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Corneal disorders

Last updated: December 2, 2019

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The cornea is the transparent, outermost layer of the eye. Certain corneal conditions, such as infection, injury, abnormal curvature, and opacification, can cause restricted vision. Because the cornea is well innervated by the ophthalmic branch of the trigeminal nerve, it is very sensitive and corneal disorders are often painful. Diagnosis of corneal disorders is made via slit lamp examination and, in some cases (e.g., corneal abrasion or erosion), fluorescein staining. Treatment typically involves local measures, such as antibiotic eye drops, ointments, and therapeutic contact lenses. Corneal transplantation is generally only performed as a last resort in patients with significant visual impairment or failed treatment for infection.

This article covers the following corneal disorders: corneal abrasion, corneal erosion, corneal degeneration (primarily band keratopathy), corneal dystrophy (primarily Fuchs dystrophy), corneal deposits, keratoconus, keratoglobus, astigmatism, and keratoplasty. For other disorders of the cornea, see the Articles on conjunctivitis and keratitis.

Also see cornea in eye and orbit.

Corneal abrasion

Retained foreign bodies in the eye that cannot be removed warrant urgent referral to an ophthalmologist!

Corneal erosion [7]

Corneal degeneration

  • Definition: changes of the cornea that cause corneal deterioration and, potentially, dysfunction
  • Etiology

Band keratopathy [12]

Corneal dystrophy [13]

Fuchs dystrophy [14]

  • Definition: inherited disease that predisposes to progressive loss of corneal endothelial cells
  • Pathophysiology: corneal endothelial cells are responsible for maintaining the transparency of the cornea by balancing water and electrolyte flow into and out of the corneal layers; deterioration of corneal endothelial cells → decreased outflow of water from the corneal stroma → corneal edema, opacification, and bullous epithelial detachment [15]
  • Clinical findings
    • Reduced visual acuity
    • Blurred vision, glare, and halos, often improving over the course of the day [16]
    • Eye pain or foreign body sensation in the eye
  • Diagnostics
  • Treatment [18]
    • Asymptomatic patients do not require treatment.
    • Symptomatic treatment
      • Medical treatment to dehydrate the cornea: hyperosmolar eye drops, warm dry air (e.g., hair dryer held at arm's length)
      • For pain or foreign body sensation in the eye: NSAIDs, bandage contact lenses
    • Keratoplasty: indicated in advanced disease with marked loss of vision that does not improve over the course of the day and if pain cannot be alleviated by symptomatic treatment

Corneal deposits

A variety of substances can accumulate in the cornea to create deposits. Two of the more well-known causes of corneal deposits are presented below.

Arcus senilis (corneal arcus)

  • Definition: a condition associated with normal aging, in which annular deposits of lipids appear around the corneal margin [19]
  • Epidemiology: Incidence increases with age. [20]
    • 60% in those 50–60 years
    • Almost 100% in those > 80 years
  • Clinical findings: asymptomatic
  • Diagnostics: slit lamp examination
  • Treatment
    • In older patients: no treatment necessary
    • Occurrence before 50 years of age: rule out lipid disorders

Kayser-Fleischer ring

Keratoconus

Keratoglobus [22]

Astigmatism

Keratoplasty (corneal transplantation) [21][23][24]

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  2. Recurrent Corneal Erosion. http://eyewiki.org/Recurrent_Corneal_Erosion. Updated: May 22, 2016. Accessed: February 26, 2019.
  3. Facts About the Cornea and Corneal Disease. https://www.nei.nih.gov/health/cornealdisease. Updated: May 1, 2016. Accessed: February 26, 2019.
  4. Mittal V, Narang P. Fuchs Endothelial Dystrophy. In: Law SK, Rapuano CJ, Soy H, Fuchs Endothelial Dystrophy. New York, NY: WebMD. https://emedicine.medscape.com/article/1193591. Updated: May 4, 2018. Accessed: February 26, 2019.
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  6. What Is Fuchs' Dystrophy?. https://www.aao.org/eye-health/diseases/what-is-fuchs-dystrophy. Updated: September 1, 2017. Accessed: March 1, 2019.
  7. Guttae in Fuchs' endothelial corneal dystrophy. https://webeye.ophth.uiowa.edu/eyeforum/atlas/pages/guttae/index.htm. Updated: January 21, 2015. Accessed: March 1, 2019.
  8. Fuchs’ Endothelial Dystrophy. http://eyewiki.aao.org/Fuchs%E2%80%99_Endothelial_Dystrophy. . Accessed: February 26, 2019.
  9. Taffet GE,. Normal aging. In: Post TW, ed. UpToDate. Waltham, MA: UpToDate. https://www.uptodate.com/contents/normal-aging.Last updated: January 1, 2019. Accessed: February 26, 2019.
  10. Corneal arcus. https://www.aao.org/bcscsnippetdetail.aspx?id=75f705e5-3ebe-4593-837d-5ae7bc3d44f3. Updated: January 1, 2019. Accessed: February 26, 2019.
  11. Verma A, Khan FH. Corneal Abrasion. In: Dahl, AA, Corneal Abrasion. New York, NY: WebMD. https://emedicine.medscape.com/article/1195402. Updated: January 3, 2019. Accessed: February 25, 2019.
  12. Corneal abrasions. https://bestpractice.bmj.com/topics/en-us/500. Updated: January 1, 2019. Accessed: February 25, 2019.
  13. Jacobs DS. Corneal abrasions and corneal foreign bodies: Clinical manifestations and diagnosis. In: Post TW, ed. UpToDate. Waltham, MA: UpToDate. https://www.uptodate.com/contents/corneal-abrasions-and-corneal-foreign-bodies-clinical-manifestations-and-diagnosis.Last updated: January 1, 2019. Accessed: February 25, 2019.
  14. Wipperman JL, Dorsch JN. Evaluation and management of corneal abrasions. Am Fam Physician. 2013; 87 (2): p.114-20.
  15. Verma A, Khan F. Corneal Abrasion Treatment & Management. In: Dahl A, Corneal Abrasion Treatment & Management. New York, NY: WebMD. https://emedicine.medscape.com/article/1195402-treatment#d10. Updated: January 3, 2019. Accessed: June 3, 2019.
  16. Jacobs DS. Corneal abrasions and corneal foreign bodies: Management. In: Post TW, ed. UpToDate. Waltham, MA: UpToDate. https://www.uptodate.com/contents/corneal-abrasions-and-corneal-foreign-bodies-management.Last updated: January 1, 2019. Accessed: February 25, 2019.
  17. Verma A, Ehrenhaus MP. Recurrent Corneal Erosion. In: Talavera F, Rapuano CJ, Roy H, Recurrent Corneal Erosion. New York, NY: WebMD. https://emedicine.medscape.com/article/1195183. Updated: September 7, 2018. Accessed: February 25, 2019.
  18. Corneal Erosion. https://www.aao.org/eye-health/diseases/what-is-corneal-erosion. Updated: July 19, 2014. Accessed: February 25, 2019.
  19. Verma A. Recurrent Corneal Erosion Treatment & Management. In: Roy H, Recurrent Corneal Erosion Treatment & Management. New York, NY: WebMD. https://emedicine.medscape.com/article/1195183-treatment. Updated: September 7, 2018. Accessed: June 3, 2019.
  20. Treatment of Recurrent Corneal Erosions. https://www.aao.org/eyenet/article/treatment-of-recurrent-corneal-erosions. Updated: March 1, 2013. Accessed: February 26, 2019.
  21. Wayman LL. Keratoconus. In: Post TW, ed. UpToDate. Waltham, MA: UpToDate. https://www.uptodate.com/contents/keratoconus.Last updated: January 1, 2019. Accessed: February 26, 2019.
  22. Taravella M, Gensheimer WG. Corneal Graft Rejection. In: Talavera F, Rapuano CJ, Roy H, Corneal Graft Rejection. New York, NY: WebMD. https://emedicine.medscape.com/article/1193505. Updated: October 16, 2018. Accessed: February 28, 2019.
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  24. Wallang BS, Das S. Keratoglobus. Eye. 2013; 27 (9): p.1004-1012. doi: 10.1038/eye.2013.130 . | Open in Read by QxMD
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