The role of the therapeutic contact lens in the management of recurrent corneal erosions: a review of treatment strategies.

Purpose : Recurrent corneal erosion is a commonly encountered condition for which multiple treatment modalities are suggested. We discuss the role of the therapeutic contact lens in the management of this condition. Methods : We reviewed treatment strategies based on published literature and on personal experience. Results : Ocular lubricants are the standard treatment for recurrent corneal erosion. Where loose flaps of epithelium are present, they should be removed before prescribing lubricants. In some dystrophic cases, reduplicated basement membrane can be scraped off before lubricant treatment is resumed. Where conservatives measures fail, three treatment modalities may be employed : application of a therapeutic contact lens ; anterior stromal puncture ; and excimer laser phototherapeutic keratectomy (PTK). The choice of treatment is determined by : etiology ; location of disease (axial or off-axis) ; coexisting ocular diseases ; individual patient reliability ; and availability of equipment. The therapeutic contact lens has a role in the management of difficult post-traumatic cases where the lesion is axial. The use of such a lens in dystrophic cases is often not very effective, and these cases may be most effectively treated with PTK. If a contact lens is used, the lens should be fit fairly tight and both physician and patient should be aware of the risk of microbial keratitis. Conclusions : The guidelines in this paper should enable physicians to maximize success and minimize risks when managing patients with recurrent corneal erosions.