What Is Recurrent Corneal Erosion and How Is It Treated?

Recurrent corneal erosion is a painful eye condition that can cause severe eye redness and sharp pain on waking in the morning, which then tends to improve as the day goes on. It involves a repeated area of damage on the front surface of the eye.

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What Is Recurrent Corneal Erosion Syndrome?

In Recurrent Corneal Erosion Syndrome (RCES), repeated episodes of breakdown of the corneal surface lead to disabling eye symptoms and make the cornea more vulnerable to infection. Recurrent corneal erosion is common and usually appears after an injury to the cornea. As healing begins, the newly formed tissue is repeatedly stripped off by the movement of the eyelid, so the epithelial layer fails to re‑adhere properly.  

The condition is very painful because it leaves the corneal nerve endings exposed, and it may be triggered by trauma.

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Structure of the Cornea

The cornea is a multilayered structure composed of (from outside to inside):

Recurrent corneal erosion occurs when there is a disturbance in the epithelial basement membrane, leading to poor adhesion of the epithelium to Bowman’s layer. This causes recurrent cycles of epithelial breakdown. Multiple recurrences are common because the basal epithelial cells require at least 8–12 weeks to regenerate or repair the epithelial basement membrane.

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What Causes Recurrent Corneal Erosion Syndrome?

Causes of recurrent corneal erosion include:

– The most common factor is superficial trauma to the cornea (including microtrauma from contact lens–related abrasions). This is the leading cause and is present in about 45–64% of cases.  

– The second most common cause is epithelial basement membrane dystrophy, found in about 19–20% of cases. The underlying mechanism involves weak adhesion of the corneal epithelium to the underlying stroma.  

– A clean, sharp abrasion is more likely to trigger the problem than a rough or irregular one. Other types of trauma may include alkali burns, foreign bodies, and exposure-related keratopathy.

Recurrent corneal erosion can also occur spontaneously, especially in the presence of cornea‑related risk factors such as corneal dystrophies, dry eye syndrome, blepharitis, and exposure keratopathy.

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How Common Is Recurrent Corneal Erosion Syndrome?

There are no precise statistics on the exact incidence and prevalence of this condition, as it is often underdiagnosed or misdiagnosed. One study suggested that the recurrence rate after a traumatic corneal abrasion was about 1 in 150. It also appears to be more common in females.

RCE is generally seen in adulthood, usually between 30 and 40 years of age, unless it is associated with one of the corneal dystrophies (for example, Reis–Bücklers dystrophy) or Alport syndrome, in which case it can appear in childhood.

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Symptoms of Recurrent Corneal Erosion Syndrome

RCES typically develops 3–10 days after the initial episode, though it may also appear several months later. Symptoms of recurrent corneal erosion syndrome include:

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Treatment of Recurrent Corneal Erosion

Recurrent corneal erosion should be treated by an ophthalmologist as soon as possible. In many cases, some of the loose or poorly attached corneal epithelium needs to be removed from the affected area to allow for better healing.

After cleaning and preparing the area, the doctor may place an amniotic membrane— a small piece of biological tissue shaped like a contact lens—over the eye to promote healing.

In addition, a bandage contact lens can be placed on the eye to protect the healing cornea from damage caused by blinking or by the act of waking up. Although recurrent corneal erosion itself is not an infection, the corneal surface is damaged and exposed, so an antibiotic eye drop is usually prescribed to prevent a secondary infection.

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Whatever the underlying eye problem may be, this delicate condition requires careful examination and appropriate treatment from a skilled ophthalmologist using effective medical tools to achieve the best possible outcome. Whatever eye disease you are dealing with, you can book an appointment at Batal Specialized Complex to undergo a thorough eye examination and start addressing your eye problems, regardless of their complexity.

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