RECURRENT CORNEAL EROSION SYNDROME

It is a common clinical disorder involving the corneal epithelium and epithelial basement membrane. Characterized by the repeated breakdown of epithelium,it can cause moderate to severe eye pain, photophobia, lacrimation, and corneal scarring leading to visual changes.
Initial cause may have been traumatic, but underlying epithelial dystrophy may also be present
Repair of epithelial basement membrane and associated epithelial adhesion complex takes around three months if largely undisturbed

SYMPTOMS 

• Mild to severe pain.

• Discomfort.
• Watering
• Redness.
• Photophobia.
• Foreign body sensation.
• Slightly blurred vision, if the visual axis is affected.
• Diminution of vision.
• diplopia.
• Astigmatism.
• Epithelial blebs.

CAUSES 

Primary

Epithelial basement membrane dystrophy

• Cogan’s micro-cystic (map-dot-fingerprint) dystrophy (most common dystrophy causing RCES).

Dystrophy involving Bowman’s membrane

• Reis- Bϋcklers dystrophy.
•  Thiel- Behnke dystrophy.

Stromal dystrophy

• Lattice dystrophy.
•  Macular dystrophy.

 ACQUIRED

Degeneration

•  Band shaped keratopathy.
• Salzmann’s nodular degeneration.

Trauma          

•  Traumatic epithelial abrasions.
•  Chemical and thermal injury.

Eyelid pathology

1. Ectropion.
2. Entropion.
3. Floppy eyelid syndrome.
4. Lagophthalmos.
5. Meibomian gland dysfunction.
6. Blepharitis.

Following ocular (eye) infection

1. Bacterial keratitis.
2. Viral keratitis.

Following refractive surgery 

Systemic causes such as

•  Diabetes mellitus.
•  Epidermolysis bullosa (a mucocutaneous autoimmune disease).

DIAGNOSIS:

• slit- lamp-microscopy
• Test for epithelial adherence: Epithelial adherence may be tested with a dry cellulose sponge
• Corneal topography (using computerised videokeratography)
• Confocal microscopy
• Electron microscopy

HOMOEOPATHIC MANAGEMENT:

1. Euphrasia – corneal ulcer. In cases needing it there is redness and puffiness in the eyes. excessive clear mucus or thick mucus like pus discharge from the eyes. Sensitivity to light (photophobia.  pain in the eyes when exposed to light. Burning sensation in the eyes may attend it. There is a feeling of a foreign substance in the eyes

2. Hepar Sulph –  superficial and deep ulcers on the cornea. Additionally there is intense sensitivity to the light. Pain in the eye is also there which worsens at night time most of the time. For using it the pain can be aching, stinging or throbbing in nature.

3. Merc Cor – excessive itching and burning sensation in the eyes. Small ulcers are present on the cornea. Intense pain is felt in the eyes along with this. Eye discharge and sensitivity to light also occurs. Sometimes there is marked dryness in the eyes.

4.Arsenic Album – needle-like pricking pain in the eyes. ulcers are present on the outer side of the cornea with elevated edges where this medicine is required. Violent burning pains in the eyes can also be present.This is mostly felt in the afternoon. Eyes are inflamed too. 

5.Calcarea Sulph – deep ulcers are present on the cornea. Cases that need it present with thick yellow pus discharge from the eyes. The cornea looks smokey. A sensation of a foreign body in the eyes is felt. Eyes are inflamed with this. The eyes look red along with heated sensation. 

6.Merc Sol – copious watering and burning sensation in the eyes. For using it the watering may be worse in the evening time. The eyelids may stick together at night hours. With this there is itching and tickling in the eyes. worsens in the open air. Pain of shooting nature in the eyes is also present. excessive sensitiveness of eyes to light. eyelids are red, inflamed and swollen..

7.Nitric Acid – excessive eye watering, eye redness and  sensitivity to light. The eyelids are inflamed and swollen. Next burning sensation is felt in the eyes. Aching or stitching pain in the eyes may be felt too. Another symptom is a biting and stinging type of pain in the eye. Lastly the eyes may be painful and sore to touch along with the above symptoms.