Corneal Erosion

As you can guess from the title, what Bertrand has been diagnosed with? Yup, corneal erosion. Due to his alacrima (lack of tears) his own eyelids are acting as sandpaper across his corneas, wearing them away and exposing the corneal nerves. This is an extremely painful condition.

Typically, symptoms include recurring attacks of severe acute ocular pain, foreign-body sensation, photophobia (i.e. sensitivity to bright lights), and tearing often at the time of awakening or during sleep when the eyelids are rubbed or opened. Obviously, Bertrand couldn't tell us about the pain, have the tell-tale watering eyes, or rub his eyes, hence delaying the diagnosis.

The erosions on both eyes were finally found by his ophthalmologist using the magnification of an ophthalmoscope, along with a fluorescein stain and a blue-light. Mis-diagnosis of a scratched cornea is fairly common, especially in younger patients.

Given that episodes tend to occur on awakening and are managed by use of good 'wetting agents', approaches to be taken to help prevent episodes include:

Environmental

• ensuring that the air is humidified rather than dry, not overheated and without excessive airflow over the face. Also avoiding irritants such as cigarette smoke.
• use of protective glasses especially when gardening or playing with children.

General personal measures

• maintaining general hydration levels with adequate fluid intake.
• not sleeping-in late as the cornea tends to dry out the longer the eyelids are closed.

Pre-bed routine

• routine use of long-lasting eye ointments (e.g. lacrilube/Polyvisc) applied before going to bed.
• occasional use of the anti-inflammatory eyedrop FML (prescribed by an opthamologist) before going to bed if the affected eye feels inflamed, dry or gritty

Waking options

• learn to wake with eyes closed and still and keeping artificial tear drops within reach so that they may be squirted under the inner corner of the eyelids if the eyes feel uncomfortable upon waking.