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Medical Forum / General / Vision / June 2004

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Corneal Erosion - My Story - What Now?

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Mjbj693 - 25 Jun 2004 06:23 GMT
Hello - I'm having a bout of Corneal Erosion in my right eye and I'm not sure
what to do now......here's my story, rather long but all advice woudl be
greatly appreciated as I'm now afraid to go to sleep at night and open my eyes
in the morning....

Nine months ago I got the usual accidental minor finger poke in the eye with
minor pain and had a corneal abrasion that healed rapidly in around 3-4 days.  
No need to see a doctor for that as I have had abrasions in my other eye many
times before......Problem over....not quite.....

(side note....I've never seen any articles on this before but I sleep on my
stomach with my right eye slightly pressing against the pillow.....I don't know
if this has anything at all to do with the fact that I've never had a problem
with abrasions in my left eye turning into erosion where the first right eye
minor abrasion is now erosion.  I do try and keep my right eye off the pillow
even though I still usually sleep on that side...not sure if it matters though
since I use ointment).

Around a month later or so I woke up in the morning with a slight pain of what
felt like a minor abrasion.  So, I closed my eyes and relaxed for an hour and
it was gone....like magic....I assumed it was nothing....but it happened the
same a way a few more times and the conditions slowly started to get worse.....

Next, about four months later while on vacation (seems like these bouts get
worse on my vacations....must be the dry climate...) I got it a day prior to my
vacation, layed down for an hour as usual and the problem went away.....This
time, it returned with a vengeance two days later while on vacation rather than
the usual few weeks to a month.  It was nasty and boy did it HURT!  Informally,
I spoke to an ophthalmologist on vacation and he said I should see an eye
doctor when I get back from vacation for it sounded to him like Corneal
Erosion....  When I got back over the weekend it was so bad that I had to go to
urgent care.....Once again.....my story is not unusual....diagnosis...pink eye
and conjunctivitis in spite of the fact that I told the doctor on call that it
could be Corneal Erosion  (has he even ever heard of this condition)?  Two days
later I saw an ophthalmologist in my area and he confirmed the Corneal Erosion
and had me put Muro 128 in at night....After a few follow up visits a month
later he said everything looked good and to stop using the Muro 128 as I was
healed......Two days before he said that I had a very very slight scratchy
feeling in my eye in the morning but it rapidly went away within 30-60 minutes.
I mentioned this to him but he said I was healed.......I disregarded his
advice and continued using the Muro as I knew that I was not healed and the
concept of the top eyelid sticking to the eye in the morning made a lot of
sense to me as to the cause of Corneal Erosion.  Also - I've heard so many
others who are on Muro for at least 3-6 months or longer....so I stayed with it
at night only.  I do not use any drops during the day as my eyes do not feel
dry during the day and I'm fine so long as I'm not battling an episode of CR.

During the next 5 months I had 2-3 minor episodes in the morning of what felt
like a scratchyness but not an abrasion as my vision was not affected.  It was
almost like a salty feeling as if it was Muro 128 feeling as if it solidified
in my eyes as rock hard salt.  But that was just the feeling and I know that
was not happening and was probably just minor occurrences of the CE.  So I
battled that for anywhere from an hour to a day.  Now....here's where Corneal
Erosion completely betrays and deceives me......yes....another business
vacation......I had another minor morning bout of that wierd scratchyness
feeling in my eye right before vacation so I went back to my eye doctor and he
said everything looks fine and that we would just minitor it.  So, I'm off that
day on vacation.  The following day I felt that scratchyness again in the
morning....first time I've felt it two days in a row.......now I'm
deceived....everything I read about how CE is worst in the morning and gets
better throughout the day falls apart as the pain INCREASES on day one on my
vacation to the point where it very much feels like another corneal abrasion at
night and I'm on the phone calling my eye doctor for the person on call to
help.....next morning I see an eye doctor in the area where I'm on vacation and
he confirms its just more corneal erosion (no infection).  But this was much
worse...this bout has lasted over a week and my vision is still slightly
blurred and there is slight discomfort in my eye 10 days later.....The eye
doctor I saw on vacation was very knowledgeable and put an bandage contact
lense in my eye to keep the eyelid from sticking and provide me with comfort.
That along with refresh drops in the day helped to once again heal the CE.  
This doctor said that the condition would REOCCUR again.....and I needed to
either have the needle poking or laser or some surgery........When I returned
from vacation a week later after seeing the doctor on vacation several
times.....my doctor back at home said my eye looks like it is healing well and
to go back on the Muro 128 and no surgery is necessary at this time......Now
what?  One doctor tells me it's going to happen again while mine at home tells
me to wait it out.   I did read somewhere on the internet that most CE episodes
that do not involve the Bowman membrane heal in a day or two otherwise when the
Bowman is involved it can take a week or longer.   Seems like this could be my
first CE episode that has involved the erosion of the Bowman.  So, what now?
I'm not sure if this massive CE episode is my body's way of sludging off more
of the corneal cells so that I get better adhesion and I'm healed or am I now
in store for yet more painful episodes of CE?  Should I get a third opinion?
Should I see a corneal specialist?  If so, how do I find them?   My eye doctor
took the soft contact lense bandage out of my eye today and so now I'm afraid
to go to sleep at night knowing the eyelid could stick again.  Worse yet, how
does one "slowly" open their eyes in the morning and stop if it sticks?  Do we
just drence the eye with drops first and then pray and open?  Uggg......this
condition is dabilitating when it breaks out and when it's yet again healed
causes anxiety.........All advice most appreciated.....Thanks.
David Robins, MD - 25 Jun 2004 07:09 GMT
Corneal erosions can appear well-healed and still recur, because you cannot
see the hemodesmosomes that anchor the epithelial cells. The sheet of
epithelium looks smooth, but it can be easily pushed around when it is not
anchored well.

I use an artificial tear ointment at bedtime for 2-6 months, rather than
Muro128, which is a hypertonic 5% NaCl ointment. The Muro128 is useful when
there is epithelial edema preventing healing. A bandage contact lens helps
acutely to speed healing and comfort.

The indication for further treatment is if there is enough irritation due to
recurrences to want to have treatment. Next step is to either remove the
epithelium with a dull-edged spatula (which may let it heal in better then),
or to do anterior stromal puncture. The punctures are very microscopic, and
create tiny scars that help anchor the epithelium. It is done with a tiny
needle. It is best not to use it in the visual axis, as it may cause glare
symptoms. Most general ophthalmologists are able to do this - I have done it
a number of times. A bandage lens is generally applied afterwards. It is
best to do stromal puncture right when it happens, so the borders of the
area can be seen, before it starts healing in.

Finally, if this is still not enough, excimer laser PTK (photo therapeutic
keratectomy) can remove the entire Bowman's membrane, hopefully letting it
recreate itself and heal more thoroughly. This treatment is generally done
only by a corneal specialist.


David Robins, MD
Board certified Ophthalmologist
Pediatric and strabismus subspecialty
Member of AAPOS
(American Academy of Pediatric Ophthalmology and Strabismus)

On 6/24/04 10:23 PM, in article
20040625012325.11616.00000436@mb-m11.aol.com, "Mjbj693" <mjbj693@aol.com>
wrote:

> Hello - I'm having a bout of Corneal Erosion in my right eye and I'm not sure
> what to do now......here's my story, rather long but all advice woudl be
[quoted text clipped - 100 lines]
> condition is dabilitating when it breaks out and when it's yet again healed
> causes anxiety.........All advice most appreciated.....Thanks.
Alvin - 29 Jun 2004 23:17 GMT
> Hello - I'm having a bout of Corneal Erosion in my right eye and I'm not sure
> what to do now......here's my story, rather long but all advice woudl be
[quoted text clipped - 86 lines]
> condition is dabilitating when it breaks out and when it's yet again healed
> causes anxiety.........All advice most appreciated.....Thanks.

MJ,

I have this condition as well so I can totally relate to your
frustration and pain.  I visited the opthomologist 30 times last year,
and he would just rush me out the door without offering any good
solutions.  Muro is crap.  SOmetimes it even triggers erosions in my
eye.  There is no clear explanation or pattern for what triggers
erosions.  I have noticed that I get the worst bouts in the spring,
summer is a huge relief.

I recommend using genteal gel at night.  It is soothing and keeps the
eye well lubed.  Try alternating between this and the muro.  Also, I
would be very cautious about the puncture procedure.  They don't tell
you about the severe eye pain  that takes 24 - 48 hours to dismiss, or
that the procedure can leave permanent scars that might affect your
vision.
Dr. Leukoma - 30 Jun 2004 02:00 GMT
> MJ,
>
[quoted text clipped - 12 lines]
> that the procedure can leave permanent scars that might affect your
> vision.

I concur with what has already been said.  RCE is a chronic condition and
must be treated as such.  There is not much you can do once you get one.  
The treatments are: bland ophthalmic ointments every night for prophylaxis;
stromal puncture; diamond keratectomy; phototherapeutic keratectomy with an
excimer laser.  In my research, I have found that diamond keratectomy and
PTK are the best, but that PTK is better than diamond keratectomy as far as
preventing future events.  However, if you are averse to surgery, using an
ointment every night should help prevent major events.  Muro128 is helpful
to reduce edema and tighten the epithelium after an acute episode.

DrG
 
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