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Evaluation of Recurrent Corneal Erosions


Key Concepts

  • Recurrent corneal erosion (RCE) syndrome is a common clinical entity that can be frustrating to both patients (due to cyclical symptoms) and treating clinicians (due to difficulty in diagnosis and treatment).

  • Although most patients can be diagnosed based on history alone, certain patients will require a thorough ocular examination and additional diagnostic testing to make a diagnosis.

  • In general, the clinician should divide RCE patients into two groups to help with treatment recommendation: loss of basement membrane (traumatic etiology) versus abnormal material between basement membrane and epithelium (dystrophies and degenerations), respectively.

Introduction

A commonly encountered entity, recurrent corneal erosion (RCE) syndrome was first described in 1872 by Hansen as “intermittent neuralgic vascular keratitis.” Characterized by repeated breakdown of the corneal epithelium due to dysfunction in the epithelial-stromal complex integrity, erosions can occur spontaneously or be associated with a prior corneal injury, certain corneal dystrophies, or systemic illnesses ( Table 21.1 ). The areas of denuded corneal epithelium reepithelialize, yet the process recurs in the future with another cycle of epithelial sloughing. Without the overlying corneal epithelium to protect the Bowman layer, the stroma is exposed in the eroded areas, leading to progressive damage and opacification of the stroma.

TABLE 21.1
Etiologies of Recurrent Erosion Syndrome
Adapted from Das S, Seitz, B. Recurrent corneal erosion syndrome. Surv Ophthalmol 2008; 53 :3–15.
Primary
Epithelial Dystrophy

  • Epithelial basement membrane dystrophy

Bowman Layer Dystrophy

  • Reis-Bücklers dystrophy

  • Thiel-Behnke dystrophy

Stromal Dystrophy

  • Lattice dystrophy

  • Macular dystrophy

  • Granular dystrophy

Endothelial Dystrophy

  • Fuchs dystrophy

Secondary
Trauma

  • Epithelial injury

  • Iatrogenic injury (superficial keratectomy, laser in situ keratomileusis, photorefractive keratectomy)

  • Chemical/thermal injury

Degeneration

  • Band Keratopathy

  • Salzmann nodular degeneration

Eyelid Pathology

  • Eyelid malposition (entropion, ectropion)

  • Lagophthalmos

  • Floppy eyelid syndrome

  • Meibomian gland dysfunction/blepharitis

Postinfectious Keratitis

  • Bacterial keratitis

  • Viral keratitis

Systemic Etiology

  • Diabetes mellitus

  • Epidermolysis bullosa

  • Juvenile X-linked Alport syndrome

Other

  • Keratoconjunctivitis sicca

  • Bullous keratopathy

  • Idiopathic

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