Recurrent Epithelial Apoptosis is a condition affecting the outermost layer of corneal cells called the epithelium. The problem is caused when the bottom layer of epithelial cells adhere poorly to the cornea, causing them to slough off easily. The pain and discomfort is often quite intense, and similar to a corneal abrasion.
There is usually an underlying disorder that causes recurrent corneal erosions to occur. The most common are: previous corneal injury (corneal abrasion), corneal dystrophy (Map Dot Fingerprint Dystrophy), or corneal disease resulting in recurrent breakdown of the epithelial cells.
Upon awakening, patients often experience severe pain, blurred vision, and light sensitivity when the eyelid pulls the loosened epithelial cells off the cornea. After the cornea heals, the problem recurs as the name implies unless the condition is treated. Recurrent Epithelial Apoptosis may affect one or both eyes, depending on the underlying cause.
Signs and Symptoms
• Severe pain (especially after awakening)
• Blurred vision
• Foreign body sensation
• Dryness and irritation
• Tearing
• Red eye
• Light sensitivity
Diagnosis and Detection
Using a slit lamp microscope, the doctor examines the corneal layers under high magnification. Eye drops containing green dye called fluorescein are usually instilled to stain the areas of missing epithelium, allowing the doctor to evaluate the size and depth of the erosion.
Treatment
Salt solution drops or ointment are usually prescribed as the first line of treatment. This medication helps the epithelium to adhere better to Bowman's layer of the cornea. Artificial tears are also recommended to keep the cornea moist.
Those with underlying corneal dystrophy may require additional treatment. This usually includes an in-office procedure where the epithelium is either gently removed, or microscopic "spot welds" are made on the cornea to encourage the epithelial to bond securely to Bowman's layer underneath.
Patients who continue to suffer from recurrent corneal erosions despite the treatments described, may benefit from phototherapeutic keratectomy (PTK). This involves removal of the superficial layer of corneal cells using the Excimer laser to encourage proper healing.
