried various approaches, but the cornea keeps getting damaged.
What should I do?

Ma Xiaoniu, 20~29 year old female. Ask Date: 2012/06/22

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's layer.
As a result, upon opening the eyes after resting, the incompletely healed area of the cornea may tear again.
If you have undergone two procedures of Phototherapeutic Keratectomy (PTK) and the results are still unsatisfactory, there may not be a better way to achieve a cure.
Abrasions most commonly occur after resting with the eyes closed; once the eyes are opened, it can lead to re-tearing of the incompletely healed corneal area, causing symptoms of corneal abrasion.
Therefore, it is advisable to keep artificial tears readily available.
Before resting with your eyes closed, apply a lubricating ointment of artificial tears to increase the moisture in your eyes.
After resting, before opening your eyes, apply artificial tears again to ensure even distribution of the tears across the cornea, and then open your eyes.
This approach should help reduce the likelihood of abrasion.
With consistent treatment over time, the chances of corneal abrasions should decrease.
Thank you for your message.

Reply Date: 2012/06/22

More Info

Persistent corneal erosion can be a frustrating and painful condition, especially when it becomes recurrent despite various treatments. Your experience of having corneal erosions that started during pregnancy and continued after multiple interventions, including PTK (Phototherapeutic Keratectomy) surgeries, indicates a complex underlying issue that may require a multifaceted approach to management.

Understanding Persistent Corneal Erosion
Corneal erosion occurs when the outer layer of the cornea (the epithelium) does not adhere properly to the underlying tissue. This can lead to episodes of pain, tearing, and sensitivity to light. Factors contributing to persistent corneal erosion can include:
1. Previous Eye Injury: Trauma to the eye can disrupt the normal healing process.

2. Dry Eye Syndrome: Insufficient tear production can lead to corneal surface damage.

3. Corneal Dystrophies: Conditions like Epithelial Basement Membrane Dystrophy can predispose individuals to recurrent erosions.

4. Inadequate Healing: After surgeries like PTK, the cornea may not heal properly, leading to further erosions.

Treatment Options
Given your history and the treatments you've already undergone, here are some additional strategies that may help manage your condition:
1. Intensive Lubrication: Using preservative-free artificial tears frequently throughout the day can help keep the cornea moist and promote healing. In some cases, overnight use of ointments can provide additional protection.

2. Bandage Contact Lenses: These soft lenses can provide a protective barrier over the cornea, allowing it to heal while reducing pain and discomfort. They can be particularly beneficial for patients with recurrent erosions.

3. Amniotic Membrane Therapy: This involves placing a human amniotic membrane over the cornea to promote healing. The membrane contains growth factors that can aid in the regeneration of the corneal epithelium.

4. Surgical Options: If conservative measures fail, further surgical options may be considered:
- Anterior Stromal Puncture: This procedure creates small punctures in the corneal stroma to promote adhesion of the epithelium.

- Corneal Grafting: In severe cases, a corneal transplant may be necessary if the cornea is significantly damaged.

5. Addressing Underlying Conditions: If dry eye syndrome is a contributing factor, treatments such as punctal plugs (to reduce tear drainage) or medications like cyclosporine (Restasis) may be beneficial.

6. Lifestyle Modifications: Protecting your eyes from irritants, using humidifiers in dry environments, and avoiding contact lenses during flare-ups can help reduce symptoms.

Follow-Up Care
Regular follow-up with your ophthalmologist is crucial. They can monitor the condition of your cornea and adjust your treatment plan as necessary. If you have not already, consider seeking a second opinion from a corneal specialist who may have additional insights or treatment options.

Emotional and Psychological Support
Chronic pain and discomfort can take a toll on mental health. It may be beneficial to seek support from mental health professionals or support groups for individuals dealing with chronic eye conditions.

Conclusion
Persistent corneal erosion is a challenging condition that often requires a comprehensive and individualized approach. While it can be frustrating to deal with ongoing symptoms, exploring various treatment options and maintaining open communication with your healthcare providers can lead to improved outcomes. Remember, you are not alone in this journey, and there are resources and professionals available to help you manage your condition effectively.

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