Recurrent Corneal Erosion Syndrome (RCES)

What is recurrent erosion syndrome?

Recurrent corneal erosion syndrome (RCES) is a condition characterised by repeated injuries or detachments of the cornea’s outermost layer, known as the epithelium.

In a healthy eye, this protective layer is securely anchored to Bowman’s membrane directly beneath it. In patients with this syndrome, the attachment is weak or defective, leaving the epithelium prone to tearing, particularly during eyelid movement.

These erosions frequently occur during the night or on waking; as the eyelid slides over a poorly lubricated cornea, it can catch and tear the fragile epithelium, causing sudden, severe pain. This can become a chronic issue, with episodes recurring at varying intervals and significantly impacting a patient's quality of life if left untreated.

In British English, we often use "predisposing factors" alongside causes to give a more comprehensive clinical picture. Here is the translation, refined for a professional website:

What are the causes?

• Corneal Trauma: A common cause is a previous scratch or injury to the cornea (such as a fingernail nick or a branch strike) that failed to heal correctly.
• Corneal Dystrophies: Certain hereditary conditions, such as map-dot-fingerprint dystrophy (also known as Cogan’s dystrophy or epithelial basement membrane dystrophy), render the epithelium fragile and highly susceptible to erosion.
• Dry Eye Syndrome: Inadequate lubrication of the ocular surface can exacerbate the condition, increasing friction between the eyelid and the cornea.
• Environmental Factors: Dry air, dust, or harsh weather conditions can irritate the eye and trigger recurrent episodes.

What are the treatments?

The primary goals of treatment are to alleviate symptoms, prevent future recurrences, and encourage the epithelium to bond more securely to the underlying layers.

Medical treatments

• Artificial tears: Used regularly to hydrate the cornea and minimise friction between the eyelid and the eye surface.
• Lubricating ointments: Applied before sleep to protect the cornea overnight (e.g. Vitamin A ointment).
• “Bandage” contact lenses: These specialised lenses act as a protective shield during the healing process. They are typically used alongside a prescription of antibiotic eye drops to prevent corneal infection.
• Hypertonic medications: Drops or ointments containing increased concentration of sodium chloride (NaCl) help stabilise the corneal surface.
  

Surgical treatments

• Phototherapeutic Keratectomy (PTK): A therapeutic laser procedure used to smooth the corneal surface and strengthen the adhesion of the epithelium.

• Photorefractive Keratectomy (PRK): This technique treats both the recurrent erosions and refractive errors (such as myopia, hyperopia, or astigmatism) in a single procedure.
  

With appropriate management, the majority of patients experience significant symptom relief, with recurrences either ceasing entirely or becoming much less frequent. Generally, a single laser procedure is sufficient, though PTK can be repeated if necessary for optimal results.

Regular follow-up with an ophthalmologist is essential to tailor the treatment and prevent further complications.