Recurrent corneal erosion
From Wikipedia, the free encyclopedia
| Recurrent corneal erosion Classification and external resources |
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| ICD-10 | H16.0 H18.4 |
|---|---|
| ICD-9 | xxx |
| DiseasesDB | 31285 |
| eMedicine | oph/113 |
Recurrent corneal erosion is a disorder of the eyes characterized by the failure of the cornea's outermost layer of epithelial cells to attach to the underlying basement membrane (Bowman's layer). The condition is frequently painful because the loss of these cells results in the exposure of sensitive corneal nerves.
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[edit] Etiology
There is often a history of previous corneal injury (corneal abrasion or ulcer), but also may be due to corneal dystrophy or corneal disease. In other words, one may suffer from corneal erosions as a result of another disorder, such as map dot fingerprint disease. [1]
[edit] Symptoms and signs
Symptoms include recurring attacks of acute ocular pain, foreign-body sensation, photophobia (i.e. sensitivity to bright lights), and tearing often at the time of awakening or during sleep when the eyelids are rubbed or opened. Signs of the condition include corneal abrasion or localized roughening of the corneal epithelium, sometimes with map-like lines, epithelial dots or microcyts, or fingerprint patterns.
[edit] Diagnosis
The erosion may be seen by a doctor using the magnification of an ophthalmoscope, although usually fluorescein stain must be applied first and a blue-light used. Opticians, optometrists and ophthalmologists have use of slit lamp microscopes that allow for more thorough evaluation under the higher magnification. Mis-diagnosis of a scratched cornea is fairly common, especially in younger patients.
[edit] Management of episodes
With the eye generally profusely watering, the type of tears being produced have little adhesive property. Water or saline eye drops tend therefore to be ineffective. Rather a 'better quality' of tear is required with higher 'wetting ability' (ie greater amount of glycoproteins) and so artificial tears (eg viscotears) are applied frequently.
Whilst individual episodes may settle within a few hours or days, additional episodes (as the name suggests) will recur at intervals.
[edit] Prevention
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Given that episodes tend to occur on awakening and are sometimes managed by use of good 'wetting agents', approaches to be taken to help prevent episodes include:
- avoiding dry or irritating environments (eg cigarette smoke)
- drinking plenty fluids to help prevent drying of the eyes. This may also involve limiting alcohol intake in the evenings. Drinking heavily may cause an episode the morning after, known by some as "Drinker's Eye".
- not sleeping-in late, as corneal hydration from lid closure may be a factor affecting epithelial adhesion.[2]
- use of long-lasting eye ointments (e.g. lacrilube) applied before going to bed.
- sleeping on the side and not on the back will reduce the risk of adhesion between eyelid and cornea.
- learn to wake with eyes closed and still. Keep high quality artificial tears within reach at bedtime. If eyes feel 'stuck shut' upon awakening, insert the tip of tears bottle slightly into inner corner of eye, gently squirting the tears, which will seep under the eyelid, often allowing opening of eyes without an erosion episode. Several repeated applications of tears may be necessary, but with patience, eyes will very likely become 'unstuck' allowing painfree opening of eyes and erosion avoidance. (personal experience)[citation needed]
- another method, after waking with eyes closed and still, is to gently rub the closed eyelids with fingers in a circular motion to "unstick" the eyelids before attempting to open them. (personal experience)[citation needed]
- control air quality and humidity while sleeping. Avoid having an over ventilated room while you sleep. Having air flowing over your face, even with your eyes closed, can and will increase eye dryness. Cool, moist and still air is the best environment to prevent unnecessary evaporation of eye moisture. (personal experience)[citation needed]
- limit your exposure to viruses (e.g. by getting an annual flu shot). Viruses like the flu (and gastro symptoms like diarrhea) seem to cause the eyes to dry out which can contribute to causing an episode. (personal experience)[citation needed]
- wear glasses (sunglasses, prescription glasses or even "fake" glasses) especially when engaging in activities like gardening or playing with children. (personal experience)[citation needed]
- since dryness can be a cause of episodes using the medication Restasis to increase tear production is considered a possible means of reducing erosions
- since the cause is dryness of corneal surface and upper lid eroding the vulnerable epithelium during waking up I followed the example of anaesthetists preventing corneal injury when patients are under anaesthesia by applying lubricants to both eyes and keeping the eye lids closed with help of surgical tape. I suffered for 25 years from recurrent erosion following accidental superficial laceration of the cornea but have been free for three years with this method. I use Lacrilube on the affected eye before going to sleep and apply Benderm 2.5cm surgical tape about 5cm length up and down holding the eye lids together lightly. In order to stop Benderm tape pulling hair off the eyebrow I use a smear of vaseline over the eyebrow before applying the tape. Gently remove the tape in the morning and you prevent recurrent erosion.
[edit] Treatment
Where episodes frequently occur, or there is an underlying disorder, three types of curative procedures may be attempted:[3] use of therapeutic contact lens, controlled puncturing of the surface layer of the eye (Anterior Stromal Puncture) and laser phototherapeutic keratectomy (PTK).[4] These all essentially try to allow the surface epithelium to reestablish with normal binding to the underlying basement membrane, the method chosen depends upon the location & size of the erosion.
A punctal plug may be inserted into the tear duct by an ophthalmologist, decreasing the removal of natural tears from the affected eye. [5]
The use of contact lenses may help prevent the abrasion during blinking lifting off the surface layer and uses thin lenses that are gas permeable to minimise reduced oxygenation. However they need to be used for between 8-26 weeks and such persistent use both incurs frequent follow-up visits and may increase the risk of infections.[2]
Alternatively, under local anaesthetic, the corneal layer may be gently removed with a fine needle, cauterised (heat or laser) or 'spot welding' attempted (again with lasers). The procedures are not guaranteed to work, and in a minority may exacerbate the problem.
Patients with recalcitrant recurrent corneal erosions often show increased levels of matrix metalloproteinase (MMP) enzymes.[6] These enzymes dissolve the basement membrane and fibrils of the hemidesmosomes, which can lead to the separation of the epithelial layer. Treatment with oral tetracycline antibiotics (such as doxycycline or oxytetracycline) together with a topical corticosteroid (such as prednisolone), reduce MMP activity and may rapidly resolve and prevent further episodes in cases unresponsive to conventional therapies.[7][8] Salt solution drops or ointment are usually prescribed as the first line of treatment. This medication helps the epithelium to adhere better to Bowman's layer of the cornea. Artificial tears are also recommended to keep the cornea moist.
[edit] See also
- Corneal ulcer#Refractory corneal ulcers for the disease in dogs
[edit] Footnotes
- ^ Review of Ophthalmology, Friedman NJ, Kaiser PK, Trattler WB, Elsevier Saunders, 2005, p. 221
- ^ a b Arun Verma; Michael P Ehrenhaus (August 25,2005). "Corneal Erosion, Recurrent". eMedicine. oph/113 at eMedicine.
- ^ Liu C, Buckley R (1996). "The role of the therapeutic contact lens in the management of recurrent corneal erosions: a review of treatment strategies.". CLAO J 22 (1): 79–82. PMID 8835075.
- ^ Indiana University Department of Ophthalmology - Phototherapeutic Keratectomy (PTK)
- ^ The clinical efficacy of silicone punctal plug therapy. Cornea Service, Wills Eye Hospital, Department of Ophthalmology, Jefferson Medical College, Thomas Jefferson University, 900 Walnut Street, Philadelphia, PA 19107, U.S.A.
- ^ Ramamurthi S, Rahman M, Dutton G, Ramaesh K (2006). "Pathogenesis, clinical features and management of recurrent corneal erosions.". Eye 20 (6): 635–44. doi:. PMID 16021185.
- ^ Hope-Ross M, Chell P, Kervick G, McDonnell P, Jones H (1994). "Oral tetracycline in the treatment of recurrent corneal erosions.". Eye 8 (Pt 4): 384–8. PMID 7821456.
- ^ Dursun D, Kim M, Solomon A, Pflugfelder S (2001). "Treatment of recalcitrant recurrent corneal erosions with inhibitors of matrix metalloproteinase-9, doxycycline and corticosteroids.". Am J Ophthalmol 132 (1): 8–13. doi:. PMID 11438047.
[edit] External links
- Facts About the Cornea and Corneal Disease The National Eye Institute (NEI)
- St Lukes eye centre information
- UK Patient associate site for eye disorders, www.Cataract-Doctor.com
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