recurrent corneal erosion syndrome melbourne vic

Recurrent Corneal Erosion Syndrome – Causes, Symptoms & Treatment

The cornea is a delicate structure and the most sensitive part of the eye. That transparent dome of tissue at the front surface of your eye, the cornea is responsible for bending, or refracting, light to provide clear vision. There is a myriad of conditions that can affect the cornea, with effects ranging from no noticeable symptoms to significantly debilitating pain and permanent loss of vision. Recurrent corneal erosion syndrome is a disease that can cause real distress for some patients, leading to corneal surgery, while for others is only a mild irritation that can be easily managed with over-the-counter lubricant eye drops. 

 

The Cornea 

As mentioned earlier, the cornea is a very sensitive part of the eye. The lightest touch from a speck of dust can cause irritation and reflexive tearing, an important reflex response designed to protect the eye. It’s no wonder that a more significant injury, such as the severely-named “recurrent corneal erosion”, can have a real impact on quality of life. 

The cornea is made up of five layers:

  • The epithelium at the front surface of the eye; the epithelial cells are adhered to a basement membrane
  • Bowman’s membrane underneath the epithelial basement membrane
  • The corneal stroma, which makes up the bulk of the cornea 
  • Descemet’s membrane, immediately behind the stroma
  • And the corneal endothelium, which is comprised of cells responsible for controlling the water content of the cornea 

 

Recurrent Corneal Erosion Syndrome

Recurrent corneal erosion syndrome is a corneal condition that involves the epithelium and its basement membrane. In this disease, the epithelial cells are poorly adhered to the basement membrane in certain patches across the cornea, resulting in these cells separating from each other in what is known as a recurrent corneal erosion. A recurrent corneal erosion is basically a defect at the level of the corneal epithelium. They are most common in people in their 30s and 40s, with a slight bias towards females. 

about recurrent corneal erosion syndrome melbourne vicA recurrent corneal erosion is typically characterised by a sudden sharp pain in the eye upon waking in the morning. The theory behind this presentation is that overnight, the corneal epithelial cells stick to the inside of the upper eyelid as the eye’s surface dries. Combined with mild superficial swelling of the epithelium due to the lids being closed during sleep which leads to weakened anchoring of the epithelium to its basement membrane, as the eyelids open in the morning this can mechanically erode, or pull, the epithelium from the basement membrane. Other symptoms associated with this condition include tearing, redness, and light sensitivity in the affected eye. There may also be some disturbance to the vision, whether from the corneal defect itself or from the excessive tearing. As the name suggests, recurrent corneal erosion tends to happen again and again, often in the same area of the cornea. 

It is not always understood why a patient may have a weakened epithelial adhesion to the corneal basement membrane. However, in up to about 65% of cases, a history of previous corneal trauma can be identified, such as a scratch from a tree branch, fingernail, or piece of paper. Another predisposing factor for recurrent corneal erosion syndrome is the presence of an epithelial basement membrane dystrophy, which is a genetic corneal condition. Epithelial basement membrane dystrophies account for up to 29% of cases of recurrent corneal erosions. Patients who have dry eye syndrome, diabetes, ocular rosacea, or blepharitis also tend to be at a higher risk of experiencing a recurrent corneal erosion

 

Recurrent Corneal Erosion Treatment

Recurrent corneal erosion syndrome can be difficult to treat, leading some patients to get quite frustrated at the lack of relief. Many eyecare practitioners will begin with conservative therapy before escalating to corneal surgery in very severe, stubborn cases. 

First line therapy is generally lubricant eye drops or eye ointment. Typically, this involves frequent use of preservative-free artificial tears during the day plus a thicker, more viscous eye ointment at night before bed to discourage the corneal epithelium from sticking to the underside of the eyelid. This should be considered as a preventative measure to avoid an attack from occurring. During an active episode of a corneal erosion, the optometrist or ophthalmologist may prescribe a preventative antibiotic to avoid a bacterial infection from taking advantage of the epithelial defect, as well as pain relief tablets as needed. Large corneal defects may benefit from having a contact lens inserted on the eye to provide some protection from the environment. If these treatments are ineffective, you may be referred for corneal surgery with an anterior eye specialist. 

Corneal surgery options for recurrent corneal erosion syndrome include:

  • Anterior stromal micropuncture – this involves using a fine needle to prick through the superficial layers of the cornea. The basis of this treatment is that the micro punctures stimulate the cornea to fortify the basement membrane
  • Debridement and superficial keratectomy – using a burr or scalpel, loose epithelium is removed from the eye, allowing new, healthy epithelium to regrow
  • Phototherapeutic keratectomy – this may be considered the last option for corneal surgery where other treatments have failed. After removing loose epithelium with debridement, a laser is used to vaporise several micrometres of Bowman’s membrane, allowing re-epithelisation with healthy cells. 

If you think you may be experiencing recurrent corneal erosions, it is important to be examined by an experienced optometrist or ophthalmologist. Call us today at (03) 9070 5753 for a consultation.

 

 

Note: Any surgical or invasive procedure carries risks. Before proceeding, you should seek a second opinion from an appropriately qualified health practitioner.

 

chalazion vs stye melbourne vic

Chalazion vs Stye – Understanding the Differences of 2 Eyelid Bumps

Our eyelids are delicate structures but are also a lot more intricate and functional than we give them credit for. Most of us will experience a little lump or bump on an eyelid at some point in our lives – some of these eyelid bumps are harmless while others need the attention of a specialist in oculoplastic surgery. Out of all the garden variety eyelid bumps, the most commonly confused are a chalazion vs stye

 

The Eyelid

Understanding a little of the anatomy of the human eyelid will help us to have a better grasp of the difference between a chalazion vs stye

Our eyelids serve several purposes, including physically protecting the sensitive surface of the eye as well as providing lubrication via several different glands. The eyelid is made up of layers of smooth muscle, connective tissue, fibrous tissue, a mucous membrane known as conjunctiva, and various secretory glands. Lining the upper and lower eyelid margins are a particularly important set of glands known as the meibomian glands, which open their orifices just behind the eyelash line. The oily secretion produced by these glands is called meibum, which has the purpose of lubricating the surface of the eye, keeping these tissues healthy and contributing to clear vision. 

Each eyelash follicle is paired with two additional types of glands known as the glands of Zeis and Moll. The glands of Zeis are sebaceous glands while the glands of Moll are modified sweat glands. Both of these glands support the health of our eyelashes, with their secretions keeping the lashes from becoming brittle.

While the glands of our eyelids are certainly useful, they can also be subject to infection and blockages, much like other glands throughout our bodies. It’s then that you may experience one of those inconvenient little eyelid bumps

 

Chalazion vs Stye 

about chalazion vs stye melbourne vicChalazia and styes are among the most common lumps and bumps found on the eyelid. Although both are considered benign, both types of eyelid bumps can be a cause of concern for many people, particularly if the lump is large, sore, or red, leading them to enquire about oculoplastic surgery. The underlying cause is what differentiates a chalazion vs stye, although many people will use the term “stye” to cover both types of bumps. 

A chalazion (plural, chalazia), is a blockage of a meibomian gland in the eyelid without an active infection. Initially a chalazion may begin as a stye but then eventually the infection resolves, leaving behind a painless bump that we then call a chalazion. A chalazion is made up of blocked meibum accumulating in the surrounding soft tissues of the eyelid as its usual drainage route through the duct is obstructed. The main concern for someone with a chalazion is not pain or redness, even when the chalazion is touched, but more of a cosmetic issue. A chalazion can vary in size, with some being large enough to put some pressure on the cornea and causing temporarily blurred vision. Unfortunately, chalazia are known to take some time to clear, from weeks to months.  

On the other hand, a stye, also known as a hordeolum, involves an active infection. An external stye is due to an infection of one the glands of Zeis or Moll, and typically appears as a yellowish-whitish pimple around the base of the affected eyelash follicle. Conversely, an internal stye or hordeolum involves an infection of a meibomian gland inside the eyelid. It’s an internal stye that is most likely to be confused with a chalazion as they both appear as bumps under the skin of the eyelid. Because there is an active infection, styes are typically sore and associated with redness and inflammation. 

 

Treatment

Most styes and chalazia will self-resolve without needing intervention from an oculoplastic surgery doctor. To hasten the healing process, you may consider using a gentle warm compress over the affected eyelid in order to encourage blood flow to the area, or your optometrist and GP may pluck the eyelash associated with an external stye to help drainage of the blocked glands. As tempting as it may be, however, you should never try to pop a chalazion or stye as this will potentially exacerbate the lesion. Some eyecare practitioners may prescribe a topical antibiotic ointment for an external stye but these should be avoided in the case of chalazia as there is no infection. 

Large chalazia and styes that are taking a long time to self-resolve with home remedies such as a warm compress can be referred to an ophthalmologist experienced in oculoplastic surgery. For very stubborn chalazia, the eye specialist can perform a surgical procedure to remove the contents of the chalazion, known as an incision and curettage. There is also the option of steroid injections into the eyelid to help the chalazion to resolve more quickly. 

Styes and chalazia are known to recur, whether in the same area of the eyelid or elsewhere. Several risk factors have been identified in the likelihood of developing recurrent styes and chalazia, such as having acne rosacea or meibomian gland dysfunction. A chalazion that frequently pops up in the same area may require examination by an ophthalmologist to rule out any other conditions that may mimic a chalazion, such as an eyelid carcinoma. 

Call us today at (03) 9070 5753 for more info.

 

 

Note: Any surgical or invasive procedure carries risks. Before proceeding, you should seek a second opinion from an appropriately qualified health practitioner.