Do your eyes hurt all the time? Let's learn about Recurrent Corneal Erosion!

Do you also feel unbearable pain when you open your eyes in the morning? Does it feel like there is something inside your eye, like something is poking you? It is difficult to look at the light, and tears just flow? These may be damage to the top layer of your eye, that is, the cornea, which is a condition in which the top part of the cornea is peeled off. We call this Recurrent Corneal Erosion (RCE) . Although the name is a bit complicated, this is a common condition. Don't worry, let's talk about this in detail, very simply.

What exactly is Recurrent Corneal Erosion (RCE)?

Simply put, the transparent membrane at the front of your eye, like the windshield of a car, is what we call the cornea . This is what protects the sensitive parts inside the eye from the outside world. It's like a safety glass that's placed over our eyes. This cornea has five layers, or layers. In the case of Recurrent Corneal Erosion (RCE), the top two layers are affected.

Those two floors are:

• Epithelium: This is the outermost layer of the cornea. It has many nerve endings, making it hundreds of thousands of times more sensitive than our skin. Even a small speck of dust can be felt by us.
• Bowman's membrane: This layer is mostly made of a protein called collagen . Think of it like a jelly that sets and holds together, and that's how it works. Bowman's membrane holds the epithelial layer above and the layer below together, helping them stay together.

Now, when you have RCE, the epithelium itself and the Bowman's membrane are not properly attached and connected. That connection is weakened. Then the top layer, the epithelium itself, can easily peel off, like a peel. When that happens, the more vulnerable layers underneath come out. This is a very painful experience because the epithelium is full of nerve endings.

How common is this RCE situation?

RCE is a very common condition, but it's hard to say exactly how many people develop it. A study in London, England, found that the condition affects about 1% of the population in that city each year. However, that number may be lower than the actual number. This is because even a minor scratch may not require medical attention. Our corneas are designed to heal themselves very quickly. So, minor scratches can heal in minutes or hours.

What are the symptoms of RCE?

If you have RCE, your symptoms often appear when you first open your eyes in the morning . For example, during the night, the connection between your eyelid and the upper layer of your cornea can weaken. When you open your eyes in the morning, the weakened area can cause the upper layer of your cornea to pull away from the eyelid. If this happens, you may experience symptoms such as:

• Severe pain: The pain may feel like something is stuck inside the eye, like a knife stabbing it.
• Redness of the eyes.
• Photophobia: Even a small amount of light can be unbearable.
• Excessive tearing from the eyes (Epiphora).
• It feels like there is a speck of dust or something stuck inside the eye, but you may not actually see anything inside the eye.

Why does this RCE situation occur?

This is like applying new paint to a wall that has been flaking off without cleaning it properly. Because the underlying paint layer is not clean, and because of the defects in it, the new paint won't adhere properly. Even if you just touch it, the new layer can come off, right? That's how it is. If there is any weakness or damage in the underlying layers of the cornea, the top layer won't adhere properly.

In most cases , the main cause of RCE is a previous injury to the eye . It can be a pinching or injury from something like your own fingernail, a corner of a paper, or a leaf from a tree, a small branch. Imagine that you are working in the garden and a small branch hits your eye. Even if it doesn't seem like a big deal at the time, after a few days, or even years, you may wake up with severe pain when you open your eyes in the morning. This injury does not have to be recent. Some people can get RCE from an eye injury that occurred years ago. RCE caused by such injuries usually only affects one eye.

RCE can also be caused by certain corneal diseases and chronic conditions that affect the eyes. Although these often affect only one eye, some people may experience symptoms in both eyes.

Examples of this are:

• Epithelial Basement Membrane Dystrophy (EBMD): Also called map-dot-fingerprint dystrophy, this is a weakness in the lower layers of the cornea.
• Dry eye syndrome: This condition occurs when the production of tears in the eyes decreases.
• Type 2 diabetes.
• Swelling and inflammation of the eyelids (Blepharitis).
• Ocular rosacea: This is an eye problem that occurs with a skin condition.

What are the possible complications of RCE?

Complications caused by RCE are usually not life-threatening, but they can be very uncomfortable and serious.

They are:

• Higher risk of RCE recurring in the future: Once RCE occurs, the chance of the cornea being damaged again is high.
• Corneal haze: When the cornea is repeatedly damaged by RCE, its transparency can decrease. This reduces the amount of light that enters the eye, making it difficult for you to see.
• Increased risk of infection: Your cornea is a protective barrier. When it is damaged, the layers underneath are exposed to germs. This can easily lead to eye infections . These can sometimes be serious.

How to identify RCE status?

RCE is usually easy to diagnose. An ophthalmologist or optometrist can suspect it by asking you about your symptoms, your medical history, and any previous eye injuries.

Then some tests are done to confirm this. Before doing those tests, you may be given a numbing medication to reduce the pain.

The tests that can be done are:

• Slit lamp exam: In this exam, your doctor examines your eye with a special microscope (slit lamp). During this test, a blue dye called fluorescein is applied to your eye (either as eye drops or with a special strip). This allows you to see any scratches on the cornea.
• Adhesion test: This involves gently touching the surface of the cornea with a surgical sponge. If you have RCE, the top layer of the cornea will move with the sponge, not sticking together properly. This is useful when other tests don't clearly show a scratch.

How is RCE treated?

Doctors treat RCE in a step-by-step manner. They usually start with simple medical treatments and only move on to more complex surgical treatments if they don't help. However, if the RCE is severe, they may go straight to more complex treatments.

Medical management

The main goal is to create an environment that is comfortable for your eye to heal on its own. Many treatments are self-administered. Your doctor will give you specific instructions on what to do.

Some treatments may last for days or weeks. Depending on the severity of the RCE, some may last for months.

Medical management may include one or more of the following:

• Pain management: RCE is a painful condition. Painkillers such as nonsteroidal anti-inflammatory drugs (NSAIDs) can help reduce pain. Also, special ointments and bandage contact lenses can help reduce pain.
• Eye lubrication: Artificial tears, saline drops, gels, or ointments may be given to the eyes. Doctors recommend applying these at night before going to bed. This is done to prevent the onset or worsening of RCE when you open your eyes in the morning.
• Hypertonic saline: This solution increases the absorption of fluid from the surface of the eye. This helps the epithelium adhere better to the underlying layers. Doctors recommend using this during the day, along with eye ointments at night.
• Antibiotic drops or ointment: These are given to help treat any eye infections that are causing RCE, or to prevent infections from occurring until the eye heals.
• Patching or bandage contact lenses: Both of these provide an extra layer of protection until the eye heals. A bandage lens is a bandage that is placed on the eye, much like a contact lens. It helps the eye heal itself.
• Cycloplegia: The muscles that control your eyes change the shape of your eyes slightly. This is what allows you to see things at different distances clearly. Cycloplegia temporarily disables the muscles in the affected eye. This allows the eye to remain the same shape, which makes it easier to recover.
• Serum drops: These special drops contain immune proteins and other ingredients that help the eye heal. They can be autologous , meaning they are made from your own blood, or they can be made from donated blood.
• Specific medications: These can be medications that block proteins that interfere with corneal healing, such as corticosteroids or doxycycline , or medications that contain growth factors that stimulate healing.

Surgical treatments

Surgical treatments involve removing damaged parts of the epithelium and allowing it to grow back in a uniform, scar-free manner. These surgeries are usually performed under topical anesthesia, so there is no pain.

Even after these treatments, your doctor may prescribe medications as mentioned above. The epithelium usually regrows within a few days. However, it may take weeks or months of continued medical treatment for the epithelium to adhere properly to the underlying layers.

Surgical treatments may include one or more of the following:

• Debridement: This involves removing damaged epithelial tissue with special instruments.
• Diamond burr polishing: A doctor uses a special instrument to scrape away the epithelial tissue from the affected area of ​​the cornea, allowing the entire area to regrow evenly.
• Stromal punctures: A doctor uses a very small needle or laser to make small holes in the stroma , the layer of the eye that lies beneath Bowman's membrane. When these holes are placed in the right places, the eye heals itself from those holes. This strengthens the bond between the upper layers.
• Amniotic membrane placement: This works like a bandage lens, but it uses tissue taken from the placenta. The placenta is removed by cesarean section and then subjected to a rigorous sterilization process. The doctor places it directly over the affected area of ​​the eye. The placental tissue protects the eye and helps the outer layers of the cornea grow back.

Complications/side effects of treatment

Complications and side effects of treatment vary greatly depending on the treatment you receive. Your doctor can best tell you what side effects you may experience and what you can do to reduce or prevent them.

How quickly will I feel better after treatment?

The recovery time after treatment depends on several factors. The epithelial layer of your cornea can regrow and heal fairly quickly. However, it can take weeks or months for the layers underneath to fully heal and bond together properly. Your doctor can tell you how long it will take for you to recover and when you can expect to see a change in your symptoms, vision, or the way your eyes feel.

What should I expect if I have RCE?

If you have RCE, the main symptom is pain . Other symptoms are common, uncomfortable, and interfere with daily activities. But minor scratches usually heal quickly. Most people seek medical attention when their scratches are moderate to severe.

The main problem you will face is that these can recur . If this happens, there is a high chance of complications affecting your vision.

Therefore, it is best to see an eye specialist if you notice symptoms of RCE, especially when you first open your eyes in the morning . Prompt treatment can limit the damage caused by RCE and reduce the risk of it recurring in the future.

How long can RCE last?

Your cornea has an amazing ability to heal itself. Minor damage can heal in a few hours, and more severe damage can take a few days.

But remember, RCE only occurs when your eyes don't heal properly. If that happens, you'll need to continue using your eye medication or other treatments as prescribed by your doctor for weeks or months. It may seem like a tedious and tedious task, but it's the best way to ensure your eyes heal properly and prevent RCE from happening in the future.

What is the outlook for RCE status?

RCE is painful, uncomfortable, and sometimes serious, but not life-threatening. Sometimes it comes back, but recurrences can be treated. Fortunately, complications that affect your vision long-term or permanently are rare.

Can RCE be prevented or the risk reduced?

RCEs can happen unexpectedly. They can't be completely prevented, but there are things you can do to reduce the chance of them happening.

The most important way to prevent RCE is to avoid eye injuries . Wear goggles, face shields, or safety glasses whenever your eyes are at risk of injury. This is especially important when you are working with tools or in an environment where there is a risk of getting objects in your eyes.

Applying artificial tears, gels, or ointments to your eyes before going to bed can be very helpful, especially if you wake up with sore eyes in the morning. Keeping the surface of the cornea and the eyelid moist helps prevent adhesions that contribute to tearing.

How do I take care of myself?

If you think you have RCE, it's best to seek treatment early . This will help you manage your symptoms and reduce the risk of future problems.

If you have RCE, your doctor will guide you on how to manage it. It is very important to follow their instructions exactly. If you follow the instructions exactly and take the medication or treatment as prescribed, you are much more likely to recover without complications.

When should I see my doctor or seek medical advice?

If you have RCE, you should go to follow-up visits as recommended by your doctor. This will allow them to monitor how your cornea is healing and adjust your treatment if necessary. If you notice any changes in your symptoms, your vision, or the effectiveness of your treatment, you should talk to them or visit them.

When should I go to an Emergency Treatment Unit (ETU) ?

RCE is not usually an emergency, but it can be painful and extremely disruptive to daily activities. If you have symptoms of RCE, it's a good idea to call your family doctor's office for guidance. You can also go to an urgent care clinic.

Although RCE is not usually an emergency, it has similarities to more serious eye injuries such as corneal lacerations , which are cuts and tears in the cornea.

If in doubt, seek emergency treatment without delay. Doing so can make a big difference in treatment, recovery, and preserving your vision.

If you have any of the following symptoms along with eye pain, you should seek medical advice:

• An injury to your eye, such as a cut, a bruise, a laceration, or a puncture wound.
• Sudden loss of vision (even if it is temporary or only affects part of the vision).
• Your eyes are burning or red in a way you can't explain.
• Nausea and vomiting.
• Headache .
• Fever.
• A feeling like something is stuck in your eye (whether or not you can see anything that could be causing the feeling).

Finally a little...

When our eyes are working properly, we don't even think about how much we use them, do we? But when our eyes hurt, and we don't know why, it can be very scary. RCE is a serious, painful condition, but there are good treatments for it.

If you have symptoms of RCE, especially if they are new, talk to a doctor or ophthalmologist. The sooner you get a diagnosis and start treatment, the better your chances of making a speedy recovery and preventing the condition from recurring in the future.

` Eye injuries, Corneal injuries, Eye pain, Eye redness, Recurrent Corneal Erosion, Cornea, Eye pain