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  • The cornea is the clear, protective outer layer of the eye. Shaped like a dome, it helps to protect the eye from foreign bodies and also plays an important role in vision.

    A wide range of diseases and disorders can affect the cornea. Even seemingly minor eye irritations can lead to scarring and ulcers, so it’s important to seek prompt medical advice.

    Some common corneal conditions are described below.

    • Corneal abrasion occurs following some physical trauma to the cornea, including the presence of a foreign body.
    • Corneal dystrophy refers to a group of genetic eye disorders, in which part(s) of the cornea loses clarity because of a build-up of fat or cholesterol deposits. The disorder usually occurs before the age of 30 and affects men and women equally. You need to see an ophthalmologist for an accurate diagnosis.
    • Recurrent corneal erosion is a disorder that occurs when the top layer of the cornea fails to adhere to the tissue (Bowman’s layer) directly underneath it. It can be caused by trauma, disease or diabetes and affects vision.
    • A corneal ulcer is an open wound on the cornea that is often the result of a bacterial infection. Viral and fungal infections can also be responsible. Early treatment is essential because a corneal ulcer can lead to loss of vision.
    • Keratitis is an inflammation of the cornea caused by infection, injury or from leaving contact lenses in too long. Keratitis can be painful and may temporarily affect your vision. In rare cases, it may lead to complications that can damage your sight.
    • Ocular herpes is a type of keratitis caused by the herpes simplex virus (HSV). There is no specific cure, but an ophthalmologist can help you manage the infection and control further outbreaks.
  • Depending on the specific corneal condition involved, symptoms may include:

    • Sensation of having a foreign body in the eye
    • Pain
    • Watering of the eye
    • Redness
    • Blurred vision
  • How do I take care of my cornea?

    Corneal abrasions (scratches) are the most common type of eye injury. No matter how minor the injury seems, it’s important to see your doctor or optometrist to make sure it doesn’t develop into a bigger problem.

    Always wear eye protection when working with hand tools to prevent a foreign object scratching or penetrating the cornea.

    What are the signs of corneal damage?

    Signs include irritation, watering, the sensation of foreign material in your eye, sensitivity to light, blurred vision, redness, swelling and pain. If your eye is injured, see your doctor or optometrist straight away to prevent complications, such as infection or scarring.

    How do contact lenses contribute to corneal problems?

    If contact lenses are left in too long, there is a risk of corneal abrasion and infection. Poor hygiene can leave your cornea vulnerable to bacteria, fungi or parasites. This includes reusing the contact lens solution and/or not cleaning the lenses or lens case properly,

    You should always check the manufacturers guidelines or follow your optometrist's advice regarding how to use and look after your contact lenses.
    If you experience pain or inflammation, get your eye checked immediately. Always have your contact lenses reviewed regularly by an optometrist.

    What if I have a family history of corneal dystrophies?

    Corneal dystrophies are mostly asymptomatic in the early stages. Anyone with a genetic disposition should have their eyes regularly checked by an optometrist, who can refer you to an ophthalmologist if necessary.

Diagnosing corneal conditions

If you have pain, redness or swelling in your eye, your ophthalmologist will conduct a comprehensive eye examination. Some tests specifically highlight problems with the cornea. Other tests may help to rule in or rule out non-corneal causes.

  • Slit lamp: A microscope with a bright, intense light allows the ophthalmologist to study the cells lining your cornea (endothelial cells) and detect irregular bumps that might indicate Fuchs’ dystrophy.
  • Fluorescein eye stain: To accurately diagnose a corneal abrasion or ulcer, your ophthalmologist may perform a fluorescein eye stain. This is a test that uses fluorescent orange dye and a blue light to detect damage to the cornea.
  • Conjunctival scraping or biopsy: A sample of cells is taken from the conjunctiva to test for serious bacterial infections, such as trachoma, which is the world’s leading infectious cause of blindness.
  • Corneal topography: This is a computer-assisted diagnostic tool that creates a three-dimensional map of the surface curvature of the cornea. It helps diagnose corneal abrasions, deformities and irregular conditions that are not visible with conventional testing.
  • Eye pressure test: After numbing your eyes with drops, your doctor will briefly touch your eyes with a special instrument that measures the pressure inside your eye. This test can help distinguish between a disease that increases pressure in your eye (glaucoma) and a corneal condition such as Fuchs’ corneal dystrophy.
  • Pachymetry: This is a simple, painless test using a small instrument about the size of a digital thermometer to measure the thickness of your cornea. The test takes less than 30 seconds per eye.

Treating corneal conditions

Corneal abrasion

If you suffer from a scratch or an injury to the surface of your eye, don’t rub your eye or touch your cornea.
If a foreign object is embedded in your cornea, do not attempt to remove it. Go directly to the emergency ward at your nearest hospital or see an ophthalmologist. It’s important to seek quick treatment to avoid potentially serious complications, such as an infection, a corneal ulcer or corneal erosion.

Tarsorrhaphy is a surgical procedure that is sometimes performed on patients with corneal exposure or abrasions. The eyelids are partially sewn together to narrow the opening and protect the cornea until healing is complete.

Corneal dystrophy

Treatment may include:

  • Lubricating eye drops and ointments: if symptoms are mild
  • Glaucoma eye drops: used to reduce the pressure inside the eye (intraocular pressure)
  • Temporary eye patch or ‘bandage’ contact lenses: to protect the cornea, increase comfort and facilitate healing
  • Excimer laser therapy: can remove abnormalities from the cornea’s surface if symptoms persist
  • Corneal transplantation: only in the most severe cases that don’t respond to other treatment

Recurrent corneal erosion

Treatment may include:

  • Topical lubricant: This treatment aims to help your epithelial cells heal and regenerate properly.
  • Antibiotic drops: Depending on the extent of your condition, your ophthalmologist may prescribe antibiotic drops and suggest the short-term use of a therapeutic contact lens, known as a ‘bandage’ contact lens (see below).
  • ‘Bandage’ contact lens: These are soft, therapeutic lenses that provide oxygen to the cornea to reduce the risk of corneal hypoxia (insufficient supply of oxygen) and oedema (fluid accumulation). They can also decrease pain and help with the administration of eye drops.
  • Phototherapeutic keratectomy (PTK): This surface laser treatment may be recommended if your episodes worsen or become more frequent.

Corneal ulcer

Treatment will depend on the severity and type of corneal ulcer and usually involves antibiotic eyedrops or ointment in the first instance. If the ulceration is in the centre of your eye, it may take longer to recover. An anti-fungal agent may be necessary if the ulcer was caused by a tree branch or dirt.

Corneal transplantation is reserved for severe cases that have failed to respond to other treatments.

Keratitis

Infectious keratitis requires urgent attention.

There are a number of ways to treat keratitis, depending on the cause. Your ophthalmologist will typically prescribe antibacterial, antifungal or antiviral eye drops or ointments to treat the infection.

Prescription eye medication, oral medication or, in some cases, intravenous therapy may be used for more severe cases.

Ocular herpes

While it’s not possible to cure ocular herpes, there are a number of treatments which may help manage or control the condition.

  • Ointments: These are used to treat superficial infections. If you wear contact lenses, you will need to stop using them during treatment.
  • Debridement: This involves the removal of infected corneal epithelial cells using a cotton swab or corneal spatula.
  • Steroid eye drops: These can lessen scarring and infection if the infection is deeper in the corneal layers. Steroid drops must be prescribed by an ophthalmologist because the eye’s natural immune system can be compromised.
  • Surgery: This may be recommended for a persistent infection, which can led to serious scarring if left unresolved.
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