Corneal resurfacing for recurrent corneal erosions

Recurrent corneal erosion is an extremely common condition which can occur at any age from the 20’s on up. It is characterized by pain, burning and watering upon waking and opening one’s eyes. The surface layer of the cornea erodes off, leaving the eye subject to infection until it heals, usually later in the day, although it may take days to weeks to heal. It is often caused by minor trauma, such as a scratch from taking one’s contact lenses out or putting eye drops in, or by epithelial basement membrane dystrophy, an extremely common abnormality on the surface of the cornea. It can also be exacerbated by dry eye and exposure to air from incomplete eye closure while the patient is asleep.

Mild cases with infrequent recurrences may be managed with lubricating drops and/or gels and ointments. More problematic cases may benefit from corneal resurfacing to generate a stronger adhesion between the surface layer and the underlying layer.

Mechanical debridement is performed with a cellulose sponge in the office. It aims to polish the underlying corneal tissue so that the surface layer has a more uniform surface on which to regrow. It is a comfortable procedure requiring only anesthetic eye drops. It takes a minute or so, and then a bandage contact lens is placed for several days to weeks for added comfort and to promote proper healing. Antibiotic drops must be used during the healing phase to prevent infection.

Anterior stromal puncture aims to “spot weld” the surface tissue to the underlying tissue by creating “cleats” of surface tissue into the deeper layers, just as cleats provide traction for athletic shoes. It is a very quick and comfortable procedure with minimal healing time and no restrictions on the patient’s activity.

Phototherapeutic keratectomy is performed with the same laser that is used for LASIK and PRK. It removes a thin layer of corneal tissue under the surface epithelium, to reveal a healthier layer onto which the epithelium may adhere more solidly. This procedure may also be combined with laser refractive surgery by PRK, for patients who have recurrent corneal erosion syndrome and also wish to decrease their dependency on glasses or contact lenses.