Cornea
Recurrent Corneal Erosion
Also known as: RCE, waking corneal pain, recurrent epithelial defect
Filed as: Soon
Source-cited from the record's own evidence list. Clinical content programme led by Dr Ankit Mathur, PhD, Grad Cert Ocu Thera, B.S. Optom. How the clinical content is governed
Clinical decision support only
OptoGuide™ supports professional judgement and does not diagnose or replace clinician responsibility.
Overview
Recurrent epithelial breakdown causing acute pain, often on waking, usually after prior corneal trauma or epithelial basement membrane instability.
Recognition
Symptoms: what patients report
- Sudden sharp pain on waking or on first opening the eyes, lasting minutes to several hours
- Previous abrasion to the same eye, even years earlier
- Blurred vision during an episode
- Photophobia
- Tearing
Signs: what the examination shows
- Epithelial defect on staining
- Loose or irregular epithelium at the erosion site, most often inferior paracentral.
- Fresh or healing epithelial defect during or shortly after an episode.
- EBMD changes (small cysts, fingerprint lines, map-like lines) — examine both eyes.
- Areas of negative staining over raised epithelium; the cornea can look normal between episodes.
- No infiltrate or other sign of infection after a recent episode; corneal sensation normal.
- Possible scar after several episodes.
What OptoGuide™ covers for recurrent corneal erosion
- Pattern reasoning: what this combination of findings points to, and its differentiators
- Don't-miss risks and escalation triggers
- Management tiers with linked New Zealand therapeutics
- Referral urgency, specialty, and letter drafting
Sources
- Recurrent corneal epithelial erosion syndrome — College of Optometrists Clinical Management Guideline
- Anterior Eye Disease and Therapeutics A-Z (Bruce & Loughnan) — standard reference text
- Interventions for Recurrent Corneal Erosions. Watson SL, Leung V. The Cochrane Database of Systematic Reviews. 2018;7:CD001861.
- Clinical Presentation and Causes of Recurrent Corneal Erosion Syndrome: Review of 100 Patients. Diez-Feijóo E, Grau AE, Abusleme EI, Durán JA. Cornea. 2014;33(6):571-5.
- Medical and surgical interventions for neurotrophic keratopathy. Kruoch Z, Choo AY, Kemp A, et al. The Cochrane Database of Systematic Reviews. 2025;12:CD015723.
- Recurrent corneal erosion: a comprehensive review. Miller DD, Hasan SA, Simmons NL, et al. Clinical Ophthalmology. 2019;13:325-335.
Standard texts: Kanski's Clinical Ophthalmology: A Systematic Approach, The Wills Eye Manual, Oxford Handbook of Ophthalmology, Oxford American Handbook of Ophthalmology, Signs in Ophthalmology: Causes & Differential Diagnosis.