Recurrent corneal erosion (RCE) is a condition characterized by repeated episodes of corneal epithelial breakdown leading to symptoms such as sharp pain (typically occurring upon awakening), along with redness, photophobia, and tearing. RCE is often associated with underlying conditions like epithelial basement membrane dystrophy (EBMD), prior ocular trauma, stromal dystrophies, or previous ocular surgeries, including refractive surgery and corneal transplantation (Xu et al, 2012). The pathophysiology of RCE involves poor epithelial adherence due to defective hemidesmosomes and extracellular matrix components, often exacerbated by nocturnal drying of the ocular surface (Miller et al, 2019).

Case Description

A 33-year-old female with a history of epithelial basement membrane dystrophy (EBMD) and recurrent corneal erosions presented with frequent episodes of severe pain, photophobia, and visual disturbances. Her previous management included conservative treatments such as preservative-free lubricating drops and oral analgesics for pain relief. Additionally, she had used therapeutic bandage contact lenses (BCL) and undergone punctal occlusion to increase tear film volume. Despite these efforts, she continued to experience recurrent erosions, significantly impacting her quality of life.

The patient expressed a strong preference against surgical or invasive interventions, making nonsurgical options essential for her treatment plan. Considering her reluctance toward procedures like anterior stromal puncture (ASP) and epithelial debridement, scleral lenses became the next viable option. Scleral lenses offered a noninvasive solution by providing a protective, tear-filled vault over the cornea, which shielded the fragile epithelium from mech-anical stress and environmental factors.

Over a 6-month follow-up period, the patient experienced a significant reduction in the frequency of erosions, improved visual acuity, and increased comfort, demonstrating the efficacy of this non-invasive treatment option.

The lens material selected was the Optimum Infinite (Contamac), which has the high oxygen permeability (Dk 180) crucial for maintaining corneal health and promoting epithelial healing. This high Dk value prevents hypoxic stress, reducing the risk of delayed healing and other complications. 

Additionally, the material’s wettability, demonstrated by a sessile drop contact angle of 90.7 degrees, helps maintain a stable tear film. This is particularly beneficial for patients with dry eye syndrome, as it minimizes mechanical friction between the lens and the eyelid, protecting the compromised corneal epithelium and reducing the risk of recurrent episodes (Eddelston, 2019).

Discussion

This case underscores the importance of advanced contact lens materials in managing challenging conditions such as RCE by providing enhanced protection and promoting epithelial healing. The material’s high oxygen permeability ensures adequate oxygenation to the corneal tissue, which is crucial for healing and preventing further episodes. Its wettability enhances patient comfort by maintaining a stable tear film, reducing dry eye symptoms commonly associated with RCE. Additionally, the structural stability offers a consistent protective barrier, making it ideal for patients with complex ocular histories and ensuring reliable performance in various lens designs. This combination of features significantly improves patient outcomes and quality of life, demonstrating the material’s effectiveness in addressing both the symptoms and causes of RCE. 

REFERENCES:

1.                 Xu K, Kam KW, Young AL, Jhanji V. Recurrent Corneal Erosion Syndrome. Asia Pac J Ophthalmol (Phila). 2012 Nov-Dec;1(6):349-54.

2.                 Miller DD, Hasan SA, Simmons NL, Stewart MW. Recurrent corneal erosion: a comprehensive review. Clin Ophthalmol. 2019 Feb 11;13:325-335.

3.                 Eddleston, M. (2019, March 26). Optimum Infinite: Responding to an industry desire for a hyper Dk GP lens material. Contamac Global Insight. https://www.contamac- globalinsight.com/articles/optimum-infinite-responding-to-an-industry-desire-for-a-hyper-dk- gp-lens-material/

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Dr. Compton is the owner of Compton Eye Associates in New York City and founder of therightcontact.com. He is a Fellow of the American Optometric Association. He has no disclosures to report.