Corneal Disease Treatment
The cornea is the clear front window of the eye. It transmits light to the interior of the eye allowing us to see clearly. Corneal disease is a serious condition that can cause clouding, distortion, and eventually blindness. There are many types of corneal disease. The three major types are keratoconus, Fuchs’ endothelial dystrophy, and bullous keratopathy.
Symptoms of Corneal Disease
- With keratoconus, as the cornea protrudes or steepens, vision becomes increasingly blurred and contact lens wear, which is often an early treatment for the disease, becomes difficult. The contact lens may not stay on the eye due to the irregular shape of the cornea.
- A person with Fuchs’ endothelial dystrophy or bullous keratopathy may first notice glare with lights at night or in bright sunlight. As these conditions progress, vision may be foggy or blurry in the morning and clear up as the day progresses. As the diseases further progress, vision will stay blurrier later into the day and eventually may not clear at all.
- Some corneal diseases can be very painful.
Keratoconus is a weakening and thinning of the central cornea. The cornea develops a cone-shaped deformity. Progression can be rapid, gradual, or intermittent. Keratoconus usually occurs in both eyes but can occur in only one eye.
Fuchs’ endothelial dystrophy is a hereditary abnormality of the inner cell layer of the cornea called the endothelium. The purpose of this layer is to pump fluids out of the cornea, keeping it thin and crystal clear. When the endothelium is not healthy, fluids are not pumped out and the cornea develops swelling, causing it to become cloudy and decrease vision.
Bullous keratopathy is a condition in which the cornea becomes permanently swollen. This occurs because the inner layer of the cornea, the endothelium, has been damaged and is no longer pumping fluids out of the tissue.
Causes of Corneal Disease
- Infection: Bacterial, fungal, and viral infections are common causes of corneal damage.
- The cause of keratoconus in most patients is unknown.
- Age: Aging processes can affect the clarity and health of the cornea
- Cataract and intraocular lens implant surgery: Bullous keratopathy occurs in a very small percentage of patients following these procedures.
- Contact lenses
- Eye trauma
- Certain eye diseases, such as retinitis pigmentosa, retinopathy of prematurity, and vernal keratoconjunctivitis.
- Systemic diseases, such as Leber’s congenital amaurosis, Ehlers-Danlos syndrome, Down syndrome, and osteogenesis imperfecta.
Diagnosing Corneal Disease
Your eye doctor can check for corneal disease and trauma by examining your eyes with magnifying instruments. Using a slit lamp and advanced diagnostic technology such as corneal topography, your doctor can detect early cataracts, corneal scars, and other problems associated with the front structures of the eye. After dilating your eyes, your doctor will also examine your retina for early signs of disease.
Treatment for Corneal Disease
As with any serious eye infection, the corneal disease should be treated immediately. Although corneal transplant is almost always the necessary treatment to restore vision when the cornea becomes clouded, there are other measures that can be taken to prolong vision in the early stages of the disease.
Who is most at risk for developing a corneal condition?
There are more than 20 corneal dystrophies, diseases that cause structural problems with the cornea. Keratoconus and Fuch’s dystrophy are the two most common of these, and both of them have a strong genetic tendency.
Contact lens wearers are at a higher risk, due to the possibility of hygienic issues with their lenses leading to an infectious corneal disease.
Can corneal diseases be prevented?
As for those corneal diseases with genetic components, there isn’t anything a person can do to prevent development. Instead of prevention, focusing on maintaining regular eye exams with the team at Central Valley is the best way to prevent vision degradation.
Otherwise, be aware of others with bacteria or viruses, as coming in contact with people with contagious forms of conjunctivitis increases your risk of developing an infectious corneal disease. Contact lens wearers who don’t keep their hands clean or share solution or lens cases are at much higher risk for developing an infectious corneal disease.
Also, don’t sleep in your contact lenses, even if the packaging says you can. Sleeping in your contact lenses greatly increases your chances of infection. The eyes need the time during sleep to cleanse themselves and to rest.
Can the cornea repair itself?
The cornea can often repair itself after minor injuries such as abrasions or with certain types of disease, but that’s not the case with the more serious conditions we’ve discussed here. Waiting for the cornea to heal itself with something like keratoconus only invites more corneal damage. For these more serious cases, you need treatment from the professionals at Central Valley Eye Medical Group.
What are the non-surgical treatments used for corneal diseases?
While not true corneal diseases, corneal problems such as keratitis, where the cornea becomes inflamed by viruses, bacteria, or fungi, can be treated with antibiotics or antifungal eye drops. Some people need antiviral drugs and steroid eye drops. Keratitis can be caused when an injury introduces the bacteria or other invaders, or it can be due to lackadaisical contact lens hygiene.
Cross-linking is the only FDA-approved treatment for halting the progression of keratoconus. Corneal cross-linking involves administering riboflavin (vitamin B2) eye drops and UVA light in carefully selected parameters that strengthen the front layers of the cornea and avoid damage to the back part of the eye.
Ocular herpes is another condition that can affect the cornea, creating inflammation. The inflammation can spread deeper into your cornea and eye. Ocular herpes is incurable, but it can be controlled with antiviral drugs or steroid eyedrops.
For the degenerative corneal diseases, such as keratoconus, invariably the treatment will eventually need to be a corneal transplant. Early stages of keratoconus can be correctable with glasses or soft contact lenses. As the disease progresses, the patient may need to wear rigid gas permeable contact lenses.
With Fuch’s dystrophy, mildly symptomatic patients are prescribed ointments and eyedrops.
What happens if the corneal disease is left untreated?
In most corneal diseases, opting to not seek treatment will impact the quality of your vision. As mentioned above, with the many diseases that affect the cornea, there is a wide range of causes and outcomes. Early treatment for many of these conditions will involve prescription eyedrops or possibly wearing an eye patch or special contact lenses.
As the progress of the condition, corneal transplants are usually necessary.
A better question than “What happens if I don’t seek treatment?” would be “Why would you want to risk the quality of your vision by leaving a corneal disease or other condition untreated?”
How is a corneal transplant performed?
Prior to this procedure, you’ll be given a sedative to help you relax. Because you need to be awake during the procedure, only a local anesthetic is used, so that you have no feeling in your eye area.
The most common option is a full-thickness replacement. Your Central Valley Eye Medical Group surgeon will cut through the entire thickness of the abnormal or diseased cornea, removing a circular disk of tissue. An instrument called a trephine is used to precisely make the circular, button-sized cut.
The next step is to cut the donor tissue to the same size. This donor tissue is then placed into the spot where the damaged tissue was removed, and this is stitched into place.
If a full-thickness replacement isn’t appropriate, we may remove certain layers at either the back or front of the cornea. These are replaced with donor tissue.