Approaching corneal erosion treatments

Buffalo, NY-There are a number of therapeutic options available for managing eyes with recurrent corneal erosion (RCE) syndrome, and a treatment algorithm developed by James J. Reidy, MD, prioritizes their use based on lesion characteristics.

“Many treatments have been described for eyes with RCE syndrome, and most work well, with an average success rate of about 75%,” said Dr. Reidy, clinical professor of ophthalmology, The State University of New York School of Medicine & Biomedical Sciences, Buffalo. “However, no one treatment is effective 100% of the time nor stands head and shoulders above the rest.”

The first step in the treatment algorithm divides lesions based on whether they are microform or macroform erosions. To manage microform erosions representing a first episode, Dr. Reidy said he begins conventional therapy with topical lubrication using artificial tears during the day and an ointment (5% hypertonic saline, preservative-free lubricant) at night. For recurrent microform erosions, he prescribes oral doxycycline for 60 days combined with a mild topical corticosteroid for 2 to 3 weeks.

“This combination of oral and topical anti-inflammatory treatment was first described by Dursun al. in 2001, and it has had a dramatic benefit in my practice for decreasing the need for surgical intervention,” Dr. Reidy said.

Management of a first episode of a macroform erosion involves manual epithelial debridement with a blade or ethanol delamination followed by application of a therapeutic bandage contact lens and conventional treatment. Recurrent macroform erosions are debrided with a diamond burr polish or treated using excimer laser phototherapeutic keratectomy or anterior stromal micropuncture.

“Diamond burr polishing should be done was light buffing, and it is probably safer to use a battery-operated tool,” Dr. Reidy said, adding that he will not use the diamond burr or micropuncture techniques if the erosion involves the central cornea.

“However, 87% of recurrent erosions are in the lower third of the cornea, outside the visual axis,” Dr. Reidy said.

Eyes that undergo surgical intervention are covered with a bandage contact lens and treated with a topical broad-spectrum antibiotic until the epithelium is healed. In addition, cycloplegic drops and a topical NSAID drops are prescribed for the first 24 to 48 hours to enhance patient comfort. Patients are also instructed on use of topical lubrication for 3 months after the epithelium has healed.

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