Dr. Rick : Hi. I'm Dr. Rick and I have two decades of ophthalmology experience. I'm online and happy to answer your question today.
Dr. Rick : This is a common occurrence after removal of stromal calcification removal using ETDA and corneal scraping.
Dr. Rick : If the salve and drops do not work at this point, there are a number of other things that can be done:
It sounds like you are suffering from recurrent corneal erosion
syndrome (RCES). What's that you might ask?
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.
Here is an excellent article on this condition that you might find helpful:
If your ophthalmologist is not willing to do anterior stromal puncture or any of the other therapies then you should consult with a cornea specialist.
Does this make sense to you?
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Thanks in advance,
Dr. Rick MD FACS