Confocal characterization of recurrent corneal erosion syndrome suspects

Purpose To characterize and differentiate recurrent corneal erosion syndrome (RCES) suspects according to cytological findings using in vivo corneal confocal microscopy (IVCM). Methods We performed IVCM (Rostock Cornea Module, Heidelberg Engineering Retina Tomograph III) in 58 patients recommended to outpatients clinic with symptoms of recurrent corneal allodynia. First, patients underwent slit‐lamp examination with anterior segment photographs. The IVCM was performed with an examination frame of 400x400 μm. Screening, full‐thickness corneal scans were performed to evaluate general condition of corneal architectonic. Focal scans aimed to analyze localized changes within corneal epithelium in all corneal quadrants. Results From among of 58 analyzed cases, 18 (31%) presented dot‐map‐fingerprint confocal changes involving epithelial basal membrane. Eight of patients (14%) presented cystic degeneration of epithelial cells, 26 patients were diagnosed with epitheliopathy of inflammatory origin – 13 patients (22%) with Thygesson keratitis and 13 patients (22%) presented features typical for post‐adenoviral keratitis. Three patients (5%) suffered from allodynia related to epithelial instability after corneal refractive procedures. There were also 3 (5%) casual cases of allodynia – 1 patient with epithelial squamous cell metaplasia, 1 patient with corneal changes associated with pemphigus vulgaris and 1 patient with post‐traumatic neuroma of corneal superficial nerve plexus. The initial clinical diagnosis of RCES was confirmed with IVCM in 34 patients (59%), other 25 patients suffered from recurrent corneal allodynia due to other than RCES causes, mostly inflammatory. Conclusions IVCM of corneal epithelium allows differentiating patients with RCES from other causes of recurrent corneal allodynia, which can determine therapeutic decisions.