September 10, 2012 | POSTED BY | Clinical Pearls
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Most patients with recurrent corneal erosion (RCE) have symptoms for years and usually experience poor treatment outcomes. Recently published research outlines a highly effective treatment regimen proven to give relief.

The enzyme responsible for RCE is matrix metalloproteinase-9 (MMP-9). It has been established that corticosteroids and oral doxycycline inhibit production of this enzyme. Other medications, such as AzaSite (azithromycin) have also been shown to inhibit MMP-9.

Almost all cases of RCE occur overnight and is most likely due to an increase in corneal edema during sleep. Use of hypertonic therapeutic ointments, such as Muro 128 ointment (sodium chloride hypertonicity ophthalmic solution 5.0%) is recommended before bedtime.

FreshKote, a newer prescription artificial tear for moderate to severe dry eye, also works well for patients with RCE. This drop works via oncotic pressure (104 mmHg) and appears to be well tolerated by patients who use it during the daytime. Lastly, patients with RCE respond well to low-dose oral doxycycline.

Here is the recommended two-month treatment regimen for RCE:

  • FreshKote t.i.d.
  • Loteprednol 0.5% q.i.d. for two weeks, then b.i.d. for six weeks. (Check IOP around week three or four)
  • Doxycycline 20 mg b.i.d.

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