Recurrent corneal erosion (RCE) is a disorder of the corneal epithelium and the epithelial basement membrane with repeated breakdown of the corneal surface leading to disabling ocular symptoms and predisposes the cornea to infections [1]. It is associated with corneal injuries [2] [3] (with fingernails or paper) or with epithelial basement membrane dystrophy (EBMD) [4] [5]. Patients present with repeated episodic eye pain typically in the morning, photophobia, excessive lacrimation [4] [6] [7] [8], redness and blurring of vision [9]. In a majority of patients, an acute episode subsides with simple medical treatment [1] [5] [7] but a few patients may suffer from painful recurrences. Acquired recurrent corneal erosions can be secondary to ocular foreign bodies, burns due to alkalis, herpes simplex infection, soft contact lens use, vitrectomy or may be associated with other corneal dystrophies. In patients with dry eyes, adhesions develop between the corneal epithelium and the palpebral conjunctiva leading to recurrent corneal erosion syndrome (RCES) [10]

A majority of RCE patients with EBMD are asymptomatic. In RCES, the epithelial layer is poorly attached to the underlying stroma and the main clinical feature is the ocular pain of varying severity. The pain is worse on waking up in the morning due to adherence between the eyelid and the cornea. Other symptoms include blurring of vision, loss of visual acuity, astigmatism, foreign body sensation in the eyes when recurrent corneal erosion leads to epithelial loosening. Recurrence is common as it takes between 8 to 12 weeks for the corneal basal epithelial cells to regenerate.

The workup in RCE includes a detailed history and a thorough corneal and ophthalmic examination to find underlying causes for the corneal erosion [11]. The diagnosis of RCE depends more on a history of early morning orbital pain rather than any specific findings on examination of the cornea as many times it may appear normal. Slit-lamp examination after fluorescein staining may reveal epithelial bullae, microcysts, or loss of corneal epithelium in acute episodes [12]. Brawny edema may involve the anterior stroma underlying the cornea. The centrally located corneal erosion with the edema results in diminished visual acuity.

Computerized videokeratography is used to assess the corneal topography. It helps to detect focal abnormal areas such as microdepressions in symptomatic patients with RCE syndrome who do not manifest epithelial anomalies.

Histological examination of the corneal epithelium reveals lines which resemble fingerprints or maps with a multilaminar basement membrane.

Treatment for RCE aims to relieve symptoms and promote healing of the corneal surface. Initial management may include lubricating eye drops or ointments to keep the eye moist and reduce friction. In more severe cases, therapeutic contact lenses or procedures like debridement (removal of loose epithelial cells) may be necessary. Long-term management might involve hypertonic saline drops or ointments to prevent recurrence. In persistent cases, surgical options such as anterior stromal puncture or laser therapy may be considered.

The prognosis for RCE varies. Many patients experience significant relief with appropriate treatment, although some may continue to have recurrent episodes. The condition can be chronic, requiring ongoing management to prevent recurrences. With proper care, most individuals can maintain good vision and quality of life.

RCE is often linked to previous corneal injuries, such as scratches or abrasions, which can disrupt the normal adhesion of the corneal epithelium. It can also be associated with corneal dystrophies, particularly epithelial basement membrane dystrophy (EBMD), which affects the cornea's structure and stability.

RCE is a relatively common condition, though exact prevalence rates are not well-documented. It can affect individuals of any age but is more frequently seen in adults. Both genders are equally susceptible, and it can occur in one or both eyes.

The pathophysiology of RCE involves a failure of the corneal epithelium to adhere properly to the underlying layers of the cornea. This can be due to structural abnormalities, as seen in corneal dystrophies, or from damage caused by trauma. The weakened adhesion makes the epithelium prone to repeated breakdown, especially during eye movements or upon waking.

Preventing RCE involves managing underlying conditions and protecting the eyes from injury. Regular use of lubricating eye drops or ointments can help maintain corneal moisture and reduce friction. For those with corneal dystrophies, ongoing monitoring and treatment by an eye specialist are essential to minimize the risk of recurrence.

Recurrent Corneal Erosion is a condition characterized by repeated breakdown of the corneal epithelium, leading to pain and vision disturbances. It is often associated with previous eye injuries or corneal dystrophies. Diagnosis involves a detailed eye examination, and treatment focuses on symptom relief and prevention of recurrences. While the condition can be chronic, appropriate management can help maintain good vision and quality of life.

If you experience sudden eye pain, especially upon waking, along with redness, tearing, or blurred vision, you may have Recurrent Corneal Erosion. This condition involves repeated breakdown of the cornea's surface layer. It can be linked to past eye injuries or certain corneal disorders. Treatment options include lubricating eye drops, special contact lenses, and sometimes surgical procedures. With proper care, most people can manage their symptoms effectively and maintain good vision.

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