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Recurrent Corneal Erosion

Recurrent Corneal Erosion

Recurrent Corneal Erosion: Causes, Symptoms & Treatment

Recurrent corneal erosion causes sudden eye pain, especially on waking. Learn how Ontario optometrists diagnose and treat this condition.

What It Is 

Recurrent Corneal Erosion (RCE) is a painful condition where the outer layer of the cornea (epithelium) repeatedly loosens or peels away from the underlying tissue. 

The cornea — the clear, dome-shaped surface at the front of the eye — is one of the most sensitive parts of the body. When the epithelium fails to stay properly attached, it exposes nerve endings, leading to sharp pain, tearing, and light sensitivity. 

Symptoms are often worst upon waking. During sleep, the corneal surface swells slightly and can stick to the inner eyelid. When you open your eyes in the morning, the fragile tissue may loosen or tear off, triggering sudden pain. 

 

Who It Affects / Causes 

RCE can happen to anyone, but it’s most common in adults with a history of eye injuries or corneal dystrophies. 

Common causes include: 

  • Previous corneal trauma (e.g., a scratch from a fingernail, paper edge, or plant) 
  • Corneal dystrophies — inherited conditions that weaken corneal structure, such as map-dot-fingerprint dystrophy (EBMD) 
  • Dry eye or poor tear quality, which makes healing harder 
  • Eye rubbing or overnight eye dryness 
  • Contact lens overwear or past infections 

After an initial injury, the cornea may not heal smoothly, leaving tiny areas where the epithelium can peel again — sometimes months or years later. 

 

Symptoms to Watch For 

  • Sudden sharp eye pain, especially upon waking ⏰ 
  • Tearing and watering 💧 
  • Light sensitivity (photophobia) 🌤️ 
  • Blurry or fluctuating vision 👁️ 
  • Foreign-body sensation (feeling like something is in your eye) 🪶 
  • Redness and discomfort that lasts hours or days 

These flare-ups can occur once or several times a year, and though symptoms usually subside, repeated episodes can affect vision and quality of life. 

 

How It’s Diagnosed 

Your optometrist will perform a comprehensive eye examination to confirm RCE and rule out other causes of pain. 
Diagnosis typically includes: 

  • Slit-lamp examination — to view loose or damaged epithelial tissue 
  • Fluorescein dye testing — to highlight erosions on the corneal surface 
  • Assessment for corneal dystrophy or prior injury 
  • Evaluation of tear quality and eyelid health 

Because RCE can recur unpredictably, ongoing follow-up is important to monitor healing and prevent future episodes. 

 

Treatment & Management 

Treatment depends on the severity and frequency of symptoms. The goals are to relieve pain, promote healing, and prevent recurrence. 

💧 Lubrication & Protection 

  • Non-preserved artificial tears used frequently during the day 
  • Lubricating ointments before bed to reduce friction/sticking overnight 

🩹 Acute Management 

During a flare-up, your optometrist may prescribe: 

  • Antibiotic drops or ointment to prevent infection 
  • Anti-inflammatory or pain-relieving drops 
  • Bandage contact lenses (soft, oxygen-permeable) to protect the cornea and aid healing 

🔁 Prevention of Recurrence 

For recurring cases, long-term therapies may include: 

  • Hypertonic saline drops or ointments to reduce corneal swelling 
  • Treatment for underlying dry eye or blepharitis 
  • Eyelid hygiene and warm compresses to support tear quality 

⚕️ Advanced Treatments 

If conservative therapy isn’t enough, an ophthalmologist may perform one of the following minor procedures: 

  • Anterior stromal puncture (ASP) — tiny, controlled punctures that help reattach the epithelium 
  • Phototherapeutic keratectomy (PTK) — a laser treatment that smooths the corneal surface 

With proper management, permanent vision loss from RCE is rare. 

 

When to See Your Optometrist 

Book an appointment immediately (same day) if you experience: 

  • Severe eye pain or tearing upon waking 
  • Recurrent eye irritation that comes and goes 
  • Blurred vision or light sensitivity 
  • A history of eye injury followed by ongoing discomfort 

Early diagnosis and treatment can greatly reduce pain and prevent long-term recurrence. 

 

Related Topics 

  • [Corneal Abrasions and Injuries] 
  • [Anterior Uveitis] 
  • [Contact Lens Safety] 

 

Resources & Programs 

  • [OHIP Coverage for Eye Exams] 

 

💙 Book an Eye Exam — Recurrent corneal erosion can be painful, but with proper care and prevention from your optometrist, healing and comfort are possible.