Recurrent cornea erosion (RCE) advice.

[Luke]

Hi all,

I've recently been diagnosed with RCE in my right eye. Unfortunately I have an exotic eye history of acute astigmatism and ocular lens implant surgery as well. The problems started a month ago when I'd wake up with a red, painful eye either during the night or in the mornings. The pain usually subsided after about an hour and my eye returned to normal. An Ophthalmologist prescribed some eye drops to prevent infection and some lacri-lube.

The laci-lube helped and my symptoms subsided until last week when I woke up in pure agony. It was too painful to read anything or look at computer screen for a week. I was prescribed heavy painkillers and a cocktail of moisturizing eye drops. This week I still have a problem of slightly red eye (during most of the day which varying levels of redness) and a minor cornea abrasion in the morning which tends to heal by the afternoon.

My pain is always worse in the mornings. I feel like I wake up with a minor cornea abrasion that gradually heals during the day. My eye usually heals fine by the evening (albeit it may still be slightly red). My doctor has suggested this may be caused by my slightly saggy and wrinkled epithelium.

Some questions:

1) My eye still has blurry vision, which I think tends to better the longer I go without sleep. My Ophthalmologist suggested that this might be caused by my epithelium sagging and wrinkling slightly. Does this sound plausible?

2) Is this saggy epithelium most likely causing my pain the mornings (and it is always mornings when it is worse). If so, how can I minimise this?

3) Is it waking up that causes the abrasion, or my eyes moving when I'm asleep?


4) What possible things can I do to minimise this whole inconvenience?
- Opening my window (to keep my room moist)?
- Sleeping in bursts of 90 minutes instead of 8 consecutive hours?
- Keeping eyes moist at all times?
- My diet? Caffeine or alcohol?
- More/less exercise?
- Sleeping on my back/front/left side/right side?
- Wearing an eye-patch (either during sleep or during the day once I've already got the cornea abrasion)?
- waking up with closed eyes
- gently rubbing my (closed) eye upon awakening (with the aim of separating my eyelid and my cornea safety)?

Any and all marginal gains are appreciated.

This is a great forum and I've already seen some very helpful advice here. Any suggestions are welcome.

Kind regards,
Luke

[Angela810]

Hi Luke,

Can you ask your doctor to prescribe Muro 128 which is good for RCE? Lacrilube is unpleasant I find. Vitapos is a much lighter lubricant for night time with vitamin A added for repair x

[indrep]

The loose epithelium is likely the cause. Find an ophthalmologist who will remove the loose cells and then place an amniotic membrane on the cornea.

[Luke]

Hi Luke,

Can you ask your doctor to prescribe Muro 128 which is good for RCE? Lacrilube is unpleasant I find. Vitapos is a much lighter lubricant for night time with vitamin A added for repair x

Many thanks for your advice, Angela.

I will look into it, although I'm based in the UK so I think I'll need the equivalent medicine here. I'm somewhat skeptical if it's appropriate for me though as it's a sodium chloride solution and I've been told to keep my eye as hydrated as possible. That said, I do often get swollen eyelids. I don't know why, but I'd guess it's probably due to eye trauma.

[Luke]

The loose epithelium is likely the cause. Find an ophthalmologist who will remove the loose cells and then place an amniotic membrane on the cornea.

Thanks for your advice.

They told me to deal with the symptoms for a few months and, if there's no improvement, they'll look into surgical options. A loose epithelium would explain why the pain is most acute upon waking and gradually gets better throughout the day. Do you know the success rate of surgery? Also, I've read on wikipedia to consider the following options:

- Not sleeping in late
- Opening eyes slowly
- massaging eyes while closed before opening
- Use a humidifier
- Changing your diet
- and so on

But is there any evidence that these actually make a difference?

[indrep]

The success rate is very good using amniotic membrane. I have not seen a formal study, in speaking with doctors who perform the procedure I would say its 95-97% successful.

[Luke]

Update for anyone interested:

I went for another checkup and I've been additionally diagnosed to have tears which don't quite provide sufficient lubrication. I don't recall the exact terminology. Anyway, I've been prescribed oral Doxycycline once a day as well as FML eye drops four times a day. Presumably this is based on the following study if anybody wants to read it: http://www.ncbi.nlm.nih.gov/m/pubmed/18290949/ There's another mention of a study here http://www.reviewofoptometry.com/con...utics/c/38713/ but for anyone suffering from RCE in the future, note that the patients in the study all suffered from traumatic etiologies; the sample did not include any dystrophic cases of RCE. The success rate of the treatment is quite high, but the sample size is also quite small.

I also bought a humidifer last week but it doesn't seem to make any difference. I asked my doctor about the various ideas floating around on the internet (eg., using olive oil, changing diet, drinking lots of water, massaging your eyeballs upon waking...) and he wasn't so impressed. It is probably psuedoscience and not useful to people suffering from RCE. RCE is entirely a problem of lubricating the eye. I did suggest changing my sleeping cycle so as to sleep less, or at least in shorter periods. The doctor said sleeping less might work but I'd obviously be really tired.This RCE is really disrupting my life, and I need to work, so I might try a biphasic sleep cycle and see if that makes any difference, depending on whether or not the current oral and eye drops treatment mentioned above works.

[Luke]

Update:

So the first day I tried the eye drops and Doxycycline I had no symptoms the next morning. The morning after I had an erosion. This morning i have none. The morning I did, it was the hottest day in the UK and it was dry as a desert and I slept in late and didn't put lubricating gel/eye drops in m eye before I opened my eye. I'll try to figure out which, if any, factors actually affect my erosions. So tomorrow for instance I might try sleeping in late but also putting in eye drops and lubricating before opening my eye.

[HEBS]

My eyes keep sticking. For the last few days its been the right eye. every time I blink I can feel my eyelid sticking to my eye ball. Ive been given nothing by the ophthalmologist and have been told to keep using the heated eye mask which isnt really helping my eyes. There' s still not a lot coming out of them. Im at my wits end with it.

[Amyfloor]

I make sure I put in drops before I open my eyes in the morning. I put several in each corner and then make sure they are well lubricated because erosions are very easy to acquire with DES I don't care how long the alarm goes off for as I am fumbling around to shut it off!!

[Luke]

I make sure I put in drops before I open my eyes in the morning. I put several in each corner and then make sure they are well lubricated because erosions are very easy to acquire with DES I don't care how long the alarm goes off for as I am fumbling around to shut it off!!

I'm sorry to hear you're going through some trouble.

I'm not recommending you any particular drugs or surgeries because it depends on your individual situation, but for me I've definitely found Doxycycline and FML eye drops have alleviated my symptoms somewhat, but I still have some minor erosion and photo-sensitivity.

Update if anyone finds this useful in the future:

I have discovered upon independent research (and I wasn't told this when i was given the Doxycycline) that Doxycycline is not effective if taken with diary products. So don't take Doxycycline with your cornflakes in the morning. Again, Doxycycline hasn't been proven to work if the RCE is caused by an underlying dystrophy.

I tried sleeping for equal time per 24 hours but in shorter bursts, and it may have helped but honestly I only tried it one or two times so it's too early to say if that helps.

I've also tried cleaning my eyelids a little and massaging my tear ducts which may help produce better quality and quantity of tears, but honestly I don't know how pseudo-science that stuff is.

In all, my symptoms are better but not yet fixed, but I'd probably put that down maybe entirely to the Doxycycline, Lacri-lube and FML eye drops. I don't know if the Doxycycline takes a few weeks to be fully effective so I'll continue to update in the coming weeks.

[Luke]

Update:

I have no symptoms of RCE at all. I still take the doxycycline, FML eye drops and lacrilube at night. Vision in my eye is still a little blurred. I think that's down to the sagging of my epithelium which should hopefully heal in a matter of months.

[Luke]

I wonder why he says he has no symptoms, after he said he had symptoms. Me, I have sagging epithelium all over my body, but it is, in my case, an old-age thing. I guess he means the upper layer over the cornea portion of his eyeballs. I dunno what lacrilube is, but if it is eye-guk similar to the Genteal Gel used by me, it is probably making his eyeballs better -- for reasons that nobody seems to understand. (If a doctor told me that I have sagging epithelium in my eyes, I would question his credentials!)

The reason 'he' said that is because my words were 'no symptoms of RCE at all'. In other words, after taking the medication, my cornea no longer recurrently erodes. That's not to say I don't have other ailments.

You're right that when I said epithelium I was referring to the outermost layer of the cornea on the eye. Apologises, the epithelium does refer to some kind of tissue over the body as well, but I thought it would be clear which epithelium I was referring to from context.

Lacrilube is some lubricant as you say. The reason it can work is that you put it on your eye so your epithelium and eyelids have less friction and therefore the chance of an erosion is less. I don't know if it's like the Genteal Gel you use, but I'm sure a Google search will tell you.

The doctors at John Radcliffe hospital in Oxford have been very good actually, especially considering they seemed to have cured me of RCE (for now). Obviously 'epithelium sagging' sounds a little silly, but it was a layman explaination for me to explain what was going on. They clearly understand it better than that, but the gist of my RCE problem is an epithelium that's a little saggy and clumpy and not that smooth, so my eyelids are prone to tearing it.

[Luke]

Hello Luke: Well, Lacrilube is vaseline and mineral oil. You could make your own and save some money. It is hard to get grease out of your eye, and fuzzes vision. Maybe you would like better the kind of drop based on cellulose gel? It only fuzzes vision momentarily, and then seems to flatten out over the eyeball.

Luke, I seriously believe that when things, for some unknown and unlikely reason, go right, one should try to find out why and, in the interest of mankind, make a record available. But frankly, Luke, your report of success in overcoming friction between eye and eyelid, as the result of having good doctors and good medicine, is unsatisfying.

Luke, why do you think that friction occurred in the first place? Do you think it could have been the result of something that happened during surgery? Could you speculate upon that? It seems that wild guesses are OK here.

I would be very, very weary of making your own gel to put in your eye. The reason I use lacrilube is because the medically qualified doctors told me to.

I'm glad we share the same goals Dicky. I wanted to write about how it went for me because too many people online talk about rubbing Virgin olive oil on their eyes, or how homeopathy cures them. That sort of stuff isn't helpful, so I'm glad you're telling me my explanation isn't satisfying either, so that I can improve it. No worries.

Again, I'm only parroting in layman's terms what the doctors have said. It's not wild guesses.

Now, googling and looking at some medical journals or websites would be a better idea, but from what I understand, RCE could have two underlying causes: (1) trauma or (2) distrophy. Trauma, which I had, is when you scratch your cornea and then it does not heal properly. Disrophy is when it's not built properly to begin with. Now, in the trauma case, the cornea doesn't heal smoothly and properly, so when your eye dries out or swells, your eyelids can cause friction on the epithelium and tear it. Then the abrasion heals but not properly. And the problem continues over and over. It's particularly bad when you sleep because your either dry your eye out by not closing them properly, or they swell due to lack of oxygen. Again, this is nothing to do with my OIL surgery (in my case but maybe not in general). By not healing 'properly' I mean the epithelium (top layer of the cornea) isnt smooth and/or doesn't anchor down to the layer of cells below. This doesn't mean RCE (for trauma) isn't curable: if you have no abrasions for a year or so there's a decent chance your cells have time to heal properly and anchor down.

The reason lacrilube helps is that it's a long-lasting gel to keep your eye moist during the night. FML eye drops help by reducing swelling. Finally, doxycycline helps by improving the quality of your tear film to reduce dryness. This is all peer reviewed science that works. It's not wild guesses.

[Rebecca Petris]

Luke, I seriously believe that when things, for some unknown and unlikely reason, go right, one should try to find out why and, in the interest of mankind, make a record available. But frankly, Luke, your report of success in overcoming friction between eye and eyelid, as the result of having good doctors and good medicine, is unsatisfying.

...It seems that wild guesses are OK here.

DickyA:

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