PRK and Other Treatment For Recurrent Corneal Erosions

An injury to the outer layer of the cornea, the Epithelium, usually heals with in a few days, and results in no long term damage. However, if the Epithelium does not fully reattach to the underlying layer, Bowman’s Layer, then that focal point may be a source of future problems. This is called a Recurrent Corneal Erosion, RCE.

An individual wakes up in the morning in severe pain upon opening their eyes. The affected eye is red and extremely light sensitive. It improves as the day progresses, but takes several days to fully remediate. This event re-occurs every few weeks, or months each time being worse then the time before. Lasting longer, hurting more, and not fully remediating. This is a typical course of action for RCE. Since the Epithelium did not fully re-attach to the Bowman’s layer after the injury, it gets pulled off at the point of injury. During sleep, it gets stuck to the inner layer of the eye lid and tears as a result of REM sleep. These events can be mild or extremely painful resulting in decreased vision, and constant foreign body feelings in the eyes.

Treatment varies substantially from using lubricating ointment at bedtime to keep the cornea from getting stuck to the eye lids during sleep; to Anterior Stromal Puncture. This involves sticking a needle into the cornea at the affected site in the hope of forcing the epithelium to re-heal, thereby attaching to Bowman’s membrane. It has proven to be moderately successful. The newest treatment has come about as a result of refractive surgery.

Photo therapeutic Refractive Keratotomy (PRK) has been used to fully treat this condition. The corneal area is first bathed in alcohol to delaminate the epithelium, or remove the top layer. Then PRK is performed to treat the damaged area. Upon healing, the epithelium is now fully re-attached to Bowman’s membrane.

While there have not been a significant number of these cases as of yet, this treatment has shown dramatic results. Ultimately PRK may prove to be the treatment of choice in severe cases of RCE.