Dr. Orwa Nasser MD MPH - Corneal diseases and transplants

The Cornea

The cornea is the clear, curved structure at the very front of the eye. It serves as both a protective barrier and a powerful focusing surface, playing a central role in vision quality.

In everyday terms, the cornea functions like the eye’s front window. It allows light to enter the eye while helping bend (refract) that light so images can be focused accurately inside the eye.

Because it is exposed to the environment, the cornea is also one of the most vulnerable parts of the eye to dryness, injury, and infection. It is one of the most sensitive tissues in the human body due to its dense nerve supply.

What is the cornea?

The cornea is the transparent, dome-shaped outer surface that covers the front of the eye. It lies in front of the anterior chamber, which contains aqueous humor, and directly in front of the iris and pupil.

The cornea has no blood vessels. It receives oxygen from the air and nutrients from tears and internal eye fluid, allowing it to remain clear while still functioning as a strong protective structure.

Layers of the cornea:

1.  Epithelium: The epithelium is the outermost layer of the cornea. It acts as a barrier against bacteria, viruses, and foreign particles. It is highly sensitive and usually heals quickly after superficial injury.

2.  Bowman’s layer: Bowman’s layer is a tough, collagen-rich layer beneath the epithelium. It helps maintain corneal shape and does not regenerate if damaged.

3.  Stroma: The stroma makes up most of the cornea’s thickness. Its precisely arranged collagen fibers are essential for corneal transparency and strength.

4.  Pre-Descemet’s layer (PDL): The Pre-Descemet’s layer (PDL) is a strong layer between the stroma and Descemet’s layer. It contributes to corneal stability and is relevant in modern corneal surgery.

5.  Descemet’s layer: Descemet’s layer is a thin but resilient membrane that supports the inner cornea and protects deeper structures.

6.  Endothelium: The endothelium is the innermost layer of the cornea. It pumps excess fluid out of the cornea to keep it clear. Damage to this layer can lead to corneal swelling and blurred vision.

Conditions and Disorders:

Corneal disorders may arise from dryness, inflammation, infection, injury, environmental exposure, or inherited conditions.

·     Dry eye: Dry eye occurs when tears are insufficient or evaporate too quickly. Symptoms include burning, redness, gritty sensation, and fluctuating blurred vision.

·     Infections: The cornea may be infected by bacteria, viruses, fungi, or parasites. A serious example is acanthamoeba keratitis, which requires urgent specialist care.

·     Cornea inflammation (keratitis): Cornea inflammation (keratitis) can be infectious or non-infectious and may cause pain, light sensitivity, redness, tearing, and blurred vision.

·     Injuries: Corneal injuries include scratches (abrasions), sores (ulcers), erosions, and lacerations. Even minor injuries can be very painful.

·     Environmental damage: Environmental damage includes corneal burns, chemical exposure, and ultraviolet injury such as photokeratitis.

·     Structural diseases (dystrophies): Corneal dystrophies are inherited disorders affecting corneal clarity or structure. Examples include keratoconus and Fuchs’ dystrophy.

What treatments are available for corneal conditions? Treatment depends on diagnosis and severity and may include lubricating drops, prescription medications, protective lenses, laser procedures such as LASIK, Eye surgeries, or Cornea transplant.

Dr. Orwa Nasser and our team individualize treatment to balance safety, effectiveness, and long-term corneal health.

Can you still see without a cornea? No. The cornea is essential for focusing light and protecting the inner eye.

How long does a damaged cornea take to heal? Healing time depends on the depth and cause of injury. Superficial injuries may heal quickly, while deeper damage requires longer treatment.

A note from Dr. Orwa Nasser and our team: Early evaluation of corneal symptoms helps prevent complications and preserve vision.

Care:

·     How can I protect my corneas from injuries? Protective eyewear should be worn during activities involving tools, chemicals, sports, or UV exposure.

·     How do I keep my corneas healthy? Healthy habits include regular eye exams, proper contact lens hygiene, avoiding eye rubbing, and good hand hygiene.

·    What are eye symptoms that mean I need medical care? Seek medical evaluation for eye pain, redness, vision changes, light sensitivity, visible injury, or foreign body sensation.

·     What should I do if something is stuck in my eye?

o   Do’s: Blink slowly and rinse gently with clean water or saline.

o   Don’t’s: Do not rub the eye or remove embedded objects.

Key Takeaways:

·         The cornea is essential for vision and protection.

·         It consists of six specialized layers.

·         Many corneal conditions are treatable with early care.

·         Eye protection and hygiene reduce injury risk.

·         Prompt evaluation helps prevent vision loss.