Recurrent corneal erosion (RCE) is a painful and unpredictable eye condition that can significantly impact one's quality of life. Treatment includes conservative therapies like eye drops or surgical interventions. Understanding the condition, its symptoms, and available treatment options is crucial for effective management of RCE. A healthy corneal epithelium is fundamental to healthy vision, and several corneal epithelial diseases are associated with severe consequences to overall ocular health. Recurrent corneal erosion (RCE) syndrome is a common, recurrent condition caused by abnormal epithelial adhesion to the underlying basal lamina.
Understanding Recurrent Corneal Erosion (RCE)
Recurrent corneal erosion (RCE) is a painful eye condition characterized by the repeated breakdown of the corneal surface due to damage and improper healing. This condition, also known as recurrent corneal erosion syndrome, often manifests after the fourth decade of life and is more frequent in females. RCE occurs when the corneal epithelium, the cornea’s outermost layer, detaches from the corneal epithelial basement membrane due to abnormal epithelial adhesion. Systemic diseases can contribute to the risk of RCE by causing inflammation and weakening of the cornea and leading to dry eye syndrome, which increases the probability of corneal erosions.
Causes and Risk Factors
Trauma is the most common cause of RCE. Other causes include certain corneal dystrophies, such as epithelial basement membrane dystrophy, Reis-Buckler dystrophy, lattice dystrophy, macular dystrophy, granular dystrophy, and Fuchs endothelial corneal dystrophy. Infections, ocular surgery, contact lens wear, diabetes mellitus, dry eye disease, and previous refractive surgery have also been identified as potential causes of RCE.
Symptoms and Diagnosis
Identifying the symptoms of RCE and securing an accurate diagnosis is vital for its effective management. The symptoms of RCE usually emerge several weeks after an initial injury to the cornea. These symptoms occur intermittently over time and typically persist from hours to days. Recurrent erosions occur secondary to inflammation from the inciting insult, which causes disruption of the epithelial basement membrane and affects proper extracellular adhesions of the hemidesmosomes.
Diagnosis of RCE involves a comprehensive patient history, slit lamp examination, adhesion tests, and advanced imaging techniques such as in vivo confocal microscopy and optical coherence tomography. A slit lamp examination for RCE diagnosis entails examining the cornea for indications such as minor irregularities, epithelial microcysts, expansive areas of loose epithelium, or epithelial defects. Adhesion tests evaluate the adhesion or stickiness of the corneal epithelium to the underlying basal lamina. A common adhesion test involves touching the eye’s surface with a surgical sponge. Should the adhesion be inadequate, it may indicate RCE.
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Treatment Options
Medical and surgical treatments for RCE are available and should be individualized for each patient depending on the slit lamp findings and clinical history.
Treatment options for RCE span from conservative therapies to surgical interventions, hinging on the severity and persistence of the condition. Initial treatment for RCE includes a combination of antibiotic and preservative-free lubricating drops.
Conservative Therapies
- Lubrication: As first-line therapy or a mainstay of treatment in the prevention of RCE, the use of preservative-free artificial tears and ointment (hypertonic or paraffin) is recommended frequently during the day and before bedtime to keep the ocular surface moist. For recurrent corneal erosion, the best eye drops are lubricant drops such as Refresh, Genteal, HypoTears PF, Cellufresh or similar non-preserved tears. To treat recurrent corneal erosion, follow doctor’s instructions to use antibiotics, preservative-free lubricating drops, and night-time ointments to avoid rubbing the eye.
- Antibiotics and pain relievers: Topical antibiotics are commonly prescribed to prevent bacterial infections in patients with epithelial defects.
- Autologous serum drops: Autologous serum drops are produced from the patient’s peripheral blood and provide a mixture of growth factors and cytokines to the ocular surface, replicating naturally produced tears.
- Hypertonic saline solution: Hypertonic saline solution should be administered throughout the day. Apply an ointment to the same skin area at bedtime for 6-12 months.
- Bandage Contact Lens: A Hydrogel soft contact lens can be left in place while the epithelium heals and stabilizes. The provider should counsel the patient on the signs and symptoms of infection. Fraunfelder et al.
- Punctal Occlusion: Punctal occlusion is safe, quick, and reversible, and helps increase retention of eyedrops on the ocular surface. Punctal occlusion can be considered in patients with dry eye syndrome. Temporary occlusion with collagen plugs, which usually dissolve in 4-7 days, can be helpful. However, if the corneal erosion is chronic, permanent occlusion with silicon plugs is recommended.
Surgical Interventions
- Anterior Stromal Micropuncture: Anterior stromal micropuncture is a procedure that can be performed with the patient at the slit lamp. Anesthetic drops are administered (proparacaine) and a 25-gauge needle with a 1 mL syringe is used to create micropunctures less than 1 mm apart over the area of loose epithelium. The use of cobalt blue light and fluorescein staining helps visualize the area of treatment. Nd:YAG laser micro puncture using 0.4 mJ-0.5 mJ pulses applied to the region of abnormal Bowman layer through an intact epithelium has also been described. Micropuncture treatment is thought to incite a fibrocystic response, resulting in stimulation of basement membrane production. Epithelial adherence is improved by scar tissue induction between the epithelium and the anterior stroma of the cornea. Zauberman et al.
- Anterior stromal puncture: Anterior stromal puncture is a technique that enhances epithelial adhesion by creating multiple shallow incisions through the epithelium into the anterior stroma. This procedure can be particularly beneficial for patients with anterior basement membrane dystrophy.
- Diamond Burr Polishing: This option involves epithelial debridement with a cellulose sponge or blade and diamond burr polishing of Bowmans membrane.
- Excimer Laser Phototherapeutic Keratectomy: After removal of the central epithelium, an excimer laser is used to ablate the cornea uniformly, creating an ablation depth of 5-6µm.
- Amniotic membrane transplantation: Amniotic membrane transplantation involves an amniotic membrane as a biological bandage to promote healing.
Additional Measures
- Wearing polarized sunglasses with adequate UV protection can help protect the cornea from harmful UV rays and decrease the likelihood of RCE.
- In addition to these measures, it is crucial to maintain good eye hygiene and avoid rubbing the eyes, which can increase the risk of corneal damage and RCE.
- Regular monitoring and follow-up care with an eye care professional can help detect and manage any complications or recurrences of RCE. Follow-up care may include a slit lamp examination and staining with fluorescein to detect any epithelial defects. Seek medical attention if necessary.
Living with RCE
Living with RCE can pose challenges due to its unpredictable nature, persistent discomfort, and impact on daily life.
- Emotional support from friends, family, and support groups can help individuals with RCE cope with the unpredictability and anxiety associated with the condition. Professional counselling and therapy can also be beneficial for those struggling with the emotional impacts of RCE.
- Other tips for managing RCE include wearing polarized sunglasses with adequate UV protection, avoiding eye rubbing, and applying ointment medication.
Dietary Recommendations for Eye Health
More than ever, people recognize the link between what they eat and how they feel overall. Incorporating the right balance of essential vitamins and minerals into your diet can alleviate symptoms associated with conditions like dry eye syndrome and enhance general eye health, contributing to effective cornea treatments, corneal edema natural treatment, and long-term prevention strategies. Maintaining a healthy diet rich in essential nutrients and antioxidants provides a strong foundation for overall health, including eye health. While a specific “keratoconus diet” doesn’t exist, incorporating dietary tips can potentially support your body’s ability to maintain a healthy cornea and manage keratoconus.
The Importance of Nutrients for Eye Health
The eyes are complex organs that rely on a steady supply of essential nutrients to function optimally. The cornea, in particular, requires specific nutrients for maintaining its strength and structure. Collagen, the main protein in the cornea, provides its shape and strength. Other essential components include antioxidants and anti-inflammatory compounds.
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Our eyes rely on tiny arteries for oxygen and nutrients, similar to how the heart relies on larger arteries.
- Vitamin A: Vitamin A is a component of rhodopsin, a protein that absorbs light in the retinal receptors. It helps convert light rays into electrical signals that can be sent to the brain for visual recognition. Without sufficient vitamin A, the eyes cannot produce enough moisture to keep the cornea healthy, leading to issues such as night blindness.
- Antioxidants: Antioxidants can help prevent age-related macular degeneration (AMD) and cataracts. This is because they combat oxidative stress in the body, a leading factor in age-related macular degeneration (AMD) development. By neutralizing free radicals, antioxidants help protect the cells in the macula, the part of the eye responsible for sharp, central vision, from damage. Healthy cells contribute to better eye function, preventing the progression of age-related macular degeneration (AMD).
- Omega-3 fatty acids: Omega-3 fatty acids contribute to the structural component of cell membranes and are instrumental in maintaining retinal integrity. For individuals suffering from dry eye syndrome, omega-3s can improve eye lubrication, alleviating discomfort and redness.
- Lutein and Zeaxanthin: Lutein and Zeaxanthin act as natural sunblock, absorbing excess light energy, particularly harmful blue light, to protect the eyes from potential damage. These antioxidants are concentrated in the macula-the part of the retina responsible for clear central vision.
General Dietary Tips
A well-balanced, nutrient-rich diet can provide the essential building blocks and protective compounds your eyes need for optimal health. Here are some key dietary recommendations for keratoconus patients:
- Focus on Fruits and Vegetables: Colorful fruits and vegetables are rich in antioxidants like vitamins A, C, and E, which can help combat oxidative stress and protect the cornea. Aim for a variety of colors on your plate daily, including leafy greens, citrus fruits, berries, and carrots.
- Prioritize Omega-3 Fatty Acids: Omega-3 fatty acids, particularly DHA, are essential for overall eye health and may play a role in reducing inflammation. Fatty fish like salmon, tuna, and sardines are excellent sources of Omega-3s. Consider incorporating them into your diet 2-3 times per week.
- Choose Lean Protein Sources: Protein is vital for collagen synthesis. Lean protein sources like chicken, fish, beans, and lentils can help provide the building blocks your cornea needs for strength.
- Don’t Forget Healthy Fats: Healthy fats from sources like avocados, nuts, and seeds can provide essential nutrients and contribute to a balanced diet.
- Limit Processed Foods and Sugary Drinks: Processed foods and sugary drinks are often high in unhealthy fats, added sugars, and refined carbohydrates. These can contribute to inflammation and potentially hinder nutrient absorption. Opt for whole, unprocessed foods whenever possible.
- Stay Hydrated: Adequate hydration is crucial for overall health, including eye health. Aim to drink plenty of water throughout the day.
Additional Considerations
- Talk to Your Doctor: While these dietary tips can be beneficial, it’s important to discuss any changes to your diet with your doctor, especially if you have any underlying health conditions.
- Consider a Multivitamin: A daily multivitamin can help ensure you’re getting all the essential nutrients needed for eye health.
- Consult a Registered Dietitian: A registered dietitian can create a personalized dietary plan based on your specific needs and preferences.
The Role of Nutrition and Nutritional Supplements in Ocular Surface Diseases
Dry eye disease (DED) is a multifactorial disease of the ocular surface system whose chore mechanisms are tear film instability, inflammation, tear hyperosmolarity and epithelial damage. In recent years, novel therapies specifically targeting inflammation and oxidative stress are being investigated and used in this field. Therefore, an increasing body of evidence supporting the possible role of different micronutrients and nutraceutical products for the treatment of ocular surface diseases is now available. In the present review, we analyzed in detail the effects on ocular surface of omega-3 fatty acids, vitamins A, B12, C, D, selenium, curcumin and flavonoids. Among these, the efficacy of omega-3 fatty acid supplementation in ameliorating DED signs and symptoms is supported by robust scientific evidence.
Omega-3 Polyunsaturated Fatty Acids
Omega-3 polyunsaturated fatty acids (FAs) are fundamental structural components of cell membranes as well as precursors for the synthesis of numerous biologically active substances. The main omega-3 FAs include short chain alpha-linoleic acid (ALA), and long-chain eicosapentaenoic acid (EPA), docosapentaenoic acid (DPA) and docosahexanoic acid (DHA). While short-chain omega-3 FAs are obtained from plant sources, long-chain omega-3 FAs are obtained from oily fish and may be synthetized by elongation of short-chain FAs. The biological activity of polyunsaturated FAs depends also on the omega-6 and omega-3 intake ratio. Omega-3 FAs present anti-inflammatory, anticoagulant and antihypertensive properties, and regulate lipid metabolism, glucose tolerance and central nervous system functions. These molecules exert their anti-inflammatory role by competitive inhibition with arachidonic acid as substrates for the enzymes cyclooxygenase and 5-lypoxygenase .
Vitamin A
The term vitamin A comprises retinol, the most biologically active form obtained from animal sources, and carotenoids, precursors that are found in a wide variety of fruits and vegetables. Vitamin A is necessary for the health of mucosal tissues, retinal phototransduction, bone metabolism, reproduction and immune health. Vitamin A deficiency due to malnutrition is one of the major causes of preventable blindness in the developing world. In Western countries, vitamin A deficiency is uncommon, and may be associated with malabsorption conditions including alcoholism, cystic fibrosis and bariatric surgery . Nyctalopia represents the earliest clinical manifestations of vitamin A deficiency. In early stages of deficiency, the visual function usually normalizes following the introduction of supplementation therapy.
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