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Recurrent Erosion Syndrome (RES)
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Anthony P. Adamis, MD
Fina Caņas Barouch, MD
Massachusetts Eye and Ear Infirmary, Harvard Medical School
October 21, 2014

What is recurrent erosion syndrome (RES)?
Recurrent erosion syndrome (RES) refers to repeated episodes of superficial spontaneous abrasions leading to eye pain. Erosions are "scratches" on the surface of the cornea, the clear portion of the eye overlying the iris and the pupil. In many cases, the cells of the outer layer of the cornea are loosely attached to the underlying tissue. These cells spontaneously slough leading to recurrent erosions. Most episodes occur without an identifiable precipitant.

What are the symptoms of recurrent erosion syndrome (RES)?
Patients typically present with attacks of mild to severe eye pain, redness, tearing, and light sensitivity. Some patients may report blurred vision. Most patients report symptoms after awakening FROM sleep. During REM sleep, the eyelids contact the moving cornea leading to abrasions, which present with the symptoms listed above.

Are there any risk factors that predispose to the development of RES?
RES typically occurs in eyes that have suffered FROM a sharp, abrading injury such as FROM a fingernail or paper cut. The area heals acutely, but is prone to recurrent erosions in the future. Some patients may have an underlying corneal dystrophy that predisposes to RES.

What is the treatment for RES?
Treatment is largely preventative and involves a stepwise approach. First, aggressive lubrication with artificial tears is recommended. Over-the-counter preservative-free artificial tears are used FROM four times per day to every hour while awake, combined with artificial tear ointment at bedtime. If there is no relief with aggressive lubrication, a therapeutic bandage soft contact lens may be used to prevent further erosions. This specially designed contact lens is left on the eye for weeks to months without removal in an attempt to prevent further corneal abrasions and promote better healing. Antibiotic drops are used to prevent infections secondary to long-term therapeutic contact lens use. Most patients recover completely with aggressive lubrication and/or placement of a bandage contact lens. For the few patients that remain symptomatic with RES, other therapeutic options remain, including anterior stromal puncture or superficial keratectomy, the latter performed with either a scalpel or a laser. Anterior stromal puncture consists of making tiny holes on the surface of the cornea to promote stronger attachments between corneal cells and the underlying substrate. Ablation with an excimer laser, the same laser used for refractive surgery, can be used in refractory cases to smoothen the substrate, promoting better healing.

How do I get more information?
In the New England area, the Massachusetts Eye and Ear Infirmary has a general ophthalmology service for non-emergent problems, and an emergency room open 24 hours for ocular emergencies.
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