What is Corneal Disease?
If we think about the eye as a camera, the cornea would be the glass at the front of the camera lens. The cornea is not only a clear window through which light passes on its way into the eye, it provides most of the focusing power in the eye as well. Corneal disease is a serious condition that can cause clouding, distortion, scarring, and eventually blindness. There are many types of corneal disease. The three major types are keratoconus, Fuchs’ endothelial dystrophy, and bullous keratopathy.
What are the symptoms of Corneal Disease?
- With keratoconus, as the cornea protrudes or steepens, vision becomes increasingly blurred and contact lens wear, which is often an early treatment for the disease, becomes difficult. The contact lens may not stay on the eye due to the irregular shape of the cornea.
- A person with Fuchs’ endothelial dystrophy or bullous keratopathy may first notice glare with lights at night or in bright sunlight. As these conditions progress, vision may be foggy or blurry in the morning and clear up as the day progresses. As the diseases further progress, vision will stay blurrier later into the day and eventually may not clear at all.
- Some corneal diseases can be very painful.
Keratoconus is a weakening and thinning of the central cornea. The cornea develops a cone-shaped deformity. Progression can be rapid, gradual, or intermittent. Keratoconus usually occurs in both eyes, but can occur in only one eye.
Fuchs’ endothelial dystrophy is a hereditary abnormality of the inner cell layer of the cornea called the endothelium. The purpose of this layer is to pump fluids out of the cornea, keeping it thin and crystal clear. When the endothelium is not healthy, fluids are not pumped out and the cornea develops swelling, causing it to become cloudy and decrease vision.
Bullous keratopathy is a condition in which the cornea becomes permanently swollen. This occurs because the inner layer of the cornea, the endothelium, has been damaged and is no longer pumping fluids out of the tissue.
What are the causes of Corneal Disease?
- Infection: Bacterial, fungal and viral infections are common causes of corneal damage.
- The cause of keratoconus in most patients is unknown.
- Age: Aging processes can affect the clarity and health of the cornea.
- Cataract and intraocular lens implant surgery: Bullous keratopathy occurs in a very small percentage of patients following these procedures.
- Contact lenses
- Eye trauma
- Certain eye diseases, such as retinitis pigmentosa, retinopathy of prematurity, and vernal keratoconjunctivitis.
- Systemic diseases, such as Leber’s congenital amaurosis, Ehlers-Danlos syndrome, Down syndrome and osteogenesis imperfecta.
How is Corneal Disease diagnosed?
Your eye doctor can check for corneal disease and trauma by examining your eyes with magnifying instruments. Using a slit lamp and advanced diagnostic technology such as corneal topography, your doctor can detect early cataracts, corneal scars, and other problems associated with the front structures of the eye. After dilating your eyes, your doctor will also examine your retina for early signs of disease.
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Treatment Options for Corneal Disease
As with any serious eye infection, corneal disease should be treated immediately. Although corneal transplant is almost always the necessary treatment to restore vision when the cornea becomes clouded, there are other measures that can be taken to prolong vision in the early stages of disease.
A successful corneal transplant requires care and attention on the part of both patient and physician. Of all transplant surgery done today – including heart, lung and kidney – corneal transplants are the most common and successful.
The cornea is the clear front window of the eye that covers the colored iris and the round pupil. Light is focused while passing through the cornea so we can see.
A corneal transplant is needed if:
- Vision cannot be corrected satisfactorily with eyeglasses or contact lenses
- Painful swelling cannot be relieved by medications or special contact lenses
- Corneal failure after other eye surgery, such as cataract surgery
- Keratoconus, a steep curving of the cornea
- Hereditary corneal failure, such as Fuchs Distrophy
- Scarring after infections, especially after herpes
- Rejection after first corneal transplant
Once you and your ophthalmologist decide you need a corneal transplant, your name is placed on a list at the local eye bank. Usually the wait for a donor cornea is not very long. Before a cornea is released for a transplant, the eye bank tests the cornea for clarity.
The Day of Surgery
Surgery is often done on an outpatient basis. You will be given eye drops and perhaps a sedative to help you relax. Either local or general anesthesia is used, depending on your age, medical condition and eye disease.