Cornea Scar treatment

I have had eye abrasions several times in the past 2 years. The last abrasion I had was treated by my Optholmologist with Acular and Vigomox. Then my doctor refered me to a cornea specialist, who recommended to have a little surgical procedure (10 minute) to clean the abrasion to stop it from recurring. I agreed. a week later, My eye devloped a cornea scar. At this time, my left eye has a very bad vision. The Corneal Specialist was surprised to see the scar and he indicated that he has never seen this kind of a scar after the little surgical procedure before. He said he has seen this kind of a scar after Laser surgery. He prescrived Predenisolone Acetate Opthalmic suspension 1% (Sterile). He indicated to me that this might take several weeks to heal. My question to you is: Can these drops heal a cornea scar completely. Or is a Surgery needed. Is this scar caused by the surgery? My vision is so foggy. It's like a cloud on the surface of my eye. Please help

[John C Hagan III, MD, FACS, FAAO]

You have "recurrent corneal erosion syndrome". The condition is common and will not destroy your sight or cause serious loss of vision. It has been discussed in the past in the eye care forums. It usually starts after a scratched cornea that does not heal properly. In some instances it occurs due to a common disease of the outer layer of the cornea (basement membrane disorder). Use the search feature and type in "corneal erosions".

Here is part of a recent post on the problem:

Recurrent corneal erosions are the bane of the practice of ophthalmology for both the ophthalmologist (Eye MD) and the poor patient. I saw 2 of them in the office today. They can be very difficult and recalcitrant to treat. Not infrequently they are controlled with drops and ointments but reoccur if these medications are stopped. I'm sure you're well versed on the medical and preventive treatment of corneal erosions.

Treatment is to avoid anything that dries the eye. So keep it moist with artificial tears. At bedtime a lubricating drop with normal saline (Muro 128 ointment---available over the counter) is put in the eye.  Extreme care must be used in the morning on awakening as this is when the tissue usually tears. Avoid rubbing the eye. If the eye wants to stay shut from the ointment leave it shut, splash with warm water till it opens then put in an artificial tear or Muro 128 DROPS (available as 2% or 5% [which often stings] also available over the counter. If Muro 128 products are irritation try Refresh-PM ointment at bedtime and a good artificial tear on awakening and several times during the day (Systane, Opteve, Soothe, Refresh, Tears Naturale, etc).

Long plane and car trips are very stressing for corneal erosions. In the car, run the air conditioner or heater on the feet vents not into the face. Put artificial tears in the eye every couple of hours on a car trip and every hour on a plane trip.

You should go a minimum of 4 months without any pain from the erosion (usually during sleep or upon wakening) before trying to stop the ointment. Be aware that some people are never able to stop the medications and must use drops, ointments and precautions indefinitely (years and years).

The next step is often corneal stromal micro-punctures. This is an office procedure done with just eye drop anesthesia; a bandage contact lens is put in the eye for several days. You may return to normal physical activities immediately.  

If the problem persists then you may need to discuss these treatments with your ophthalmologist. He/she should be able to do the first method. The second he/she may or may not be able to do, sometimes referral to a cornea specialist is indicated.

1. There is a new method of treatment when all else fails. It involves taking oral tetracycline for a couple of weeks coupled with steroid eye drops. If your ophthalmologist is not familiar with the method he/she can do a literature search of the medical ophthalmology journals. The first time I read of it was in the journal "Ophthalmology". I have used this method on two patients that were "at their wits end and had tried everything else. In both cases it worked. I still have them use an ointment at bedtime such as Muro 128 or Genteal Gel but the severe pain has stopped.

2. The last technique would be to use the eximer laser to "resurface" the corneal epithelium and soft contact lens wear during the healing. This technique is most often used when the cornea has disease that keeps causing the erosions, the most common of these is corneal epithelial basement membrane disorder.

Keep trying and good luck.

JCH III MD

[Ali1959]

Thanks for your response.
My Corneal Specialist already did a Procedure to correct the recirring problem. The issue that I am facing now is a cornea Scar. The erosion pain is gone and based on the corneal specialist who perofrmed the surgical procedure on my cornea epithelium, he said the Cornea SCAR was developed. The concern that I have is the SCAR. Can the Sterile drops treat the scar, I still see with foggy vision.
I will show the corneal specialist your response. Thanks again
Ali

[John C Hagan III, MD, FACS, FAAO]

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[Ali1959]

Your comment is not clear.. Please re-enter .
Thank you

[Ali1959]

The Corneal Specialist told me that he has not seen this kind of scar after the procedure he performed. He said that he has seen it after a Laser Surgery. Can the Scar be taken off by the Sterile drops, or do I need a surgery to remove it?

[John C Hagan III, MD, FACS, FAAO]

Sterile drops will not remove a scar. You will need to ask the surgeon about the role of surgery, I can't make that determination from  here.

JCH III MD

[Ali1959]

I visited the Corneal Specialist for follow up. He said that the scar is about 40% better. He told me to continue to take the Sterile drops with Acular. He also told me to continue to take 1000mg of Viatmin C daily. The only change was he wants me to take the strile drops 4 times a day instead of one drop per hour.

[John C Hagan III, MD, FACS, FAAO]

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[Ali1959]

Yesterday, The corneal specialist told me to stop the Sterile drops because it affected my cornea thickness. He also told me to stop Acular and Vigomox. I am only taking Vitamine C and Doxycycline. The scar is still there. He looked so confused and didn't know what to do. I am trying to see another corneal specialst in the area. Is there anything else I can take for it. What is the side effect of a Laser surgery to remove the Scar? Thanks in advance.

[John C Hagan III, MD, FACS, FAAO]

True scars don't change that quickly. Perhaps he/she is using "scar" when a better term would be opacity. In any case laser scar removal is done only after the eye is quiet and infection/inflammation free and only works if the scar is on the superficial layers (it will not treat very deep scars).

JCH III MD

[Carole60]

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