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Recurrent Corneal Erosion Syndrome

Repeated episodes of spontaneous corneal epithelial breakdown causing acute pain on awakening, due to defective epithelial adhesion to underlying basement membrane after trauma or anterior basement membrane dystrophy.

Written by: Saygı Hospital Health Guide Editorial Board
Last updated:

This content has been compiled by the Saygı Hospital Health Guide Editorial Board and is periodically reviewed by a specialist physician.

References (5)

This content is for informational purposes only and does not constitute medical advice. You can book an appointment at our Göz Hastalıkları department. Book Appointment →

What is Recurrent Corneal Erosion Syndrome?

Recurrent corneal erosion syndrome (RCES) is repeated episodic spontaneous breakdown of corneal epithelium at the same location, typically due to defective adhesion between epithelium and Bowman membrane secondary to prior corneal abrasion (especially fingernail, paper, or branch injuries) or anterior basement membrane dystrophy (epithelial basement membrane dystrophy, EBMD).

Pathogenesis involves abnormal hemidesmosomes, basement membrane reduplication, and weak adhesion complexes. The poorly adherent epithelium is pulled off by the closed eyelid during sleep (via tear film adhesion) or by sudden eye opening, exposing sensory nerve endings and causing acute severe pain.

Clinical features include recurrent attacks of severe sharp eye pain, photophobia, tearing, and blurred vision, characteristically on awakening or with sudden eye opening. Slit lamp examination during attack shows epithelial defect, punctate erosions, or microcysts. Between attacks, basement membrane changes (map-dot-fingerprint pattern in EBMD) may be visible. Treatment is stepwise from medical (lubricants, hypertonic saline, bandage contact lens, autologous serum, oral doxycycline) to surgical (anterior stromal puncture, epithelial debridement with diamond burr, PTK).

Symptoms

Recurrent acute sharp eye pain on awakening
Severe photophobia and tearing during attacks
Foreign body sensation, blurred vision
History of prior corneal abrasion or trauma
Episodes lasting hours to days, then resolving
Pain triggered by sudden eye opening

Risk Factors

Prior corneal abrasion (fingernail, paper, branch)
Anterior basement membrane dystrophy (EBMD)
Diabetes mellitus (impaired epithelial healing)
Meesmann or other corneal dystrophies
Dry eye disease, meibomian gland dysfunction
Female sex (EBMD more common in women)

When to See a Doctor?

If you experience any of the following symptoms, seek medical attention promptly:

  • Recurrent eye pain on awakening
  • Severe photophobia, tearing, foreign body sensation
  • History of prior corneal injury
  • Vision changes during episodes
  • Symptoms not relieved by lubricant drops
  • Suspected corneal dystrophy on prior examination

Treatment Methods

01
Slit lamp examination during and between episodes (map-dot-fingerprint, microcysts)
02
Acute attack: topical anesthetic (diagnostic only), cycloplegic, lubricant ointment, bandage contact lens
03
Maintenance: preservative-free lubricants and ointment at bedtime, hypertonic saline (5%) drops/ointment
04
Oral doxycycline (50-100 mg) and topical corticosteroids for matrix metalloproteinase inhibition
05
Autologous serum eye drops for refractory cases
06
Surgical: anterior stromal puncture (peripheral lesions), diamond burr epithelial debridement (visual axis), excimer laser phototherapeutic keratectomy (PTK)
07
Treatment of underlying dry eye and meibomian gland dysfunction

Which Department to Visit?

You can visit our Göz Hastalıkları department for these complaints. Our specialist physicians will create the most suitable treatment plan for you.

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Health Disclaimer: The information on this page is prepared for general informational purposes only. It does not replace medical diagnosis and treatment. Please consult your physician for your complaints. Saygı Hospital does not accept responsibility for actions taken based on the information on this page.