Recurrent erosions common

Chicago-Recurrent corneal erosions are common. However, ophthalmologists may not be aware of them unless they probe their patients' history, looking for classic symptoms such as pain in the middle of the night or on awakening.

Recurrent erosions can elude the physician since patients may not be in the middle of an episode when they come to the office, especially if they have minor or microform erosions that typically cause short-lasting symptoms that occur only in the morning, said David B. Glasser, MD, during cornea subspecialty day at the annual meeting of the American Academy of Ophthalmology.

If a patient is not experiencing an acute episode during the office visit, then a history of trauma and symptoms of pain, foreign body sensation, or a sense that the lid is stuck to the globe, which occur at night or on awakening, is suggestive of recurrent corneal erosion, as are objective indications such as slit lamp evidence of anterior corneal dystrophy.

Recurrent erosions may be categorized in several ways. One is to describe them as microform (microscopic epithelial breakdowns that tend to heal quickly) or macroform (larger erosions that last longer, often presenting with a visible abrasion).

Erosions also can be classified by etiology, as either traumatic or dystrophic. Traumatic erosions usually occur after basement membrane damage due to trauma and are most commonly unilateral and focal. Dystrophic erosions are typically bilateral and multifocal or diffuse. The etiology of the erosion influences treatment decisions.

"When you're treating the focal recurrent lesion you have a good likelihood of being able to treat the damaged area and successfully eliminate recurrences," said Dr. Glasser, assistant professor of ophthalmology, Johns Hopkins University School of Medicine, Baltimore, and in practice with Patapsco Eye MDs, Columbia, MD. "When you have a dystrophic lesion you may be able to treat the area that is breaking down today, but the patient may go on to have additional symptoms due to erosions in another area that wasn't apparent the last time you treated."