RCE

[yarelly]

Hi I am looking for some hope so that I do not have to get a corneal transplant. I have RCE and just this year (on Christmas) I had another episode, for the fifth time in my life. It is incredibly painful, and I will probably go on the rest of my life dreading the next one. This past episode was the worst I've experienced. Althought the scar did not reopen? any deeper it did stretch into the pupil area blurring my vision so that I have approximatley 20/50 vision in my right eye. It's been more than a month and I see no improvement. Is there any way that this can be reversed with time? I'm only 21 not a contact lense wearer and since the trauma I've used thick lubricant in my eye at night and preservative free drops during the day. I wash my eyelids and eyelashes at night with baby shampoo. I just don't know what to do. Please help! Thank you.

[Andrewkyle]

I've had problems with RCE since the fall of 2013. I think it was from a scratch that may have happened that summer, because the first doctor I went to (before the problem got worse and they said it was RCE) said that there was a scratch.
Well it's $75 an appointment, and I've been to a ton of them, and I don't always get the same doctor. It's at the same eye clinic, but they don't seem to read/take good notes. Every time I see the specialist, he acts like its my first time seeing him. And the other doctors are always telling me different things. I've been on the contact bandage since late winter of 2013 and haven't stopped. That's also getting expensive - at $70 a box. (I don't have a job)
My last appointment was a checkup in 2014, and he told me he saw no improvements, and set me up with the specialist to get the laser surgery. The specialist treated me like a new patient, and sent me home telling me to stay on the contact. $150 wasted on both appointments running me around.
I was just going to stay on the contact for a long while before I tried messing with them again, but it's been irritating me more lately.
I had a contact fall out one night, so I replaced it, only to have the new one fall out the very next night. I replaced that one as well, and now this new one already feels terrible - like it would close to the time that it usually falls out, but it's only been 16 days, and the doctors wanted each contact to last a month - which sometimes they do last that long. But every once in a while I'll have issues with them like I am now. I use preservative free drops. I dont like the ones Im using now, but they're thera tears.

Would it be worth it to talk to them about the oral tetracycline? Is that something I can't get over the counter?
And are there any oils or supplements or any kind of natural treatments I can try?

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

I would suggest seeing a corneal Eye MD to discuss the tetracycline/steroid combination, or corneal micropuncture of eximer laser resurfacing.

Find a cornea MD near you at www.aao.org

JCH MD

[S_R_J]

Thank You soo much for the information.
I had tried using only liquigel. But my condition got worse. So doctor told me to use steroids for some time.And gradually reduce it. So i am worried. I am software engineer.And my eyes get strained in my job. Its almost an year since then I am suffering this.
Should I consider taking alternative treatment apart from using eye drops or ointments.

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

In my opinion it is not appropriate or safe to take a steroid for a year for recurrent corneal erosion syndrome.

Better off to use Muro 128 ointment at bed time and artificial tear perehaps a gel like genteal gel or refresh liquigel on awakening and several times per day.

JCH MD

[S_R_J]

Thanks a lot for the information provided by you. As you have told i am having this RCE from past 1 year. My doctor has prescribed me Refresh liquigel and Flurometholone (FML) eye drops. I have been taking that from one year.. I use Refresh eye drops every hour and flurometholone twice a day.Some doctors say i should not take FML for a long time. But my eye doctor has told to take it and it is very safe. I am confused. Can you please tell me whether it is safe to take. And also i am planning for a baby next year. Is it safe to take when i am pregnant. Please let me know.

Thanks,
S_R_J

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

You are welcome.

[yarelly]

Thank you so much Dr. Hagan. You have helped calm my worries. I haven't worn any eye makeup or driven at night (because of the bouble/blurred vision). But now I am a bit more stress free and am on the way to my recovery. Thank you!

[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.