PTK Laser recurrent corneal erosion corneal erosion syndrome rces

PTK Laser for Recurrent Corneal Erosion Syndrome (RCES) London

Recurrent corneal erosions occurs when the epithelium (surface layer of the cornea) comes loose from the underlying corneal stroma causing intense eye pain and a watery eye. It may occur after mild eye injuries or in those with an underlying condition known as epithelial basement membrane dystrophy (EBMD) which is a type of corneal dystrophy.

The pain in those with recurrent erosions, otherwise known as (RCES) can be brief or may last for several hours, is typically on waking at night or in the morning when the corneal epithelium becomes more adherent to the back of the eyelid instead of the corneal stroma.

Treatment of Recurrent Corneal Erosions

The main stay of treatment for corneal erosion is managing acute exacerbations and then longterm regular lubricants (eg. Thealoz Duo daytime drops and Hycosan Night ointment) to help prevent future recurrences.

Acute flare ups usually respond to intensive lubricant drops and ointment combined with an antibiotic drop to help prevent secondary infection. Sometimes a bandage contact lens or removal (debridement) of the loose corneal epithelium is needed in the acute phase where there is little response to intensive lubricants or the erosion is large.

Where symptoms remain frequent despite intensive topical lubricants or other treatment, then Excimer laser resurfacing (PTK, phototherapeutic keratectomy) may be performed which is a straightforward 10 minute daycare treatment.

Frequently Asked Questions

Can Recurrent Corneal Erosion Be Cured?

Phototherapeutic keratectomy effective such that at least two in every three patients are symptom free at one year after PTK. Lubricating eye drops will still be needed.

What Causes Recurrent Corneal Erosion?

Recurrent corneal erosion is caused by the surface skin layer of the eye (the corneal epithelium) not being stuck down as securely as it needs to be to the base layer (Bowman’s layer).

What Is Recurrent Corneal Erosion Syndrome?

After an injury, or if there is a familial tendency, sometimes the new corneal epithelium does not stick properly to the base layer. Then for example, if the eye gets dry at night, the adhesion between the back of the eyelid and the corneal epithelium can be stronger than that between the corneal epithelium and the base layer causing sloughing of the corneal epithelium (recurrent corneal erosion) when the eye is opened. As the cornea has the highest nerve density of any area of the body, the pain can be quite intense until it heals.

How Do You Treat Corneal Erosion?

The first line treatment for recurrent corneal erosion is copious lubricating eye drops, and an ointment at night. If this doesn’t work or during bad flare ups, a bandage contact lens can be used to help protect the corneal epithelium whilst it is healing. Phototherapeutic keratectomy (PTK) is performed when there are still frequent recurrent erosion symptoms that affect a patient’s normal daily activities despite copious topical lubricants being used.

How Do You Prevent Recurrent Corneal Erosion?

The mainstay of preventing recurrent corneal erosion is copious lubricating eye drops, and an ointment at night. Staying hydrated and not rubbing your eyes also helps.

Can Recurrent Corneal Erosion Cause Blindness?

This is very unlikely, but as each flare up of recurrent corneal erosion is by definition a defect in the corneal epithelium (a raw area on the cornea), occasionally an infection can develop (microbial keratitis). If this were to be severe and untreated, corneal scarring can result so impacting your vision. If your recurrent corneal erosion symptoms do not resolve within a few hours of boosting lubricating eye drops, or if there is any deterioration or loss of vision you should always contact your Ophthalmologist the same day for advice and to arrange a follow up appointment.

Is Recurrent Corneal Erosion Hereditary?

Yes it can be. Epithelial basement membrane dystrophy (EBMD, also known as map-dot-fingerprint dystrophy) is when the corneal epithelium does not stick properly down to the basement membrane. EBMD can be hereditary, and mutations in the TGFB1 gene have been linked to recurrent corneal erosion syndrome.

What Is PTK Eye Surgery?

Phototherapeutic keratectomy (PTK) eye surgery is where the loose corneal epithelium is gently removed and the excimer laser used to smooth and remove part or all of the base layer so when the corneal epithelium heals is grows over and sticks to a new, freshed up base layer. The depth of the excimer laser ablation is typically 15 microns.

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