Cornea and External Disease
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 (a fluid in the anterior portion of the eye) 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: 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.
Injuries, Diseases, and Disorders
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The cornea copes very well with minor injuries or abrasions. If the highly sensitive cornea is scratched, healthy cells slide over quickly and patch the injury before infection occurs and vision is affected. If the scratch penetrates the cornea more deeply, however, the healing process will take longer, at times resulting in greater pain, blurred vision, tearing, redness, and extreme sensitivity to light. These symptoms require professional treatment. Deeper scratches can also cause corneal scarring, resulting in a haze on the cornea that can greatly impair vision. In this case, a corneal transplant may be needed. Some diseases and disorders of the cornea are:
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Allergies
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Conjunctivitis (Pink Eye)
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Corneal Infections
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Dry Eye
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Fuchs’ Dystrophy
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Corneal Dystrophies
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Herpes Zoster (Shingles)
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Iridocorneal Endothelial Syndrome
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Keratoconus
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Lattice Dystrophy
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Map-Dot-Fingerprint Dystrophy
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Ocular Herpes
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Pterygium
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Refractive Errors
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Stevens-Johnson Syndrome
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If you have been diagnosed with a corneal disease, book an appointment with our specialist below!