The Cornea and Cornea Conditions

The cornea is the eye’s outermost layer. It is the clear, dome-shaped surface that covers the front of the eye. Although the cornea is clear and seems to lack substance, it is actually a highly organized group of cells and proteins. Unlike most tissues in the body, the cornea contains no blood vessels to nourish or protect it against infection. Instead, the cornea receives its nourishment from the tears and aqueous humor that fills the chamber behind it. The cornea must remain transparent to refract light properly, and the presence of even the tiniest blood vessels can interfere with this process. To see well, all layers of the cornea must be free of any cloudy or opaque areas.

The corneal tissue is arranged in five basic layers, each having an important function. These five layers are:

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Epithelium

The epithelium is the cornea’s outermost region, comprising about 10 percent of the tissue’s thickness. The epithelium functions primarily to: (1) Block the passage of foreign material, such as dust, water, and bacteria, into the eye and other layers of the cornea; and (2) Provide a smooth surface that absorbs oxygen and cell nutrients from tears, then distributes these nutrients to the rest of the cornea. The epithelium is filled with thousands of tiny nerve endings that make the cornea extremely sensitive to pain when rubbed or scratched. The part of the epithelium that serves as the foundation on which the epithelial cells anchor and organize themselves is called the basement membrane.

Bowman’s Layer

Lying directly below the basement membrane of the epithelium is a transparent sheet of tissue known as Bowman’s layer. It is composed of strong layered protein fibers called collagen. Once injured, Bowman’s layer can form a scar as it heals. If these scars are large and centrally located, some vision loss can occur.

Stroma

Beneath Bowman’s layer is the stroma, which comprises about 90 percent of the cornea’s thickness. It consists primarily of water (78 percent) and collagen (16 percent), and does not contain any blood vessels. Collagen gives the cornea its strength, elasticity, and form. The collagen’s unique shape, arrangement, and spacing are essential in producing the cornea’s light-conducting transparency.

Descemet’s Membrane

Under the stroma is Descemet’s membrane, a thin but strong sheet of tissue that serves as a protective barrier against infection and injuries. Descemet’s membrane is composed of collagen fibers (different from those of the stroma) and is made by the endothelial cells that lie below it. Descemet’s membrane is regenerated readily after injury.

Endothelium

The endothelium is the extremely thin, innermost layer of the cornea. Endothelial cells are essential in keeping the cornea clear. Normally, fluid leaks slowly from inside the eye into the middle corneal layer (stroma). The endothelium’s primary task is to pump this excess fluid out of the stroma. Without this pumping action, the stroma would swell with water, become hazy, and ultimately opaque. In a healthy eye, a perfect balance is maintained between the fluid moving into the cornea and fluid being pumped out of the cornea. Once endothelium cells are destroyed by disease or trauma, they are lost forever. If too many endothelial cells are destroyed, corneal edema and blindness ensue, with corneal transplantation the only available therapy.

Common corneal diseases include Allergies, Dry Eye, Fuchs, Keratoconus and Shingles

Keratoconus

The cornea is the window of the eye. Light travels through the cornea past the lens to the retina and then the brain to form a visual image. The normal corneal surface is smooth and aspheric i.e. round in the center, flattening towards its outer edges. Light rays passing through it moves in an undistorted manner to the retina to project a clear image to the brain.

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In patients with keratoconus the cornea is cone shaped (hence the name keratoconus, derived from the greek word for cornea (‘kerato’) and cone shaped (‘conus’). In patients with keratoconus the cornea is not only cone shaped but the surface is also irregular resulting in a distorted image being projected onto the brain.

 

Because the cornea is irregular and cone shaped, glasses do not adequately correct the vision in patients with keratoconus since they cannot conform to the shape of the eye. Patients with keratoconus see best with rigid contact lenses since these lenses provide a clear surface in front of the cornea allowing the light rays to be projected clearly to the retina. Hence the vast majority of patients are treated with rigid contact lenses. There are however some excellent new surgical options for patients with keratoconus who cannot tolerate these lenses.

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Fuchs’ dystrophy is a slowly progressing disease that usually affects both eyes and is slightly more common in women than in men. Although doctors can often see early signs of Fuchs’ dystrophy in people in their 30s and 40s, the disease rarely affects vision until people reach their 50s and 60s.

Fuchs’ dystrophy occurs when endothelial cells gradually deteriorate without any apparent reason. As more endothelial cells are lost over the years, the endothelium becomes less efficient at pumping water out of the stroma. This causes the cornea to swell and distort vision.

Eventually, the epithelium also takes on water, resulting in pain and severe visual impairment. Epithelial swelling damages vision by changing the cornea’s normal curvature, and causing a sight-impairing haze to appear in the tissue. Epithelial swelling will also produce tiny blisters on the corneal surface. When these blisters burst, they are extremely painful.

Shingles

This infection is produced by the varicella-zoster virus, the same virus that causes chickenpox.

Be aware that corneal problems may arise months after the shingles are gone. For this reason, it is important that people who have had facial shingles schedule follow-up eye examinations.