• What is a recurrent corneal abrasion?
• The cornea, and the corneal epithelium
• The original injury, the abrasion
• The injury returns: the 'recurrent abrasion'
• The examination
• What is happening?
• Routine treatment to prevent recurrences
• Lid cleaning
• Other treatments
• What to expect

• Link
• Medscape
• also called recurrent corneal erosion

Recurrent corneal abrasion is a painful eye condition, although your eye heals after a few hours or days. It is caused by a scratch on the surface of the eye in the previous months.

Although the first injury heals, the healing is not perfect and the 'scratch' returns over the next months for no apparent reason.

This page describes what is happening, and how you can reduce the number of recurrences.

The cornea is the transparent 'window' of the eye at the front.

It is covered with a very thin skin, the epithelium.

the cornea, and its
epithelium, shown in red

Typically the condition starts when the surface of the eye is scratched, possibly by a finger nail. A patch of epithelium is scratched off or wrinkles up, leaving a bare patch of cornea.

As the cornea has many nerves, this injury feels exquisitely painful, like a needle.

The abrasion always heals and the pain goes.

The healing takes 1mm a day from each side, so a large 7mm abrasion takes about 31/2 days, less in children, longer if you are older.

When a doctor looks into your eye, even with the microscope slit lamp in the Eye Department, it may be very difficult to see the injury.

Sometimes it may not be apparent at the first examination. The doctor or nurse uses a yellow dye, called fluorescein, to examine your eye, and this dye sticks to a bare patch of cornea if there is one.

There may not actually be a bare patch ..the cornea may just be wrinkled and very loosely attached.

Recurent corneal abrasion
green when seen with fluorescein drops added, but are sometimes difficult to see

Normally the epithelium sticks down to the layer underneath (the basement membrane) firmly. Tiny pegs underneath the cells that make up the epithelium keep the cells stuck on to the basement membrane.

This is like painting on a wall: if you paint on the undercoat first, and then paint on the top coat, when the paint dries it will be well stuck down.

However, these pegs may take 6-12 months to reform properly after the original injury. During this time the epithelium may be prone to slipping and sliding, and this slipping and sliding causes this condition.

This is like painting on a bare surface with a 'top coat' of paint, when there is no 'undercoat'. The paint will dry but peel off really easily.

A few people will this condition have inherited genes that make this sticking process faulty, but this is quite unusual.

Certainly if your condition keeps happening year after a year a corneal specialist may detect this condition.

A second reason for the faulty sticking may lie in your tears.

The glands in your eyelid, especially your lower lid, make secretions that help tears to spread. If these glands get blocked, your tears do not spread properly, and the eyelid may stick to the epithelium and pull it off before the pegs have firmly fixed it in position.

If you clean your lids as below, the glands start to make their secretions again, and the process stops.

In addition to the regular cleaning of the eyelids, sometimes using a cream at night can stop the sticking (the 'sticking' of the eyelid to the epithelium occurs when you wake up in the morning).

All of a sudden, perhaps a month after the first injury, your eye starts to feel exquisitely painful again.
It is as though the first injury recurrs all by itself. Again this injury heals, and your eye starts to feel comfortable again.

If the patch of cornea with the recurrent abrasion is small, as it usually is, your eye may heal after a few hours.
A larger patch will take days to heal.
Occasionally, you may not remember the original injury, and all of a sudden the condition develops.

• antibiotic drops such as chloramphenicol drops or cream x4/day or cream x3/day
  or fucithalmic x2/day
• A eye pad does not normally help �
• rest at home until healed
• no driving until healed
• lubricants at night such as viscotears, gel tears, or lacrilube
• see
• topiramate may help corneal pain

• treat the abrasion as above
• lubricants every night such as viscotears, gel tears, or lacrilube
• lid hygiene (see below) usually helps (with or without antibiotic cream) �
• if the lid hygiene does not help, doxycycline as above 100mg once/twice a day (not if you are pregnant).
  It takes a few weeks to work, and works for several weeks after it is stopped. One 3 month course is usually helpful, but occasionally longer treatment is needed.
• this paper suggests doxycycline and steroid drops
• other treatments, review

• Use clean face cloth soaked in warm water, as hot as your eyelids can stand.
• Bathe your eye (closed) for 5-10 minutes. Rewarm the cloth if it gets cold. This makes the debris easier to remove, as below.

Clean eyelids

• Clean the edge of your eyelids (the eyelash edge) with a wet cotton bud.
• Gently scrape off the debris moving the bud side to side.
• Looking in a mirror, pull your lower eyelid down with the index finger of one hand, and gently but firmly wipe the bud along the edge of the lid to scrape the debris off.
• With your chin up try the same on the upper, but this is harder.

gently clean with a cotton bud, looking in mirror

Cleaning the eyelids

• First try warm sterile water, that is boiled water allowed to cool but still warm. (Warm tap water is usually quite safe.)

• Some people recommend a bicarbonate solution instead of plain water. Use a teaspoon of bicarbonate of soda, available from a chemist or supermarket bakery sections, to a pint of water. You can use this solution for a few days, keeping it in the fridge. Use a small amount each time.

• Using baby shampoo may help. Place a few frops in a pint of water to dilute it first.

• An antibiotic cream may help (as above); this can be squirted into the eye, or squirted onto your finger, and you can then spread it over the eyelids. Alternatively, apply the ointment with the cotton bud onto the eyelid.

• may be a healthy diet will help

• If the patch of epithelium is very loose, your doctor may scrape it off to allow fresh epithelium to grow in: this often helps. This is called debridement.
• There are more complex treatments available from corneal specialists, but these are not usually needed and not discussed here. They include micro-puncture of the loose patch, and laser.
• Some experts recommend contact lenses (see and here and here).
• There is one report botulinum toxin may help by closing the eyelid more completely at night, but this would not be necessary for most patients.
• there may be an underlying corneal dystrophy and here.

Over a year you should start to feel a lot better, and have very little problem then.