eyes.nhs.scot

• 5.1 Blunt Trauma
• 5.2 Chemical Injury, Cornea
• 5.3 Abrasion, Corneal
• 5.4 Foreign Body, Corneal
• 5.5 Hydrops, Cornea
• 5.6 Transplant Rejection, Cornea
• 5.7 Fuchs' Endothelial Corneal Dystrophy
• 5.8 Herpes Zoster Ophthalmicus
• 5.9 Keratitis, Peripheral, Infiltrative, Contact Lens-Associated
• 5.10 Keratitis, Marginal
• 5.11 Keratitis, Microbial, Acanthamoeba
• 5.12 Keratitis, Microbial, Bacterial
• 5.13 Keratitis, Microbial, Fungal
• 5.14 Keratitis, Viral, Herpes Simplex
• 5.15 Penetrating Injury, Cornea
• 5.16 Photokeratitis (Ultraviolet Burn, Arc Eye, Snow Blindness)
• 5.17 Corneal Suture Breakage, Post-Operative
• 5.18 Recurrent Corneal Epithelial Erosion Syndrome

5.18 Recurrent Corneal Epithelial Erosion Syndrome

Date of last review:

10/04/2026

Date of next review:

10/04/2028 

Date of publication:

20/04/2026

Differential diagnosis ⁽¹⁾

• Herpes simplex keratitis

• Exposure keratopathy

• Other corneal dystrophies with epithelial manifestations

• Contact lens-related epithelial conditions

Possible management by optometrist

Advice ⁽¹⁾

• Eye padding does not improve mild abrasion management

Treatment

• Mild cases:

  • Ocular lubricants for symptomatic relief as required (preferably unpreserved) ⁽¹⁾ (drops/gel for use during the day ± unmedicated ointment for use at bedtime ⁽⁷⁾) – should be continued for at least 3 months from date of last occurrence)⁽¹⁾. Refer to local formularies for suitable options ⁽⁶⁾

• Advise patient to return/seek further help if symptoms persist ⁽¹⁾

• More severe cases (large area of epithelial loss, significant pain and light sensitivity):

  • Cycloplegic agent to prevent pupil spasm ⁽¹⁾

  • Antibiotic ointment ⁽¹⁾

  • Systemic analgesia e.g. paracetamol, ibuprofen ⁽¹⁾ - recommend simple over the counter pain relief with advice from pharmacist if needed or stronger analgesics (co-managed with GP)⁽⁷⁾

  • Hypertonic saline at bedtime ⁽¹⁾

• If symptoms persist despite conservative therapy:

  • Consider a 12 week course of an oral tetracycline ⁽¹⁾
    
    

• Bandage contact lens:

  • A bandage lens may be used, though studies suggest no clear advantage over lubrication alone for symptom control ⁽¹⁾

  • If fitting a bandage lens consider addition of prophylactic topical antibiotics ⁽¹⁾

Typical adult dosage/duration

(Blue text = IP, black text = non-IP)

• Cyclopentolate hydrochloride 1% eye drops ^(1,5) (POM generic): One drop up to 3 times daily, consider reducing (or stopping) as condition improves ^(6,7) (consult local guidance as they may vary on timescales ⁽⁷⁾)

• Chloramphenicol 1% eye ointment ^(1,5) (P/POM generic): Apply 3–4 times daily. The course of treatment should be 5 days (even if symptoms improve) ^(2,3) (Consult local guidance as they may vary on timescales ⁽⁷⁾)

• Sodium chloride 5% eye ointment (P/CE): Apply before bedtime ⁽¹⁾

• Oral Doxycycline tablets / Capsules (POM): 100mg daily for 2-3 months ⁽⁷⁾

Regimens should be adjusted according to severity and patient factors (e.g. age, weight, pregnancy, renal function). Prescribing should follow local formulary and national guidance where available ⁽⁷⁾.

In cases of known sensitivities, please consult local formularies for alternative options ⁽⁷⁾.

Further management options

• Typically, no referral is required. Consider routine referral if symptoms remain persistent, epithelial defects are large/unstable, or conservative measures fail ⁽¹⁾

• Possible prescription of drugs ⁽¹⁾

• Treatment (including prescribing of additional medications or extended management) may be provided within available locally enhanced schemes, or by community IP optometrists/OMPs, as appropriate ⁽⁷⁾

Possible management in secondary care or local/community pathways where available

• For cases unresponsive to medical management, several procedural options may be considered, although evidence supporting their superiority is limited:

  • See further management options ^{(1, 7)}

  • Epithelial debridement ⁽¹⁾

  • Excimer laser phototherapeutic keratectomy (PTK) ⁽¹⁾

  • Anterior stromal puncture ⁽¹⁾

  • Nd:YAG stromal micropuncture ⁽¹⁾

  • Alcohol delamination ⁽¹⁾

  • Diamond burr polishing of Bowman’s membrane ⁽¹⁾

College of Optometrists Clinical Management Guideline ⁽¹⁾ 

Recurrent corneal epithelial erosion syndrome - College of Optometrists*  

*With special thanks to The College of Optometrists for providing the evidence framework for diagnosis and management from the Clinical Management Guidelines (CMGs) for this condition. All references to the College/CMGs are included where appropriate and form the basis of the Community Eyecare Guidelines.

Guidance is informed by the following sources 

1. College of Optometrists Clinical Management Guidelines Clinical Management Guidelines - College of Optometrists

2. Advisory alignment with the College of Optometrists Formulary Optometrists' Formulary - College of Optometrists

3. Advisory alignment with the BNF BNF (British National Formulary) | NICE

4. Advisory alignment with the Summary Product Characteristics taken from the EMC Home - electronic medicines compendium (emc)

5. Advisory alignment with Scottish Health Board formularies (where a clear majority is present) *

6. Advisory alignment with expert consensus (CEGG), informed by sources 2-5 above

7. Advisory alignment with expert consensus (CEGG) 

8. “Annex C of the Statement” https://www.eyes.nhs.scot/for-professionals/legislation/

* Scottish formularies should be available within the Prescribing section of your Health Board pages on the eyes.nhs.scot website. If unavailable, contact your local Health Board for further information; Health Boards landing page

If you have a query relating to this page, please email NSS.ComEyecareGuidelineGroup@nhs.scot