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Natural history of recurrent erosion syndrome
  1. Birmingham and Midland Eye Centre, City Hospital NHS Trust, Dudley Road, Birmingham B18 7QU
    2. JOHN DART
    1. Moorfields Eye Hospital, City Road, London EC1V 2PD

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      Editor,—I read with interest the recent article by Heyworth and coworkers.1

      In their paper there is no specific mention of, or discussion of, the role of oral tetracycline in the treatment of recurrent corneal erosions. In their results they state that 55% of patients who were symptomatic were taking some form of treatment, which included topical drops or ointment. They do not mention whether any patients were using systemic treatment in the form of oral tetracycline or any other systemic treatment. In the discussion there is no reference to the possible role of oral tetracycline in the management of these patients. They refer to topical treatment and possible surgical treatments. They also do not indicate whether any of the patients in the review are using a bandage contact lens to manage their symptoms. In their introduction they state there have been no randomised controlled trials of treatment in the management of recurrent corneal erosion. This in fact is incorrect and our paper in 1994 on the role of oral tetracycline in the treatment of recurrent corneal erosions reported the results of a prospective randomised controlled trial.2Continued clinical experience since then strongly supports the use of oral tetracycline in the treatment of recurrent corneal erosions, where the symptoms are not controlled by simple lubricating treatment.



      Editor,—McDonnell is correct in stating that no mention was made regarding the role of systemic tetracycline in the management of recurrent corneal erosions. Our studylooked at a group of patients who were initially treated for recurrent corneal erosions using topical lubricants. This group of patients was recruited over 5 years ago before the results of Hope-Ross and McDonnell’s valuable study were known. Our study was a telephone questionnaire which was not investigating different treatment modalities in the management of recurrent erosions but merely reporting the symptomatology of a well documented group 4 years after the original study. We can say with some certainty that among those who were using some form of treatment those who were self medicating (67%) were not taking systemic tetracycline, but with regard to the remainder it is unlikely that those attending their general practitioner (26%) were taking systemic tetracycline. We do not have the data available for the remaining two patients who were continuing to attend an ophthalmologist. Although we accept Hope-Ross and McDonnells’s study findings our continued clinical experience with tetracycline has been less encouraging than theirs.

      Only two patients from this study continue to attend an ophthalmologist. One had certainly used a bandage contact lens in the past but had subsequently undergone phototherapeutic keratectomy and was still symptomatic, although to a lesser degree. Bandage contact lenses certainly have a role in the management of recurrent erosions in patients who are sufficiently troubled by symptoms to seek medical advice—something that the vast majority of these patients were not doing.