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Recurrent corneal erosion

Introduction

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Synonyms and keywords: Refractory corneal ulcer; indolent ulcer; boxer ulcer

Overview

Overview

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.

Causes

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]

Diagnosis

History and Symptoms

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.

Physical Examination

Signs of the condition include corneal abrasion or localized roughening of the corneal epithelium, sometimes with map-like lines, epithelial dots or microcysts, or fingerprint patterns.

Other Diagnostic Studies

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.

Treatment

Surgery

Where episodes frequently occur, or there is an underlying disorder, different types of curative procedures may be attempted:[2] use of therapeutic contact lens, controlled puncturing of the surface layer of the eye (anterior stromal puncture) and laser phototherapeutic keratectomy (PTK).[3] 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 and size of the erosion.

References

  1. ↑ Review of Ophthalmology, Friedman NJ, Kaiser PK, Trattler WB, Elsevier Saunders, 2005, p. 221
  2. ↑ 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.
  3. ↑ Indiana University Department of Ophthalmology – Phototherapeutic Keratectomy (PTK)

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Kalsang Dolma, M.B.B.S.[2]

Historical Perspective

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References

Pathophysiology

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References

Causes

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Overview

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]

References

  1. ↑ Review of Ophthalmology, Friedman NJ, Kaiser PK, Trattler WB, Elsevier Saunders, 2005, p. 221

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Kalsang Dolma, M.B.B.S.[2]

Differentiating Recurrent Corneal Erosion from other Diseases

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References

Epidemiology and Demographics

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References

Natural History, Complications and Prognosis

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References

Diagnosis

Diagnosis

History and Symptoms | Physical Examination | Laboratory Findings | Other Diagnostic Studies

Treatment

Treatment

Medical Therapy | Surgery | Primary Prevention | Cost-Effectiveness of Therapy | Future or Investigational Therapies

Case Studies

Case Studies

Case #1

Related Chapters

Template:Eye

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Kalsang Dolma, M.B.B.S.[2]

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