If your eyes hurt like crazy when you wake up, as if you are yanking off a band aid, you may have a Recurrent Epithelial Erosion (RCE). This usually occurs when you first wake up, or when you rub your eyes. Recurrent corneal erosion is a disorder of the eyes when the cornea’s outermost layer of epithelial cells is not attaching correctly to the underlying basement membrane (Bowman’s layer). The condition is excruciatingly painful because when these cells are torn off, the uber-sensitive corneal nerves are exposed. OUCH! This condition can often leave patients with temporary blindness due to extreme light sensitivity, and a distorted corneal surface.
The most common cause for RCE is a recent corneal injury (corneal abrasion or ulcer) that didn’t heal correctly. Other causes include corneal dystrophy or corneal disease such as map-dot-finger dystrophy. Familial corneal erosions occur in dominantly inherited RCE Dystrophy.
Symptoms include recurring attacks of severe acute ocular pain, foreign-body sensation (scratchy), photophobia (sensitivity to bright lights), and tearing when waking up or rubbing the eyes. Patients often report to me that they cannot open their eyes, and when they do, their vision is very blurry. What I see when I examine the eyes under the slit lamp microscope, is often a corneal abrasion or an irregular pattern on the corneal epithelium, sometimes with map-like lines, epithelial dots or microcysts, or fingerprint patterns.
An RCE is aggravated by conditions that cause dry eyes such as: excessive computer use and screen time, dry environment (flying on a plane, living in a desert climate like Los Angeles), drinking alcohol (which dehydrates the body), not enough sleep, or eyes that do not fully close while sleeping (lagophthalmos).
Treatment options include: hyperosmotic drops, bandage contact lenses, and oral antibiotics such as doxycycline.
For patients who continue to have recurring RCEs, I can treat them effectively with an amniotic membrane. Amniotic tissue is excellent at decreasing inflammation, promoting healing and lessening scarring and hazing. Amniotic membrane is a natural tissue from the innermost layers of the placenta that is donated by mothers after giving birth. Amniotic membrane grafts have been shown to reduce inflammation and scarring while promoting re-epithelization and healing of the cornea. They contain anti-inflammatory cytokines and peptides that assist with tissue repair. A very thin disc of sterile tissue is placed on the and covered by a bandage contact lens. Over the next 5-7 days, the graft is absorbed ty the cornea which heals in the healing process. Amniotic membrane grafts are typically covered by insurance for the treatment of RCE, and the procedure can be done with little discomfort or extensive complications.
Amniotic membranes can treat a wide range of corneal conditions including: chemical and thermal burns, severe dry eye disease, neurotrophic ulcers associated with Diabetes, or prior Ocular Herpes infections that are not healing.
Dr. Brisco at the Hollywood Vision Center has helped many patients with RCE. Only about 1% of optometrists in the U.S. are skilled in treating patients with amniotic membrane grafts, and Dr. Brisco is one of the select few. Call our office today for a consultation today.