Recurrent cornea epithelial erosion syndrome

What Is It?

Recurrent cornea epithelial erosion syndrome (RCEES) is a disorder of the surface layer of the cornea. The cornea is the transparent 'front window' of the eye. It has an extremely fine surface layer, only one-twentieth of a mm thick, which is normally firmly attached to the rest of the cornea underneath it. Imagine it as clingfilm wrapped tightly around a sandwich. In RCEES the surface layer has a weakness causing it to become detached from the cornea underneath, leading to the formation of minute blisters on the cornea surface. It is as though the clingfilm has developed tiny bubbles between it and the sandwich.

The minute cornea surface blisters that cause RCEES

Cause

Sometimes an injury to the cornea surface, such as a scratch from a babies' fingernail, can trigger the syndrome. Some patients have an extra disorder of the cornea surface, for example 'map-dot-fingerprint dystrophy', which itself leads to RCEES. Finally in some patients no cause is ever found.

Symptoms

The main symptom is eye pain which typically begins on waking in the morning. It can also begin at night during sleep. This is because the eyelids stick to the surface layer of the cornea when they are closed during sleep. When the patient wakes up in the morning (or during the night), the eyelids open suddenly and pull the abnormal surface layer away from the underlying cornea. This creates minute blisters which are painful. The pain usually lasts only a few minutes. However severe cases can suffer pain for long periods during the day. A bad blister can become infected although this is infrequent.

Treatment

The initial treatment is to apply a thick lubricating ointment to the eye last thing at night before sleep. Suitable ointments are simple eye ointment and lacrilube. These do not contain medicated ingredients which might cause side effects. They are based on lanolin and simply coat the surface layer of the cornea, preventing the eyelids from sticking to it. This stops the formation of painful blisters. The ointment must be applied every night for several weeks to allow the condition to settle. It can then stopped and re-instituted if the pain returns.

If the ointment does not work two other treatments are available. An extended wear contact lens may be worn. This protects the cornea surface layer until it has healed. However it does not cure the underlying weakness which may return later. The alternative is a laser therapy called phototherapeutic keratectomy (PTK). This is done with the same type of laser used to correct short sight. It has the advantage that the cornea surface layer is often permanently stabilised so curing the disease once and for all.