Recurrent corneal erosion sufferer

[liz56]

I am considering laser eye surgery, do you think my 'spontaneous without reason' erosions are a reason to avoid getting it done?

Yes, I think that spontaneous recurrent corneal erosions are something that should deter one from having LASIK.

The last-ditch treatment for rce is PTK, and some people have PRK, which both smooth the corneal surface. PTK is less evasive, but it does not change one's refraction. I am subject to rce's, and there is not much that would motivate me to go under a laser. Studies that follow rce sufferers after PTK and PRK never go beyond three years. I don't really trust breaking down any layer of my cornea in any way.

[Rebecca Petris]

I am considering laser eye surgery, do you think my 'spontaneous without reason' erosions are a reason to avoid getting it done?

LASIK is major no-no when you've got a compromised epithelium. As has been stated, the common cause of erosions is poor adherence of the layers of the epithelium (this goes by many names... ABMD, EBMD, map-dot-fingerprint dystrophy etc). Cutting a LASIK flap into a cornea like that is asking for much worse trouble than you've got. There are people on the board with UN-diagnosed ABMD who had LASIK done and their epithelium basically sloughed off right there and then during surgery. Long painful recovery, lousy vision, and postop RCEs.

As LIz56 says, surface laser treatment is actually used therapeutically sometimes (PTK) by removing the epi and letting it grow back, and sometimes in conjunction with vision correction (PRK). Note though that even PTK can affect your vision, for example, leaving you far(long)sighted. Personally I think that it's important to first get the best possible diagnosis and see what can be done with non-surgical treatment. There's a lot of people here who successfully manage it with night covering, hypertonic ointment (Muro 128) or Dwelle. None of which are available locally in the UK but all can be shipped from the US.

[liz56]

Adding to Rebecca's Point

Rebecca makes a good point about how hard it is to diagnose rce's. I went to a corneal specialist for my erosions. When I told him that I felt as if I had had an erosion in the OTHER eye just that morning, he looked, and said, "I don't see anything wrong." He told me that I had ebmd in one eye but not the other. I went out of state to another corneal specialist, and he told me that I have it in both eyes. (I knew it by then.) My guess, if you have spontaneous corneal erosions, is that you might have ebmd. I'd find a good, good, doctor, one who specializes in diseases of the cornea and not just LASIK and cataracts.

This page might help to explain a bit more about rce's:

http://www.refractivesource.com/pati...th_erosion.htm

This excerpt is especially insightful:

"Corneal erosions are more severe [than injuries that result in corneal abrasions], affecting a larger area of the cornea than a typical corneal abrasion. However, in a small minority of LASIK patients, a small corneal abrasion from the suction ring may lead to a corneal erosion at the same location on the cornea.

"A person's risk for corneal erosions increases with advancing age. People with a specific corneal dystrophy have a significantly higher risk of recurrent corneal erosions. Dry eye is also a risk factor."

[Mcgoldilocks]

LASIK is major no-no when you've got a compromised epithelium.

Point taken. It's scary to think that a year ago I went through the whole process of going to a LASIK surgeon for the assessment, and was told there was no problem in getting it done, the only thing that stopped me was my finances at the time. I'll scrap that idea for good.

Rebecca, would you recommend I get the Muro 128 or Dwelle shipped over for myself even though I have no prescription? My appointment with the corneal specialist isn't until 19th May.

[Mcgoldilocks]

After looking round on this site, I've ordered myself Clinitas Ultra 3, which was cheapest from Matheson at £8.99 inc postage.

[Lucy]

Oh, hear Rebecca's words! Every word is seconded by me. I'm post-lasik 8 years, still with RCE/EBMD/dry eyes/yada-yada-yada. Don't get bitten by the Lasik Lizard if you have any corneal problems. Trouble is, this is often missed by the drs doing the lasering. Or, they see it and.....well, keep on going. Lucy

[liz56]

New Work on RCE's

Hi,

I was just looking around for new or more information on the distressing problem of recurrent corneal erosions. I was inspired by the recent discussions of the FDA hearings on LASIK, and I was wondering if RCE's would be on the rise, since they can develop years after an eye injury, as was my case. The onset of ABMD usually does not occur until "the fourth decade of life," though it can come earlier or later for some people.

So, keeping in mind how LASIK and other refractive surgeries cut the cornea, it may be a more pronounced problem, even for people who healed right up shortly after the surgery.

Anyway, there seems to be some interesting work on stem cells happening in the area of epithelial adhesion to the basement membrane:

http://www.gwumc.edu/anatomy/mastepp.html

This caught my eye:

"To be able to prevent stem cell loss and recurrent corneal erosions, we need to understand how they happen and our animal models will allow us to do just that. This knowledge will lead to improved treatment of patients with corneal epithelial stem cell deficiency and recurrent corneal erosions. It will also enhance our knowledge of the factors that regulate proliferation of epithelial stem cells during tumor and pterygia development."

[Rebecca Petris]

I started replying before I clicked on your link... then suddenly realized that what I was going to share was the exact same thing. I went to a presentation by Dr. Stepp years ago in Gainesville FL at a conference. Most of the conference was science way over my head but her session has ALWAYS stuck with me, where she was presenting early data from a study where they used an excimer laser to induce limbal stem cell deficiency and resultant RCEs in mice. Phew. I need to get back on top of where this stuff is at.

[liz56]

Thanks for the additional information, Rebecca-- that you are familiar with this research.

I would not be surprised if the next several years brings more people to the DEZ, because of RCE's. When I was searching for help on line, which is how I found out about Dr. Foulks, who is the kindly doctor who suggest that I "call Rebecca," there were so many stories, some post-LASIK, of people with this problem who had nowhere at all to turn for treatment. Their treatment ended after an ophthalmologist gave them some ointment and told them to "be careful." Some of these sufferers had been living with this problem for years and never seemed to have found an effective treatment program. Those discussion boards and posts on blogs were so depressing to me. I thought that I would never recover. To see researchers, like Dr. Stepp continue to develop that cellular-level work that Dr. Holly began is so incredibly uplifting to me.

[Rojzen]

Dr. Holly's Jan. 28, 19:01 hrs. post on recurrent erosions

Just want to be sure that those seeking all useful input on how to manage recurrent corneal erosions do not overlook Dr. Holly's post here from Jan. 28, 2008, at 19:01 hrs. In that post, Dr. Holly gives some additional perspectives on the prevailing approaches (such as use of bandage lenses and hypertonic drops/ointments (such as Muro)). . .and explains why a high-oncotic pressure drop should be extremely useful in this context...

[Mcgoldilocks]

Update on my erosions

Hello everyone, just thought I'd let you know my progress with managing my corneal erosions.

I ordered the UK version of the 'Dwelle' product which is Clinitas Ultra 3, but a week later I had an erosion. At Moorfields eye hospital the doctor said he could see some 'mapping' from map dot dystrophy and he prescribed the thicker 1% Celluvisc drops, 4 times per day, plus the lacrilube at night. So I'm not using Clinitas anymore.

Seeing corneal specialist on Monday which is exciting! Will do lots of Dry Eye Zone homework for it.

[liz56]

Hi, Mcgoldilocks.

I'm so sorry to hear about the relapse. You are being smart to go to a corneal specialist.

Just for the record, it took me months and months to get over the erosions with an oncotic eye drop. I started oncotic drops on July 9th 2007 and had my last erosion on March 15th 2008. I am still feeling like I am not out of the woods. However, I can say that during that time, the erosions became "smaller," that is, less painful, occurring later in the night (not two hours after drifting off to sleep as in the earlier stages), and they became less frequent-- several times a night to several times a week; then, after five months (!) every two weeks, then every month.

I sure hope that I did not give the impression that they worked in a week; they did not work like that for me at all. I just wanted to clear that up.

Good luck with your new plan of treatment! I hope that you find success with your new specialist!

--Liz

[introverted]

What is a corneal erosion please?

I am four years post lasik and still suffer chronic pain, dryness and
inflammation of the eyes.

Doctors have said I have meiobiam gland disorder, after lasik.

Thank you.

[liz56]

Welcome

What is a corneal erosion please?

I am four years post lasik and still suffer chronic pain, dryness and
inflammation of the eyes.

Doctors have said I have meiobiam gland disorder, after lasik.

Thank you.

Hi, Introverted. I'm sorry to hear about the post-LASIK complications.

A "recurrent corneal erosion" is something that happens when the uppermost layer of the corneal epithelium fails to anchor itself to the next layer down, the Bowman's layer or the basement membrane. The erosions usually happen at night, when our bodies sort of swell with fluid, which is why we have puffy eyes in the morning, for instance. When the fluid is not pumped from the basement membrane efficiently, like when the cornea has been injured or when there is a corneal dystrophy, fluid deposits, like blisters, remain under the epithelium. If the eye is too dry, this thin layer of epithelium can stick to the eye lid, causing excruciating pain upon opening the eye, which is caused by the loose epithelium tearing away from the basement membrane.

Symptoms of it are sudden pain, tearing, redness, and, if the erosion happens over the pupil, blurriness and / or double vision, followed by a foreign-object feeling through the day, as the epithelium heals. The pattern repeats, and for some, it does not just happen in the morning but after one drifts off to the REM stage of sleep.

I really hope that you are not having these! If you are, however, I find that a combination of Dwelle eye drops, TranquilEyes goggles, and Gentel Gel at night do a lot to help me avoid them.

--Liz

[Mcgoldilocks]

Contact lens bandages

As predicted, I have been recommended therapeutic use of the continuous wear contact lenses as a 'bandage' over my corneas. Apparently after 9 months or so my corneas should have healed properly.
I now have in Acuvue Advance with 'hydraclear' contacts and I have an appointment to go back in 3 weeks to see how I'm getting on with them. Sadly they are the plain kind so I still have to wear my glasses but I hope to get the prescriptive ones next time I go in. It was stressed to me that I have to be extremely careful of eye infections, so I can't go swimming or get tap water near my eye! (It will be difficult to wash my hair then, I only have a shower). I'm going to Morocco on Wednesday but I won't be able to go in the saunas or anything, and I was told to take particular care in the dry atmosphere of the plane, and to put in 'Blink' or 'Refresh' drops in every hour.

I'm a bit scared because only once before did I have an erosion while I had contacts in, taking it out had me screaming and I haven't worn contacts since (4 years ago).

Good thing is I can stop taping my eyes and using lacrilube every night.

I really hope this does the trick.