Cornea and Ocular Surface

The cornea is a transparent layer in the front portion of the eye. Light from objects first falls on the cornea and is refracted inside the eye to go through the pupil and then on to the retina through the lens. The human cornea is avascular (devoid of blood vessels) and constitutes the major refractive surface in the eye.

The various common diseases of the cornea and ocular surface are:

1. Corneal ulcer and infectious diseases: The eye is constantly exposed to external environment. The lids and the tear film keep away most of the infectious agents like bacteria, fungus and viruses from affecting the cornea however, direct injury by vegetable matter, infected objects and sometimes contact lenses can lead to infectious keratitis. Early diagnosis is essential as in early stages these infections are amenable to medical treatment with eye drops. In severe cases, the entire cornea can get infected which necessitates a corneal transplant.

2. Pterygium: This is a fleshy growth from the white portion of the eye that encroaches on the cornea. The cornea can get distorted leading to abnormal glass power and in advanced cases it can cover the visual axis leading to reduction in vision. Treatment involves removal of the pterygium by surgery and a conjunctival autograft.

3.Chemical Injury: Chemical injury to the cornea and ocular surface is common in people working in factories and automobile industry. The chemical burns the external surface of the eye and leads to loss of blood supply. If treated early with topical steroids and other surgical modalities recovery is good. In late stages the cornea becomes opaque and requires stem cell transplants and other ocular surface reconstructive procedures to improve vision.

4.Keratoconus: Normally the cornea is elliptical and has a regular curved surface. In certain patients the cornea starts to become conical and thinner. This condition is called Keratoconus and usually occurs in teenage children and young adults. Keratoconus progression is monitored by topography. Early stages are treated with spectacle correction and rigid gas permeable contact lenses/sclera lenses. Progressive keratoconus is treated by corneal collagen crosslinking. Late stages are treated with a corneal transplant.

5.Bullous keratopathy after cataract surgery: The innermost layer of the cornea called the endothelium, is responsible for keeping the cornea dry and provides nourishment. Sometimes, due to poor or complicated cataract surgery, the endothelium gets damaged and is not able to keep the cornea clear and dry leading to swelling and opacification of the cornea. These cases are managed by replacing the diseased endothelium with a lamellar corneal transplant. Late stages require a full thickness transplant.

6. Dry Eye Disease: Inadequate or abnormal production of tears or increased evaporation can lead to dry eye. Dry eye is common among computer users, post-LASIK patients, menopausal females, diabetic patients and the elderly. It can also occur as a complication of rheumatoid arthritis, autoimmune diseases and conditions such as Stevens Johnson Syndrome and Ocular cicatricial pemphigoid. Treatment depends on the severity of the dry eye with mild cases managed by topical lubricants and severe cases needing mucous membrane grafts and punctual occlusion.

7. Ocular Surface disorders: The healthy ocular surface is responsible for maintaining a clear cornea and an adequate tear film. The ocular surface dynamics are altered in diseases such as Stevens Johnson Syndrome, Ocular cicatricial pemphigoid, chemical injury and sometimes chronic use of eye drops. This leads to inflammation and scarring of the ocular surface which in turn leads to dryness and loss of corneal clarity. Treatment involves use of topical and oral immunosuppression, stem cell/amniotic membrane transplants and mucous membrane grafts.

8. Corneal Dystrophy: Corneal dystrophies are generally hereditary conditions that lead to opacification of the cornea in different patters usually due to abnormal functioning/structure or chemical composition of the particular layer of the cornea. Dystrophies generally affect both eyes and treatment depends on the severity of visual deficit. Advanced cases necessitate a transplant.

Daksh Netralaya is the only centre in Jabalpur and Mahakoshal region providing the complete spectrum of cornea services. Our cornea consultant, Dr. Chaitali Patel Harshey is trained in cornea and ocular surface disorders from the prestigious LV Prasad Eye Institute, Hyderabad.

Facilities available at Daksh Netralaya for cornea and ocular surface patients:

• Amniotic Membrane and Mucous Membrane Grafts
• Stem Cell Transplants
• Corneal Collagen Crosslinking

Visit our Corneal Transplant and Ocular Surface Surgeries page to know more about corneal surgical procedures performed at Daksh Netralaya.