Recurrent Corneal Erosion Syndrome in Epithelial Basement Membrane Dystrophy: Current Treatments and Mechanism-Guided Therapeutic Opportunities

Recurrent corneal erosion syndrome (RCES) and epithelial basement membrane dystrophy (EBMD), also termed anterior basement membrane dystrophy, are distinct entities. RCES most often follows shearing corneal trauma, whereas EBMD may be asymptomatic, may blur vision without pain, or may predispose to erosions through defective epithelial attachment. This narrative review focuses on RCES associated with EBMD. It emphasizes how treatment choice depends on clinical findings, on whether the main goal is pain control, recurrence prevention, or visual rehabilitation, and on how directly the evidence applies to EBMD rather than to mixed-cause erosions. Lubrication and bandage lenses protect the healing surface, while anti-inflammatory and blood-derived therapies support repair. Debridement removes unstable epithelium; manual superficial keratectomy, diamond burr polishing, alcohol delamination, and phototherapeutic keratectomy treat the abnormal interface. Anterior stromal puncture provides focal scar-mediated anchoring, principally outside the visual axis. Contemporary procedural studies support individualized treatment but do not establish a universally superior technique. A heparan sulfate mimetic polymer has been tested directly in EBMD, but only in one small uncontrolled series; topical insulin, neurotrophic treatments, and differentiation-related targets lack EBMD-specific evidence of benefit. Epithelial closure, prevention of painful erosions, and optical rehabilitation are distinct outcomes and should not be treated as interchangeable measures of success. Management of EBMD-associated RCES should therefore be guided by the dominant clinical problem, lesion location, and the specific therapeutic outcome sought.