The cornea is the transparent part of the front of the eye. It is the first part of the eye to capture light and is responsible for a large portion of our vision. When the cornea is damaged by injury or disease it can lead to loss of vision or sometimes even blindness. Our corneal & external disease specialists are fellowship-trained in the latest procedures and treatments for corneal disease.
There are many different corneal diseases. Some are caused by bacterial, fungal or viral infections, while some are hereditary or develop over time.
Carolina Eyecare Physicians offers treatment for many corneal and external eye diseases, including:
Scleritis, or inflammation of the sclera, can present as a painful red eye with or without vision loss. The most common form, anterior scleritis, is defined as scleral inflammation anterior to the extraocular recti muscles. Posterior scleritis is defined as involvement of the sclera posterior to the insertion of the rectus muscles.
Anterior scleritis, the most common form, can be subdivided into diffuse, nodular, or necrotizing forms. In the diffuse form, anterior scleral edema is present along with dilation of the deep episcleral vessels. The entire anterior sclera or just a portion may be involved. In nodular disease, a distinct nodule of scleral edema is present. The nodules may be single or multiple in appearance and are often tender to palpation. Necrotizing anterior scleritis is the most severe form of scleritis. It is characterized by severe pain and extreme scleral tenderness. Severe vasculitis, as well as infarction and necrosis with exposure of the choroid, may result from a rare form of necrotizing anterior scleritis without pain can be called scleromalacia perforans. The sclera is notably white, avascular and thin. Both choroidal exposure and staphyloma formation may occur.
Posterior scleritis, although rare, can manifest as serious retinal detachment, choroidal folds, or both. There is often a loss of vision as well as pain upon eye movement.
Keratitis is a condition where the cornea—the clear, round dome covering the eye’s iris and pupil—becomes swollen or inflamed, making the eye red and painful and affecting vision. Keratitis is also known as a corneal ulcer.
Some forms of keratitis may involve infection, including bacterial keratitis, viral keratitis, fungal keratitis, and parasitic keratitis. Contact lens wearers need to remember that infectious keratitis can result from not caring for your contact lenses properly.
A non-infectious form of keratitis may be caused by a simple fingernail scratch or from wearing your contact lenses too long. Whatever form of keratitis you may have, it is crucial that you see an ophthalmologist right away. Waiting to have your keratitis diagnosed and treated can lead to serious complications, including blindness.
Keratitis or corneal ulcer causes can include:
Keratitis or corneal ulcer treatment depends on the type and severity of this corneal problem. Antibacterial or antifungal eye drops may be used to treat corneal infections. Sometimes steroid eye drops may be necessary to reduce the inflammation (swelling) of keratitis.
If the cornea is severely scarred or thinning has occurred, a corneal transplant may be needed to restore vision.
It is important to remember that keratitis must be treated early to reduce the risk of complications, and it is likely that frequent visits to an ophthalmologist may be needed to fully treat this corneal problem.
Corneal ulcers are usually caused by the following types of infections:
Other causes of corneal ulcers include:
Fuchs’ dystrophy is a disease of the cornea. It is when cells in the corneal layer called the endothelium die off. These cells normally pump fluid from the cornea to keep it clear. When they die, fluid builds up and the cornea gets swollen and puffy. Vision becomes cloudy or hazy.
Fuchs’ dystrophy has two stages. In the early stage (stage 1), you may notice few, if any, problems. Vision is usually hazy in the morning but gets better throughout the day. This is because your eyes normally stay moist when they are closed during sleep. But when you are awake, the fluid dries normally.
With later stage 2, vision remains blurry all day. Too much fluid builds up during sleep and not enough dries up during the day. Also, tiny blisters may form in the cornea. The blisters get bigger and eventually break open, causing eye pain.
People in their 30s and 40s may have Fuchs’ dystrophy but not know it. Vision problems might not appear until age 50 or later. Women are more likely than men to have Fuchs’ dystrophy.
In the later stage (stage 2), your blurry or hazy vision will not get better as the day goes on. Here are other symptoms:
There is no cure for Fuchs’ dystrophy. However, you can control vision problems from corneal swelling. Your treatment depends on how Fuchs’ dystrophy affects your eye’s cells.
Here are treatments for early Fuchs’ dystrophy:
For very poor vision or scarred corneas, you may need a cornea transplant. This surgery could be one of two types:
Your ophthalmologist will discuss what treatments are best for your condition.
Doctors do not know for sure why people have keratoconus. In some cases, it appears to be genetic (passed down in families). About 1 out of 10 people with keratoconus have a parent who has it too. Keratoconus often starts when people are in their late teens to early 20s. The vision symptoms slowly get worse over a period of about 10 to 20 years.
Keratoconus can be diagnosed through a routine eye exam. Your ophthalmologist will examine your cornea and may measure its curve. This helps to show if there is a change in its shape. Your ophthalmologist may also map your cornea’s surface using a special computer. This detailed image shows the condition of the cornea’s surface.
Keratoconus often affects both eyes and can lead to very different vision between the two eyes. Symptoms can differ in each eye, and they can change over time.
In the early stage, keratoconus symptoms can include:
In later stages, keratoconus symptoms often include:
Keratoconus usually takes years to go from early to late stage. For some people, though, keratoconus can get worse quickly. The cornea can swell suddenly and start to scar. When the cornea has scar tissue, it loses its smoothness and becomes less clear. As a result, vision grows even more distorted and blurry.
Here are other ways that your ophthalmologist might treat keratoconus:
The cornea is the clear, front window of the eye. It helps focus light into the eye so that you can see. The cornea is made of layers of cells. These layers work together to protect your eye and provide clear vision.
Your cornea must be clear, smooth and healthy for good vision. If it is scarred, swollen, or damaged, light is not focused properly into the eye. As a result, your vision is blurry or you see glare.
If your cornea cannot be healed or repaired, your ophthalmologist may recommend a corneal transplant. This is when the diseased cornea is replaced with a clear, healthy cornea from a human donor.
A human donor is someone who chooses to donate (give) his or her corneas after their death to people who need them. All donated corneas are carefully tested to make sure they are healthy and safe to use.
There are different types of corneal transplants. In some cases, only the front and middle layers of the cornea are replaced. In others, only the inner layer is removed. Sometimes, the entire cornea needs to be replaced.
Your entire cornea may need to be replaced if both the front and inner corneal layers are damaged. This is called penetrating keratoplasty (PK), or full thickness cornea transplant. Your diseased or damaged cornea is removed. Then the clear donor cornea is sewn into place.
PK has a longer recovery period than other types of cornea transplants. Getting complete vision back after PK may take up to 1 year or longer.
With a PK, there is a slightly higher risk than with other types of corneal transplants that the cornea will be rejected. This is when the body’s immune system attacks the new corneal tissue.
Sometimes the front and middle layers of the cornea are damaged. In this case, only those layers are removed. The endothelial layer, or the thin back layer, is kept in place. This transplant is called deep anterior lamellar keratoplasty (DALK) or partial thickness corneal transplant. DALK is commonly used to treat keratoconus or bulging of the cornea.
Healing time after DALK is shorter than after a full cornea transplant. There is also less risk of having the new cornea rejected.
Some things to know:
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