Download Recurrent corneal epithelial erosion syndrome

CLINICAL MANAGEMENT GUIDELINES
Recurrent corneal epithelial erosion syndrome
Aetiology
Recurrent breakdown of corneal epithelium due to defective adhesion to
basement membrane
Prevalence greatest between third and fourth decade
Initial cause may have been traumatic, but underlying epithelial
dystrophy may be present
Repair of epithelial basement membrane takes around three months if
largely undisturbed
Predisposing factors History of superficial trauma
Corneal dystrophy (especially Map-Dot-Fingerprint Dystrophy [Epithelial
Basement Membrane or Cogan’s Dystrophy])
Posterior marginal blepharitis (Meibomian gland dysfunction)
Diabetes
Previous refractive surgery (particularly PRK)
Symptoms
Unilateral sharp pain, typically sudden onset on waking and opening
eyes; may also awake patient in middle of night
Feeling as if eyelid is stuck to eyeball
Lacrimation
Photophobia
Blurred vision
May recur over weeks, months or years
Signs
Epithelial erosion (usually inferior cornea)
 stains with fluorescein
 ‘loose’ edges, ‘slipped rug’ appearance
Intra-epithelial microcysts
Mild stromal oedema
NB: examine both eyes for signs of corneal dystrophy
Differential diagnosis Tear deficiency
Other corneal dystrophies with epithelial manifestations
Contact lens-related epithelial conditions
Management by Optometrist
Practitioners should recognise their limitations and where necessary seek further advice or refer
the patient elsewhere
Non pharmacological
Bandage contact lens (although trials suggest that bandage lenses are
equivalent to lubrication alone)
(GRADE*: Level of evidence=moderate, Strength of recommendation=weak)
Pharmacological
Mild cases:
ocular lubricants
 artificial tears (e.g. gutt. hypromellose) frequently during day
 unmedicated ointment (e.g. oc Lacrilube) before sleep – should
be continued for at least 3 months from date of last recurrence
(however, one study showed that the use of unmedicated
ointment at night for two months following traumatic corneal
abrasions led to increased symptoms of recurrent corneal
erosion)
 review at monthly intervals for three months. Advise patient to
return/seek further help if symptoms persist
(GRADE*: Level of evidence=low, Strength of recommendation=strong)
More severe cases with large area of epithelial loss:
 cycloplegic agent (e.g. gutt. cyclopentolate 1%) to prevent pupil
spasm
 antibiotic ointment (e.g. oc. chloramphenicol)
Recurrent corneal epithelial erosion syndrome
Version 10, Page 1 of 2
Date of search 24.04.15; Date of revision 27.05.15; Date of publication 20.10.15; Date for review 23.04.17
© College of Optometrists
CLINICAL MANAGEMENT GUIDELINES
Recurrent corneal epithelial erosion syndrome
(GRADE*: Level of evidence=low, Strength of recommendation=strong)
Padding the eye has not been shown to enhance the management of
simple corneal abrasions
(GRADE*: Level of evidence=high, Strength of recommendation=strong)
B2: alleviation/palliation, normally no referral
If persistent or if defect large and unstable:
B1: possible prescription of drugs; routine referral
Possible management by Ophthalmologist
For those not responding to medical therapy:
 débridement of loose epithelium
 excimer laser photo-therapeutic keratectomy
 micropuncture with hypodermic needle or YAG laser
 ‘alcohol delamination’
 diamond burr polishing of Bowman’s membrane
Evidence base
*GRADE: Grading of Recommendations Assessment, Development and
Evaluation (see http://gradeworkinggroup.org/toolbox/index.htm)
Management Category
Sources of evidence
Diez-Feijóo E, Grau AE, Abusleme EI, Durán JA. Clinical presentation
and causes of recurrent corneal erosion syndrome: review of 100
patients. Cornea. 2014;33:571-5
Mencucci R, Favuzza E. Management of recurrent corneal erosions: are
we getting better? Br J Ophthalmol. 2014;98:150-1
Watson SL, Lee MH, Barker NH. Interventions for recurrent corneal
erosions. Cochrane Database Syst Rev. 2012;9:CD001861
LAY SUMMARY
In this condition the surface skin of the cornea (the clear window of the eye) breaks down, causing
sharp pain, watering and sometimes blurred vision. This may happen as the patient wakes after
sleep. It may be due to a previous mild injury (corneal abrasion) or to a condition known as a
dystrophy in which the surface of the cornea is unusually delicate. The condition may recur over
weeks or months. It is treated by reducing friction between the eye and the eyelids, using
lubricating drops and/or ointments, to encourage complete healing of the eye surface. Sometimes
other measures are needed, for example a special contact lens applied as a bandage, minor
surgery or laser therapy.
Recurrent corneal epithelial erosion syndrome
Version 10, Page 2 of 2
Date of search 24.04.15; Date of revision 27.05.15; Date of publication 20.10.15; Date for review 23.04.17
© College of Optometrists