Recurrent Corneal Erosion
I just realized today I've never blogged about this before, and it's so common I feel I need to. RCE is a condition where a patient has an eye injury that causes a corneal abrasion, HEALS completely from it...then later (weeks, months, years) that area of "healed" cornea just spontaneously falls off again, basically just like the initial "abrasion" w/o the associated eye INJURY. What happens is...in some people when they re-grow their top layer (corneal epithelium) from an abrasion, the new epithelial cells don't anchor themselves very well to the layer below them (Bowman's membrane). Consequently that area is forevermore "fragile" and easily comes off, which is painful. Again this is not EVERY ABRASION. Only SOME people are unlucky enough to have RCE. Most people heal fine from a corneal abrasion and never have another problem ever again. The hallmark symptom of RCE is WAKING UP with pain and excessive tearing in an eye that has a previous history of a pretty severe corneal abrasion in the PAST. Of course if you go to the doctor and you show them your eye, they may diagnose "corneal abrasion", which is technically not incorrect. EXCEPT THAT people with a corneal abrasion REMEMBER the injury that caused the abrasion! It's not a mystery. They got poked in the eye and it hurt and they showed up to the doc complaining of eye pain. That's an abrasion. An EROSION happens when the patient WOKE UP with eye pain. They don't remember an eye injury immediately preceding the pain (but they had an OLD abrasion in that eye that they healed from). Those are different. One has an obvious, immediate cause, one does not. Short term treatment of RCE is the same as that of an abrasion: bandage contact lens and a short course of prophylactic antibiotic eye drops. "Pressure patching" has not been recommended by the American Optometric Association since the year 2000, so if someone is taping a patch to your eye...well that's a bit old school. The problem with treating RCE, of course, is that they're RECURRENT! Although the condition is generally not sight-threatening, it can sure be annoying to wake up every 6 weeks in excruciating eye pain! There have been many attempts in the past to try and "prevent" an RCE from recurring...here are a few terrible/stupid ones that don't work (from Wikipedia): sleeping with a humidifier (worthless), wearing glasses (what?), drinking plenty of fluids (worthless), "not sleeping late" (ha!), steroids (no), "learn to wake up with your eyes closed" (what?), "rubbing" your eyes before waking (getting stupider here), punctal plugs (treats dryness, but is this a dryness problem?)...none of those will work. Using eye ointments at night probably helps some IMO. Using "hyperosmotics" (Muro, etc) might help but has not been proven I don't think. Some surgeons used to recommend Anterior Stromal Puncture, a procedure where a needle is used to punch a bunch of holes in the Bowman's layer, the idea being to create places where epithelial cells can anchor. It's not being used much anymore...I don't think it ever really caught on b/c I don't think it ever really worked great. Some surgeons recommend PTK or phototherapeutic keratectomy, a laser procedure to remove corneal epithelial cells and hope they regenerate properly. In the last TWO of these cases of RCE that I had, I treated them with LONGER TERM extended contact lens wear. These 2 were patients who were in here literally every 4-6 weeks with a new, fresh RCE and they were miserable. On the advice of another O.D. (heard this at a conference in San Antonio in 2012, wish I could remember who said it, sorry) I placed these patients on TWO MONTHS of extended bandage contact lens wear. Basically I put an Alcon Night & Day lens on their eye (even if they didn't wear contacts) and told them not to remove it for EIGHT WEEKS. That's a long time. Neither of them had a problem during the 8 weeks (that's not an endorsement for wearing contacts that long, BTW)...and to date NEITHER of them have had an RCE since we did that. Now is that a "cure?" Who knows? but anecdotally I'm 2-for-2 with this cheap, easy method. I will be treating all of my known RCE's this way for the foreseeable future until I have one that recurs. I'll skip telling them to use a humidifier and never sleep in.