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SYMPTOMS
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Sharp eye pain especially when awakening, Eye discomfort, Photophobia, Foreign body sensation, Difficulty opening the eye, Excessive tearing, Decrease in vision
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Typically unilateral
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Conjunctival injection, Corneal epithelial defect, Loose or irregular corneal epithelium, Corneal haze, Corneal scarring
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SIGNS
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Lid swelling, redness
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WORK-UP
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Pupils | Full eye exam | Anterior segment OCT | NaFl staining
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Corneal adhesion test (If there is no evidence of an epithelial defect, a dry surgical sponge can be gently rubbed over the epithelium. If epithelium is movable, this indicates a positive test)
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TREATMENT
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If acute attack/Corneal epithelial defect present: Begin Preservative free artificial tears Q2H (First line treatment) | Begin a topical antibiotic (Polytrim 1gtt QID or Moxeza 1gtt BID) | Begin lubricating ointment (Systane Refresh) ¼ inch ribbon QHS | Treat any blepharitis and meibomian gland dysfunction that is present | Oral NSAIDs may help with pain
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Consider debriding any loss corneal epithelium with a spud, allowing for better corneal epithelium re-adherence Consider using a bandage contact lens Consider using an amniotic membrane
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If chronic/Corneal epithelium is intact: Begin Preservative free artificial tears Q2H (First line treatment) | Begin hypertonic sodium chloride (Muro-128) ¼ inch ribbon QHS | Treat any blepharitis and meibomian gland dysfunction that is present | Consider punctal plugs | Consider Doxycycline 50mg PO 1 tab bid (to reduce MMPs) and Vitamin C | Consider an amniotic membrane | Consider adding autologous serum 20-40% concentration
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If these treatments are not successful, refer to ophthalmology for further evaluation and surgical treatment such as anterior stromal puncture, superficial keratectomy, or phototherapeutic keratectomy
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FOLLOW-UP
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If an acute attack/corneal epithelial defect is present, evaluate in 48 hours
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If chronic/corneal epithelium is intact, monitor in 1-3 months
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ADDITIONAL LAB | TESTS
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None
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ETIOLOGY
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Occurs due to abnormal epithelial adhesion to the basal lamina.
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The most common cause of a recurrent corneal erosion is a corneal injury. Other causes also include EBMD and corneal dystrophies (granular dystrophy, etc.), corneal degenerations (band keratopathy, etc.), refractive surgeries, and other corneal surgeries
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DIFFERENTIAL DX
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Herpes simplex epithelial keratitis, Neurotrophic keratitis, Dry eye syndrome, Corneal ulcer, Corneal abrasion
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NOTES
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Recurrent corneal erosions are most likely to occur in patients with diabetes, dry eyes, ocular rosacea, meibomian gland dysfunction, and blepharitis
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