Peter Hibberd, M.D., is a doctor whose advice is based on more than 28 years of hospital outpatient and inpatient experience. He is an experienced emergency medicine physician, surgeon, and consultant. Dr. Hibberd is certified by the American Board of Emergency Medicine. He is also a fellow and active member of the American Academy of Family Physicians, an active member of the American College of Emergency Physicians, and a member and fellow of the American Academy of Emergency Medicine. Dr. Hibberd has earned numerous national and international professional certifications, memberships, and awards.

What's Causing Recurrent Corneal Erosion?

Monday, 19 July 2010 12:28 PM

Question: I've been told by an opthamologist that the burning and scratching feeling in one of my eyes is caused from recurrent corneal erosion. He gave me some steroid drops to clear it up and warned not to use the drops for "too long,” indicating they would build pressure in my eyes and cause glaucoma. I try to use the drops for two to five days and then revert to Natural Tears when I have a flare-up. What is the underlying cause of this condition is, and is there any better way to treat it?

Dr. Hibberd's Answer:

Recurrent corneal erosion is often caused by local irritation or infection of the surface of the cornea. The cornea is a clear, normally transparent tissue on the surface of the front and middle of the eyeball. Light passes through it, then through the lens to the retina. Contact lenses and dry eyes are the most common causes of irritation. Erosion is a loss of surface integrity of the cornea without perforation. The scratchy feeling and discomfort implies disruption of the surface of your cornea.

Conjunctival irritation (usually caused by allergy, infection, or irritation) may also be present in tissue surrounding the cornea, but does not cause discomfort that any opthamologist will confuse with corneal erosion.

Untreated and progressive corneal erosions will result in corneal opacity and vision loss if allowed to continue. Once oxygen diffusion to the cornea is restricted, its integrity becomes compromised and an erosion forms. There is no blood supply to the normal cornea. The cornea obtains its nutrients by diffusion from the layer of tears over its surface.

Contact lenses are to be removed and preferably replaced together with fresh cleaning solution when eye irritation is encountered. There were recent lots of contaminated eye solutions withdrawn from the market earlier this year, so be sure your solution was not recalled by the FDA.

Artificial tears remain the mainstay for patients with dry eyes. Removal of irritating agents is advised, and patients need to be sure their corneal surface has sufficient lubrication as well as protection from the drying effects of wind and weather.

Another common cause of recurring erosion is entropion of one of the eyelids. This is where the outer surface of the lid turns in and scratches the surface of the cornea. The inability to fully close your eye will result in recurring erosions. Treatment involves artificial eye drops and ointments, temporary stitching of lids, and even surgical correction if persistent.

The use of topical steroids is usually discouraged except in select circumstances under the direct supervision of an opthamologist. This is because herpes virus infections may present as erosions. Infections may progress to dendritic ulcers that cover the entire cornea with scarring and vision loss since the cornea becomes opaque if left untreated. Dendritic ulcers and herpetic infections of the eye require a slit lamp examination for confirmation. Infectious processes are generally worsened by topical steroid use.

Your doctor was correct in warning you of repeated steroid complications. Since I don’t believe the cause of your erosions is clear to you, I recommend you re-consult your opthamologist regarding their cause, then obtain a second opinion from another opthamologist, preferably at a nearby teaching hospital or perhaps a specialty eye hospital such as The Bascolm Palmer Eye Institute in Miami, Florida.

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