Recurrent Corneal Erosion: Symptoms, Causes & Treatment

Recurrent Corneal Erosion: Symptoms, Causes & Treatment

Daily, the average person blinks between 15,000 and 20,000 times. ¹ They do so without thinking about their cornea (the transparent outer layer of the eye) until they develop a problem with it. A minor injury to the cornea can lead to extreme discomfort, blurred vision, and increased sensitivity to light.

One such condition is Recurrent Corneal Erosion (RCE), where the outer layer of the cornea repeatedly breaks down instead of healing properly. The condition can often be mistaken for dry eyes or a minor eye injury. But RCE can become really frustrating if left untreated. Therefore, it’s important to understand its causes, warning signs, and treatment options to maintain a healthy vision. ²

In this blog, we’ll be uncovering everything you need to know about this condition. So keep reading!

What is Recurrent Corneal Erosion?

The cornea is the clear layer at the front of the eye that helps to focus light. The outer layer or protective coating on the eye is called the corneal epithelium. The epithelial basement membrane and the anchoring complexes are microscopic structures that normally hold the corneal epithelium securely in place. ²

With Recurrent Corneal Erosion, the attachments become weak. Therefore, the epithelial layer of the cornea gets repeatedly separated from the underlying tissue, exposing the very sensitive nerve endings in the eye that cause sudden episodes of extreme pain. ²

The problems will repeat themselves since the area is not healed with a strong enough attachment to withstand another episode of breakdown. ²

What Causes Recurrent Corneal Erosion?

The two most common causes of Recurrent Corneal Erosion (RCE) include: ²

1. Previous Eye Injury

Even a small injury to your eye, such as a scratch from a nail, paper, tree branch, or contact lens, can damage the top layer of the cornea, known as the epithelium. Although the epithelium may heal after the injury, it may not form a secure attachment to the underlying corneal layers. This can increase the likelihood of future episodes of corneal erosion. ²

2. Corneal Dystrophies

Certain inherited conditions, particularly Epithelial Basement Membrane Dystrophy (EBMD), can weaken the normal bond between the corneal layers. This makes the cornea more vulnerable to recurrent episodes of erosion. ²

Other factors that may contribute to recurrent corneal erosion include: ²

• Dry eye disease
• Diabetes
• Ocular rosacea
• Previous eye surgery (less commonly)

Symptoms of Recurrent Corneal Erosion

Symptoms often occur immediately after waking up. That’s because the eyelid can stick to the corneal surface during sleep. And when the eyelid opens, it may pull away the fragile epithelium. ²

Common symptoms include: ²

• Sudden, sharp eye pain
• Foreign body sensation (feeling like something is stuck in the eye)
• Excessive tearing
• Redness
• Light sensitivity (photophobia)
• Blurred vision
• Difficulty opening the affected eye
• Recurrent episodes affecting the same eye

Some episodes resolve within hours, while others may take several days to heal.

How is Recurrent Corneal Erosion Diagnosed?

An ophthalmologist usually diagnoses RCE through: ²

• A detailed history of recurring symptoms
• Slit-lamp examination to evaluate the corneal surface
• Fluorescein dye staining to identify epithelial defects

In some patients, additional tests may be performed to look for underlying corneal dystrophies or severe dry eye disease.

Treatment Options for Recurrent Corneal Erosion

Treatment aims to relieve pain, promote proper healing, and prevent future episodes.

1. Conservative (Non-Surgical) Treatment

Most patients improve with medical management, which may include: ²

1. Lubricating eye drops and ointments

   Frequent use of preservative-free artificial tears during the day and lubricating ointments before bedtime helps reduce friction between the eyelid and cornea.

2. Hypertonic saline ointment or drops

   These help reduce fluid accumulation within the cornea, improving epithelial attachment after healing.

3. Bandage contact lenses

   A soft therapeutic contact lens may protect the healing corneal surface in selected patients under close medical supervision.

4. Medications

   Depending on the cause, your ophthalmologist may prescribe antibiotic drops, anti-inflammatory medication, or oral doxycycline in carefully selected cases, particularly when associated with meibomian gland dysfunction or ocular rosacea.

2. Surgical Treatment

If symptoms continue despite conservative care, many effective surgical procedures are also available.

These include: ²

• Anterior stromal puncture (for carefully selected peripheral lesions)
• Diamond burr polishing
• Phototherapeutic keratectomy (PTK) using an excimer laser

Can Recurrent Corneal Erosion Heal Permanently?

Yes, many patients experience long-term relief with appropriate treatment. ²

Some people recover after consistent lubrication and preventive care alone, while others benefit from minor procedures that help to heal the corneal epithelium and form stronger attachments.

Because recurrence is possible, following your doctor’s entire treatment plan, even after symptoms improve, is important.

When Should You See an Eye Specialist?

You must visit a doctor or an ophthalmologist immediately if you experience any of the following symptoms: ²

• Severe eye pain
• Sudden blurred vision
• Repeated episodes of eye discomfort
• Persistent redness or excessive tearing
• Symptoms after an eye injury

Final Thoughts

Recurrent Corneal Erosion may seem like a mystery at times, especially when symptoms suddenly disappear and then unexpectedly return. But it's a well-recognized disorder with effective treatment options.

So if you're frequently waking up with eye pain, excessive tears, blurred or lost vision (temporarily) in an eye, do not assume it is "just dry eyes." Getting assessed by an eye care provider early is the best way to find out what is happening and help avoid future episodes.

FAQs

1. Is Recurrent Corneal Erosion An Emergency?

   While not always an emergency, sudden severe eye pain should never be ignored. An eye examination is necessary to rule out infection, corneal ulcers, or other serious conditions.

2. Can Recurrent Corneal Erosion Cause Vision Loss?

   Most cases heal without permanent vision loss. However, repeated erosions or complications such as infection and corneal scarring can affect vision if left untreated.

3. Is It Safe To Wear Contact Lenses?

   Avoid wearing contact lenses during an active episode unless specifically advised by your ophthalmologist. Therapeutic bandage contact lenses should only be used under medical supervision.