CORNEAL DISEASES

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Since the abundant nerve supply of the cornea makes it one of the most sensitive parts of the body, it serves as an excellent “watchdog” for foreign material entering the eye. Dirt or specks lodging in the eye may produce scratching, knife-cutting sensations that the sensitive corneal nerves transmit to the brain. If the cornea loses this sensitivity due to in- jury or impairment by disease, it loses it’s protective function. Foreign bodies may embed in the cornea. A foreign body on the cornea needs urgent attention by an ophthalmologist. One should not attempt to remove it by rubbing the eye.

A twig of a tree, a piece of paper, or a fingernail can produce corneal abrasions. If not attended to immediately, secondary infection can occur which could lead to vision-threatening complications. Contact lenses also can produce an irritable eye from a corneal abrasion. Until an eye specialist can be consulted, the contact lens should be removed and the eye patched.

Injuries to the eye with sharp or blunt objects require urgent attention of you’re ophthalmologist, especially to rule out corneal injuries, which can be sight threatening.

Acid or alkaline solutions splashed into the eye may be potentially sight threatening. Symptoms (such as pain, redness, watering and light-sensitivity) occur immediately after exposure to the chemical and may be severe in nature. Chemicals in the eye need to be thoroughly washed out immediately with water. Thereafter, urgent consultation with an eye specialist is necessary. Infections.

What is Dry Eye Syndrome ?

Dry eye syndrome is a leading cause of ocular discomfort affecting millions of people. Dry eye conditions are a spectrum of disorders with varied etiology ranging from mild eyestrain to very severe dry eyes with sight threatening complications.

This grayish elevated growth of elastic and connective tissue containing blood vessels invades and grows over the cornea. It may result from irritation to the eye from wind, heat of the sun, dust, or smoke. If the pterygium progresses to grow over the center of the cornea, sight may be impaired or even lost. Before this occurs, the pterygium should be removed surgically. At our centre, pterygium is removed by a specialized technique called Conjunctival Autografting, where, the pterygium is excised, and a conjunctival graft, taken from a healthy part of the same eye is used to cover the defect. This technique prevents recurrence of the pterygium, which would normally occur after conventional pterygium removal without grafting. Some people confuse a cataract with a pterygium by calling a cataract a “skin growing over the eye.” A cataract, however, is a clouding of the lens, which is located inside the eyeball.

Normally the cornea is nearly spherically shaped thus allowing light to be focused clearly on the back of the eye (retina). However in a condition called Keratoconus, the cornea begins to thin, and this allows the normal pressure of the eye to make the cornea bulge forward taking on a cone-shape. As the cornea gradually becomes more cone-shaped, the vision blurs and becomes distorted due to a high degree of astigmatism. Initially vision may be correctable with spectacles, but as the condition progresses, and the cornea becomes more irregular causing distorted vision, spectacles become less effective. In such a situation, contact lenses not only provide better vision, but also help to retard the progress of the disorder. A rigid contact lens (RGP / “semi-soft” contact lenses) must be used, so that it can hold it’s shape, as a soft lens would simply mould to the existing shape and thus not allow complete correction of the problem. Sometimes the patient is fitted with soft lenses (for comfort), over which semi-soft lenses are fitted (“piggy-back” lenses).

Corneal infections are a leading cause of ocular morbidity. These infections are due to different microbes such as bacteria, virus, fungi and protozoa like acanthamoeba, microsporidia. Inflammation of the cornea, or keratitis, may be secondary to conjunctivitis, blepharitis (inflammation of eyelid margins), or injury. Keratitis is characterized by a painful red eye, sensitivity to light, and an occasional scratching sensation upon blinking. An ulcer may develop in the cornea after a bacterial, viral, fungal, or other infectious organism invades it’s outer layer. Herpes simplex, a virus can invade the cornea after injury, producing keratitis. Herpes zoster, another viral agent, produces inflammation of the cornea, especially if the skin of the nose is involved. A marginal ulcer is a corneal infection that occurs near the outer edge of the cornea. Central corneal ulcers due to bacteria, viruses, or fungi can be severe and serious; they may even cause loss of the eye. With these severe ulcers, the eye sets up a defense reaction to help fight the infection. This disease requires the immediate attention of an ophthalmologist. ..

• It is not necessary to find a cornea with a matching tissue or blood type
• The race, gender, eye color of the donor is not important
• A Cornea transplant won’t change you’re natural eye color
• The Cornea heals slowly and improvement in vision may take a year or more
• It is difficult to shape the new Cornea perfectly. So, astigmatism (a condition where the Cornea has an irregular shape, making images seem blurred or distorted) is common after a cornea transplant. However, this can be corrected.

If you are advised to undergo a cornea transplant you’re Ophthalmologist will tell you what is required. The transplant will be scheduled according to the condition of you’re eye and the availability of a donor Cornea. Occasionally a shortage of donor corneas may delay surgery. If both you’re eyes need new corneas, the second transplant will not be performed until the first eye has stabilized, which may take up to a year.

Usually local anesthesia is used for surgery, so you will be awake but feel no pain. The nerves in you’re eye will be numb so you cannot see or move you’re eye. Sometimes the doctor may use general anesthesia.

For the transplant procedure doctors use an operating microscope and very delicate instruments. Once the old Cornea is removed the new Cornea is stitched into place. The sutures are not visible and are not painful.

If necessary other procedures may be performed at the same time as you’re transplant. For example a cataract may be removed and replaced with an intraocular lens (IOL). An IOL may be replaced or removed, the iris may be repaired, and the additional procedure required will be explained to you by you’re ophthalmologist.

Nowadays only the diseased portion of the cornea can be replaced known as lamellar corneal transplant. They’re are conditions of the Cornea such as Scars, dystrophies, degenerations, keratoconus where the pathology is limited to the anterior portion of the cornea and only that portion is replaced known as anterior lamellar keratoplasty. They’re are conditions such as Endothelial dystrophy, aphakic and  pseudophakic corneal edema where the corneal endothelium is affected and only that is replaced known as endothelial keratoplasty. However these are not an option for every patient who needs a cornea transplant and you need to discuss the appropriate option with you’re ophthalmologist.

Please follow the instructions regarding medication given by you’re doctor, do not abruptly stop the drops it can be detrimental for the corneal graft and do adhere to a regular follow up schedule for long term success.

Corneal Dystrophies

These are primary, inherited, bilateral changes of the Cornea that occur unaccompanied by systemic disease, which effect the normal transparency of the Cornea and result in reduced vision. Dystrophies can effect the Corneal Epithelium, Stroma, or Endothelium. The epithelial and stromal  dystrophies in the early stage can be managed by phototherapeutic keratectomy (PTK) whereby the laser can removed the affected portion of the Cornea, when the deeper Cornea is involved a lamellar or full thickness corneal transplant will be required depending on the extent of involvement. The endothelial dystrophies require either an endothelial or full thickness corneal transplant.