Good Hope, Heartlands, and Solihull Eye Clinics

Recurrent corneal erosion  (abrasions)

David Kinshuck

What is a recurrent corneal erosion?

Corneal abrasion
(green when seen with fluorescein drops)

Recurrent corneal erosion is like a scratech in the surface of the eye. It is a painful eye condition, It is caused by a scratch on the surface of the eye in the previous months, that does not heal prperly and 'recurrs'. The eye heals quickly after a few hours or days.

It occurs becuase the first injury does not heal  perfectly and the 'scratch' returns over the next months for no apparent reason. Often the eyelid sticks to the surface of the eye during he night, and when you try to open the eye it pulls on the surface making a tiny rip.

This page describes what is happening, and how you can reduce the number of recurrences.


The cornea, and the corneal epithelium

corneal epitheliumthe cornea, and its epithelium, shown in red enlarge

The cornea is the transparent 'window' of the eye at the front.

It is covered with a very thin skin, the epithelium.






The original injury, the abrasion

the corneal injury..the abrasion  enlarge

Typically the condition starts when the surface of the eye is scratched, possibly by a finger nail. A patch of epithelium is scratched off or wrinkles up, leaving a bare patch of cornea.

As the cornea has many nerves, this injury feels exquisitely painful, like a needle.

The abrasion always heals and the pain goes.

The healing takes 1mm a day from each side, so a large 7 mm abrasion takes about 4 days, less in children, longer if you are older.




The examination

Recurrent corneal abrasion
green when seen with fluorescein drops , but are sometimes difficult to see

microcysts from

When a doctor looks into your eye, even with the microscope slit lamp in the Eye Department, it may be very difficult to see the injury.

Sometimes it may not be apparent at the first examination. The doctor or nurse uses a yellow dye, called fluorescein, to examine your eye, and this dye sticks to a bare patch of cornea if there is one.

There may not actually be a bare patch ..the cornea may just be wrinkled and very loosely attached. Occasionally there is an underlying map-dot-finger-print dystrophy (genetically inherited sometimes), or epithelial microcysts.





What is happening?

there are tiny pegs that hold each cell in place




blepharitis with blocked glands causes irregular tears and may help to cause recurrent abrasions

Normally the epithelium sticks down to the layer underneath (the basement membrane) firmly. Tiny pegs underneath the cells that make up the epithelium keep the cells stuck on to the basement membrane.

This is like painting on a wall: if you paint on the undercoat first, and then paint on the top coat, when the paint dries it will be well stuck down.

However, these pegs may take 6-12 months to reform properly after the original injury. During this time the epithelium may be prone to slipping and sliding, and this slipping and sliding causes this condition.

This is like painting on a bare surface with a 'top coat' of paint, when there is no 'undercoat'. The paint will dry but peel off really easily.

A few people will this condition have inherited genes that make this sticking process faulty, but this is quite unusual.

Certainly if your condition keeps happening year after a year a corneal specialist may detect this condition.

A second reason for the faulty sticking may lie in your tears.

The glands in your eyelid, especially your lower lid, make secretions that help tears to spread. If these glands get blocked, your tears do not spread properly, and the eyelid may stick to the epithelium and pull it off before the pegs have firmly fixed it in position.

If you clean your lids as below, the glands start to make their secretions again, and the process stops.

In addition to the regular cleaning of the eyelids, sometimes using a cream at night can stop the sticking (the 'sticking' of the eyelid to the epithelium occurs when you wake up in the morning).

There is damage to the corneal nerves and poor tear function IOVS20.


The injury returns: the 'recurrent erosion'

the original abrasion, very painful indeed

All of a sudden, perhaps a month after the first injury, your eye starts to feel exquisitely painful again.
It is as though the first injury recurs all by itself. Again this injury heals, and your eye starts to feel comfortable again.

If the patch of cornea with the recurrent abrasion is small, as it usually is, your eye may heal after a few hours.
A larger patch will take days to heal.
Occasionally, you may not remember the original injury, and all of a sudden the condition develops.

The 'recurrent erosion syndrome may be related to

  • collagen under bowmans and stops hemidesmosome function and get reduplication of bowmans
  • Map dot finger print dystrophy, Granular dystrophy, Granular dystrophy even after graft ..delaminate if superficial, catch early, Thygersos, genetics 19

Typical treatment for corneal abrasion

  1. chloramphenicol ointment 4 times a day at night for 4 days (longer for a larger abrasion)
  2. continue chloramphenicol ointment at night for 3 weeks as a lubricant
  3. cyclopentolate 1% twice daily for 2 days then
  4. cyclopentolate 1% at night for 1 week, then stop
  5. stop smoking as it delays healing (electronic cigarettes much, much safer)
  6. note cyclopentolate...
    • halves the pain, but blurs sight (poor near vison)
    • twice a day when eye painful, only at night when no ache
  7. pad eye/bandage contact lens if severe
  1. if using a a bandage a contact lens
    • bandage contact lens pure vison 2  14mm for all corneal problems licenced 30 days
    • change lens every 2 weeks if possible
    • use chloramphenical minims if there is an abrasion present

To prevent a cycle of recurrences

  • treat the abrasion as above
  • stage 1
    • NaCl 5% 4 times a day (this is very safe and dehydrates the cornea helping the epithelium to stick)
    • lubricants every night : VitaApos
    • if there is blepharitis: lid hygiene (see below) usually helps (with or without antibiotic cream)
    • 1-4 hourly preservative free drops, such as Hylofort (many others, see)
    • try for 3 takes 3 months for the epithelium to adhere
    • stopping smoking will  make a recurrence significantly less likely
    • FML 3 times a day may help...this is a low dose steroid that also has a special effect of helping  tears to spread (similar to doxycycline below)
  • stage 2
    • doxycycline 100mg once a day (not if you are pregnant)
      It takes a few weeks to work, and works for several weeks after it is stopped. One 3 month course is usually helpful, but occasionally longer treatment is needed.
    • refer to Monday pm Mr Barua's ARC (acute referral corneal) clinic.
  • stage 3
  • Healthy diet, as for blepharitis, standard healthy diet, may help a little
    • portions of vegetables/day
    • 2 portions fruit
    • fish, especially oily fish, small portions twice week (eg salmon, tuna, sardine, mackerel, tuna, trout)
    • very little saturated fat and transfats (saturated fat: dairy food, red meat (beef, lamb, pork))
    • pulses such as soya beans, other beans, lentils, have plant sterols..these lower cholesterol
    • no added salt, no sugar (cakes, chocolates, sweetened drinks)
    • vitamin achieved by walking 1-2 hours in daylight
  • other treatments, review
  • cyclosporine drops 19

Lid hygiene

Very brief

  1. Heat compresses and massage twice a day
  2. Blephaclean or blephasol twice a day
  3. Preservative free lubricant
  4. vitaPos night

More details

  • The cleaning helps to reduce the number of bacteria in the glands of the lid. This is the same treatment as for blepharitis and reduce all sorts of lid problems.
  • Gently clean with a cotton bud, looking in mirror

    Gently clean with Blepharaclean wipes ( or a cotton bud if unavailable), looking in mirror, pull the lower eyelid down with the index finger of one hand, and gently but firmly wipe the wipe or bud along the edge of the lid to scrape the debris off. With your chin up try the same on the upper lid, but this is harder.

  • Cleaning: clean lids with Blepharaclean wipes (these can be bought or obtained from a doctor's prescription, or if unavailable a cotton bud). Clean the edge of the eyelids (the eyelash edge) with the wipe or wet cotton bud. Gently scrape off the debris moving the wipe/bud side to side. If using a bud, warm tap water is usually quite safe. The Blepharaclean wipes are probably more effective.
  • Bathing: warm compresses with an 'Eyebag' hot compress: these can be bought or obtained on prescription, and one lasts a long time (or similar compress, there are may brands). If you don't have a compress or a microwave, use clean face cloth soaked in warm water, as hot as your eyelids can stand. Bath the eye (closed) for 5-10 minutes. Re-warm the cloth if it gets cold. This makes the debris easier to remove, as below.
  • massaging: gently pull the low lid down and (using a mirror) gently press on the lid margin moving fingers over the bone under the lid. (see text   YouTube video) WIth the upper lid this is much harder ..try to gently press on the upper lid. Repeat this over 30 seconds. Try to express he secretionsin the glands by massaging towards the edge of the lid.


Other treatments

  • If the patch of epithelium is very loose, your doctor may scrape it off to allow fresh epithelium to grow in: this often helps. This is called debridement.
  • There are more complex treatments available from corneal specialists, such as alcohol delamination but these are not usually needed and not discussed here.
  • Some experts recommend contact lenses (see and here and here).
  • There is one report botulinum toxin may help by closing the eyelid more completely at night, but this would not be necessary for most patients.
  • there may be an underlying corneal dystrophy and here.

What to expect

Typically you may notice recurrences even with these 'preventative' measures, but gradually the painful episodes become fewer with longer between. Also, instead of the pain lasting hours, your eye should start to heal more quickly, perhaps after half an hour.

Over a year you should start to feel a lot better, and have very little problem then.