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Re: Rce
Jun 14, 2006
David - a few things (this is "long winded" but I hope it helps):

First, the reason it has come "in full force" is because your epithelium has "thinned out." In other words, think of it like this: imagine a bowl of sand and you then "scoop out" or "rub off" or "erode" the center by taking a handful of sand out of the center of the bowl. Now, what happens is the sides of gap you created in the bowl "fill in the gap" you created or "eroded" away from the center so as to create a new level surface. That's exactly what happens with the epithelium.

Here's the process: no one's eyes produce tears when sleeping and you may even sleep (as many of us do) with our eyes just slightly open which causes extreme dryness and also explains why over 90% of all erosions are in the 6 o'clock position of the cornea. Then when you awaken and move your eyelid it sloughs off the cells before you have a chance to produce tears. Now, you have that "gap" like in the analogy of the sand example. There can be moderate to severe pain. The gap is then "filled in" by the surrouding epithelial cells. When this happens, the pain may be gone. It's even possible that is gone within an hour or by the end of the day. But, you are less healed than the day before because as in the sand analogy there is now LESS sand in the bowl. Similarly, your epithelium is now "thinner" even though the "gap" is filled in. Therefore, it takes even less erosion now for you to feel pain that you otherwise would not feel if your epithelium were thicker.

Now for some advice on what has worked wonders for me along with some things to consider:

1. As Jane pointed out doxycycline can be a big boost for helping with any occular surface disorder. It's not the antibiotic but rather a side effect from the antibiotic that helps prevent erosions (many doctors are not at all aware of this side effect). The side effect is only present in the "cycline" antibiotic group and doxycycline is among the best. The recommended dosage is 100 mg daily for 6 weeks but check with your doctor. Even a dermatologist prescribes this stuff for acne.

2. There have been additional studies that show over a 90% recovery when combining doxy with prednisone (and not using any other techniques but that). Many doctors will not prescribe prednisone because it's a steroid and can increase eye pressure. The prednisone from what I have read is combined with doxy and the prednisone eye drops are only prescribe for 1-2 weeks.

3. PTK has a 90% recovery and 99% recovery when doing a second app if necessary and also may improve nearsightedness (since most RCE sufferers are at least in or approaching their 4th decade of life). I personally believe many doctors don't do it (just my opinion here) because they either are not trained well enough in the procedure or just don't want the risks or prefer more conservative means...just not sure but they have a "regimen" and stick with it.

4. ASP - personally I would avoid stroma puncture. It can cause scarring and may only be 50% effective or more but there are other methods. I'd do PTK over ASP any day of the week.

5. Dehydrex drops - still in the trial studies but if you are timid of surgery these drops have shown around 90% cure rate with no side effects.

6. Home Methods - well, if you are somewhat lazy and timid of surgery like me, then I'll tell you what I learned and do. First, I used to get erosions at least weekly with increasing frequency from 2-3 times a week and increasing pain to the point of enormous panic and anxiety. July 2004 - I will never forget it - my last major erosion I ever had and it took 10 days to heal. That's when I got the idea of adding drops before opening my eyes. So, here are the tricks:

a. First, almost all erosions happen when you are awake even if you are groggy. No major erosion is going to happen in your sleep unless you move your eyelids with great intensity. Put another way, it's movement of the eyelids that cause erosions and nothing else.

Learn to put artificial tears in immediately when you awaken before you move your eyelids; it's that simple, and it is simple. When you awaken, lay on your back and put them in at the corner of your eye and nose so that gravity allows them to flow down your eyes. You cannot overdose on artificial tears so be liberal with them especially when you are healing.

b. Open your eyes SLOWLY and add more tears if necessary.

b. Don't sleep on your back.

c. Do what you can to keep your eyes shut when you are asleep. Sleep on your stomach if you can or wear an eyemask or have the pillow press against your forehead so as to keep your eyes closed.

d. [B]If you have an erosion[/B] - What you immediately do is important. Remember, erosions set you back because you are "thinning out" your epithelium (just like removing sand in the sand example) and it will then take time for it to thicken again. It can easily take 6 months or even a year or longer even though you are in no pain at all. The process can go either way (thicken or thinning of the epithelium).

Therefore - if you have an erosion, you want to make the erosion as "minor" as possible so that as few cells rub off the epithelium. Here's how:

First - do not blink. Blinking is the worst thing you can do after an erosion as it will rub off more cells until your eye produces tears and then continue to rub off even more cells like an avalanch. I know it's painful. Instead, lay flat on your back just as you would when adding tears without an erosion. Continue to try as best you can to relax and keep your eyes closed. Add artificial tears as soon as possible and continue to add them for pain. Lay flat on your back with your eyes closed for at least 15 minutes. Just try to relax until the pain subsides and continue to relax longer almost as if going back to sleep or meditating (but don't go back to sleep - remember never fall asleep on your back). Continue to add artificial tears for pain as often as you like with your eyes closed. The back is the worst position for sleeping but ironically it's the best after an erosion for limiting the severity. After what feels like 15 minutes add artificial tears and SLOWLY open your eyes. If they still feel awful, repeat the process. If things appear much better, wait another 15-30 minutes and warm your muro 128 tube under warm/hot water and gently pull down your lower eyelid and add the ointment in the crevice (as much as you like, you can't over due it but usually 1/4 to 1/2 inch is more than enough). Do not drive right away as your vision may be blurred.

You must program your brain to not move your eyelids at all when you awaken. You can do it believe me. It's classical conditioning. We don't go to the bathroom in our sleep so there is no reason we can't learn to stop immediately popping are eyes open when we awaken. I believe I have learned to awaken even when my eyes start to feel dry in my sleep. You can develop an enormous subconscious awareness of your body (mainly your eyes) by doing this. It's not as hard as you might think. When you go to sleep you have to tell yourself that you must keep your eyes still when you awaken or you risk being in extreme pain. Anyways, I'm erosion free with this now for almost 2 years with a few minor erosions (maybe 3-4 due to either carelessness or learning things along the way). But, as your epithelium "thickens" major erosions are far far less likely and the minor erosions become warnings to "get your guard back up."

Last - remember, adding drops is the key. It's not so much what you do 8 hours before an erosion (like adding muro) but rather what you do right before an erosion is about to happen (when you awaken). Add those artificial tears and your eyelid will not rub anything off. Do not "test anything" but just add artificial tears every single time you awaken even if you fall asleep and awaken again 15 minutes later. I have awakened many times where it feels as if my eyes are "cemented or stuck closed." No question that moving my eyelids could have caused a massive erosion. Now, I just add artificial tears and wow - the magic of feeling in control; I'm no longer powerless to this horrible syndrome but now I'm in control. It really works.

Best to you and keep us posted,

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