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Dr. Rick
Dr. Rick, Board Certified MD
Category: Eye
Satisfied Customers: 7851
Experience:  Ophthalmology since 1994 with Retina sub-specialty interest
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I have a recurring eye damage to my right eye in the last

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I have a recurring eye damage to my right eye in the last 2 years( 5 times , no history of trauma to this eye. this is how it play out each time

Day 1. both eyes feel irritated
Day 2. right eye get red around the pupil
Day 3. right eye is extremely painful. like cuts ,impossible to sleep.
Day 3 Go to E & A to see Ophthalmogist.

given anastetic eye drops for the pain and tombrex gel (anti viral)

it takes 5 day to improve .

the specialists at the hospital say that they thought it was a herpes infection.

after that my last visit a few days ago with the same problem they now believe it is not herpes.

went to another optho yesterday , after a 3 minute inspection he said that it was erosion of the cornea , of which the cause is unknown , he said it was very common and will return several times again without reason.

Diabetes is in my family , which i checked last week and shows 115 mg dl fasting .

I went last year twice to a specialist in Rheumatism as i suspected i have a form of Gout. he said my uric acid levels were normal and gout was not the issue, he said it was a form of Rheumatoid arthritis. Now as i speak i have a low level joint pain in my big toe and had the classic big toe pain for gout.

all the specialist ruled out any connection with the above .

bascially they conclude that the eye gets injured by itself for no apparent reason with no other influence from diet etc and just use drops to lubricate the eye every night.

any ideas?
Submitted: 1 year ago.
Category: Eye
Expert:  Dr. Rick replied 1 year ago.
Hi. I'm online and happy to answer your question today. Thank you for the extensive post.

From what you have posted, I have to agree with the second ophthalmologist: You most likely are suffering from recurrent corneal erosion.

As an aside, you should NEVER use anesthetic drops for persistent eye pain. This can cause very serious eye damage...up to and including loss of the eye. This drop should only be used in the ophthalmologists office....

So. Let me tell you a little bit more about what I think is going on in your eye....

Recurrent corneal erosion is a condition where, usually after some type of trauma, the epithelial layer of the cornea ("skin") no longer attaches to the underlying tissue (bowman's layer) and keeps coming loose. Think it as a piece of Velcro, with the epithelium and bowman's layer as the two strips. In recurrent corneal erosion syndrome the little "hooks" in the Velcro are broken. RCES can also be seen as a secondary result of another disorder, such as map dot fingerprint disease.

Drops and ointment are the first line of treatment. The next step is the use of a bandage contact lens at night along with the natural tears. This helps to prevent the epithelium from sticking to the inside of the eyelid, although just taking out the contact can cause an erosion. The next step in treatment is anterior stromal puncture. This is where the ophthalmologist uses a bent 25 gage needle and makes little punctures in the cornea. This is thought to help by allowing the hemidesmosomes (Velcro hooks) to attach better. I would not recommend this if the erosion is in the center of the visual axis as it can leave a small scar.
The next step in treatment is phototherapeutic keratectomy with a laser (PTK). This is the same laser used in Lasik, but used in a different way. In PTK the epithelium is removed from the cornea and the laser is used to remove part of the cells in the corneal stroma. It is thought to work by stimulating the natural regrowth of cells such that these new cells can better attach to the epithelium and prevent RCES.

Is there anything else you would like to discuss at this point or have all your questions been answered to your satisfaction?

I hope this information was helpful for you. But I do work for tips so I want to make sure you are happy with me before rating me. If you have another question on this or a related issue feel free to fire away. And please let me know if the rating system gives you any troubles.

Thanks in advance,

Dr. Rick MD FACS


Expert:  Dr. Rick replied 1 year ago.
I am still available if you have any further questions or comments. Just type in the box on your screen and hit "reply"
Customer: replied 1 year ago.

Hi , Thanks for your reply, my question is this , as i did not have any physical trauma to my eye , can other factors, diet , allergy , Alcohol , Gout , etc etc, cause the erosion of the cornea and to keep it recurring? or is this simply a failure in the eye itself?


 


 

Expert:  Dr. Rick replied 1 year ago.
Smoking is bad for this issue but, truthfully, there is not much known about how other issues, such as drinking, gout, diabetes etc affect.

Mostly, this is a problem with the eye itself due to defects in the "velcro" (hemi desmosomes) that holds the skin onto the cornea.

The best thing you can do is use artificial tears frequently during the day and always use an ointment, such as refresh PM or lacrilube, right before closing your eyes as you go to sleep.

It's safe for you to press the positive feedback button now if you so desire. And, never fear, even after you press that button I don't go up in a puff of smoke -- I'll still be right here to continue helping you, but, as I do work for tips, I want to make sure you are happy before rating me.
Customer: replied 1 year ago.

Hello thanks for your reply , yesterday i have found an article that explains in full the condition as its called "Recurring corneal erosion". This article really explains in dept the condition which none of the specialists here could explain in dept about the management of the condition and how allow time to heal the damages and avoid recurrences.


 


http://emedicine.medscape.com/article/1195183-overview


 


every time i received treatment it was always short term for 5 days only , no follow up treatment or management was proposed , hence the recurring problem. I have really understood from this article how to manage this condition to enable recovery over a period of months or years if necessary.


 


I want to thank you for your answer and it helped me to find the answer on how to deal with this for the long term.


 

Expert:  Dr. Rick replied 1 year ago.
Adrian,

My pleasure. I'm glad I was able to help.

It's safe for you to press the positive feedback button now if you so desire. And, never fear, even after you press that button I don't go up in a puff of smoke -- I'll still be right here to continue helping you, but, as I do work for tips, I want to make sure you are happy before rating me.
Dr. Rick, Board Certified MD
Category: Eye
Satisfied Customers: 7851
Experience: Ophthalmology since 1994 with Retina sub-specialty interest
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