Pearls: Management of Recurrent Corneal Erosion

Pearls: Management of Recurrent Corneal Erosion

Pearls: Management of Recurrent Corneal Erosion

By Paul M. Karpecki, OD, FAAO

Recurrent corneal erosion (RCE) is an important aspect of clinical practice, as well one of the topics that we cover in the Eyecare Educators’ course on Ocular Surface Disease. Consider the following pearls when dealing with RCEs.

First if there is an abrasion, cover with an antibiotic (such as a topical fluoroquinolone given as directed in the prescribing information) and a bandage contact lens until healed. Once the cornea is reepithelialized, one of the most successful regimens I have found for the treatment of RCE is as follows:

• Muro 128 (5% NaCl) ointment at bedtime for 2 months. This helps reduce overnight edema and improves epithelial adherence just prior to the morning (when most RCEs occur).
• FreshKote drops three times a day for 2 months. (The regimen can be maintained longer to prevent recurrences). The FreshKote liquid bathes fresh epithelial cells in fluid and reduces microcystic edema; and the high concentrations of polyvinyl alcohol and polyvinyl pyrrolidone help to heal damaged cells.
• Lotemax (loteprednol etabonate 0.5%) four times a day for 2 weeks, then twice a day for 6 weeks (check intraocular pressure within 1 month). Studies have found that corticosteroids (and tetracyclines) inhibit MMP-9 and other enzymes that are known to cause epithelial breakdown in RCE.
• Oral doxycycline (either 20mg or 50 mg) twice a day for 2 months. (Sometimes I omit the doxycycline in acute, but not in recalcitrant, cases.)

Long-term, management, especially in cases of epithelial basement membrane dystrophy, should include:

• Restasis (cyclosporine 0.05%) twice a day
• FreshKote twice a day or artificial tears with hyaluronic acid such as Blink Tears or Oasis Tears
• Omega-3 free fatty acid supplements three times per day.

My success rate with the above regimen is higher by a significant margin than any other treatment regimen I have tried to date.