Cornea erosion

[shadell]

My eye problem started in Aug of 2007 when my 4 month old scratched the first few layers of my eye.  Since then, I have had problems with my eyelid adhering to the inside of my eye ball when I sleep.. also, I am told I have dry eye.  (sided note.. I see 20/20 and never had problems with my eyes until Aug 2007 when my boy scratched the cornea.   I am 37 yrs old)

The Dr suggested scraping my eye so that the tissue can “reset”.  He said there is a chance that it may not work.. but MOST likely will.  That does not sit well with me…He also said it could make it worse, but not likely.  The second Dr. (for my second opinion) did not see any cornea erosion and said I have dry eye and wants to plug my tear ducts.  

Can you give me info on scraping of the eye?  How does it work/does it work? AND more so, the pro’s and cons of this procedure.  I am not comfortable with someone telling me this.  

[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

[hanny102]

A related discussion, RCE - side effect from medication? was started.

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

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[shadell]

Thanks for your insight!  It makes me feel better to know there are other options that the Dr. did not discuss with me.  I will talk to him about the next step.  

Thanks again!

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

scraping is not the same as micro-punctures. Neither are likely to make it worse. You would be the best judge of whether you wish to have one of these procedures for a once in three months problem. You might ask your EYE MD about going on Restasis or putting in tear duct plugs.

Pregnancy is not likely to make it worse (your eye erosions).

JCH II MD

[shadell]

If they do corneal stomal micru-punctures, (scraping of the eye) can that cause new erosion in "new" areas of my eye?  Is it possible that it could cause it to be worse?  As of now, I have no pain in the day, only at night and it happens about every 3 months.  It happens for about 3 days in a row though and at that time is painful.  I can feel my eyes dry out during the day now though if its windy.. I think its is because I am know it can happen.  :) I am more aware.  I am also trying to get pregnate and wonder if it will get worse?