Corneal disorders

Last updated: September 18, 2023

Summarytoggle arrow icon

The cornea is the external, transparent layer of the eye covering the iris and pupil. The cornea is highly sensitive, and corneal disorders (e.g., abrasions, infection, erosion, ulcers, foreign bodies) are often painful and associated with reduced visual acuity. Diagnosis is most commonly clinical, based on slit lamp examination with fluorescein staining. Treatment includes supportive care (including analgesics) and foreign body removal, if present. Topical antibiotics may be used, e.g., in corneal abrasions and corneal ulcers. Therapeutic contact lenses are used in keratoconus. Keratoplasty (corneal transplantation) is generally a last resort for patients with significant visual impairment or failed treatment for infection.

For inflammatory disorders of the cornea, see “Conjunctivitis” and “Keratitis.”

Anatomy of the corneatoggle arrow icon

Also see “Cornea in “Eye and orbit.”

Corneal abrasiontoggle arrow icon

Definition [1]

A defect in the epithelial surface of the cornea caused by trauma

Etiology [2]

  • Direct injury (e.g., scratch from fingernail or makeup brush)
  • Foreign body under the eyelid
  • Prolonged contact lens wear or improperly fitted lenses
  • Entropion
  • Trachoma

Clinical features [1][2]

Diagnostics [1][2]

Resolution of pain with local anesthetic in the setting of superficial eye injury suggests corneal abrasion. [2]

Exclude open globe injury and corneal foreign bodies in all patients with corneal abrasion.

Management [1][2]

Limit use of topical NSAIDs to 2–3 days due to risk of corneal toxicity. [1]

Disposition [1][2]

Complications [1][2]

Corneal lacerationtoggle arrow icon

For full-thickness lacerations, see “Open globe injury.” [2][6]

Corneal foreign bodytoggle arrow icon

Etiology [1][2]

  • Most commonly results from dust or debris blown into the eye during:
    • High-risk activities without adequate protective eyewear, e.g., grinding, drilling, sawing, welding, mowing
    • Exposure to high winds

Clinical features [1][2]

  • History of sudden onset and persistent discomfort following trauma
  • Signs of ocular inflammation: copious tearing, redness, foreign body sensation, difficulty keeping the eye open, photophobia, and blurred vision

Diagnostics [1][2]

Corneal foreign bodies that penetrate the full thickness of the cornea should be considered as open globe injuries that require urgent ophthalmology consultation. [2]

MRI is contraindicated for the evaluation of suspected metallic foreign bodies.

Management [2][7]

Corneal foreign body removal

Utilize a stepwise approach from the least to most invasive technique.

  • Administer a topical anesthetic (e.g. tetracaine )
  • Irrigate the affected eye copiously with saline.
  • Sweep a moist cotton swab over the object and cornea.
  • Attempt removal with a 25–27 gauge needle, corneal spud, or burr drill.
    • Ask the patient to look at a distant object to stabilize the eye.
    • Visualize the foreign body using magnification (e.g., loupes, slit lamp).
    • Hold the instrument tangential to the cornea.
    • If using a needle or corneal spud: Scoop or pick up the foreign body with the instrument.
    • If using a burr drill: Hold the burr against the foreign body until removed.
  • Residual rust rings may be removed during initial presentation or after 24–48 hours.

Do not attempt to remove the foreign body if an open globe injury is suspected.

Supportive treatment [1][2][7]

Disposition [1][2]

  • Consult ophthalmology urgently for:
    • Suspected open globe injury
    • Inability to remove a foreign body
    • Large or deep foreign bodies
    • Foreign bodies affecting the central field of vision
  • See also “Corneal abrasion.”

Complications [1][2][7]

Complications from a corneal foreign body are rare but may include:

Corneal erosiontoggle arrow icon

Corneal ulcertoggle arrow icon

Definition [2]


Corneal ulcers most frequently occur as a complication of keratitis. [2][16]

Clinical features [2][16]

Diagnostics [2][16]

Corneal ulcer is a clinical diagnosis based on slit lamp examination with fluorescein staining. Bacterial and viral cultures can help direct definitive treatment.

Management [2][16]

Disposition [2][16]

  • All patients should be seen by ophthalmology within 24 hours.
  • Admit patients with:

Complications [1][2]

Corneal ulcers are an ophthalmological emergency and can result in permanent corneal scarring and vision loss.

Corneal denegeration, dystrophy, and depositstoggle arrow icon

Corneal degeneration

Band keratopathy [21]

Corneal dystrophy [22]

Fuchs dystrophy [23]

  • 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 [24]
  • Clinical findings
    • Reduced visual acuity
    • Blurred vision, glare, and halos, often improving over the course of the day [25]
    • Eye pain or foreign body sensation in the eye
  • Diagnostics
  • Treatment [27]
    • 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 [28]
  • Epidemiology: Incidence increases with age. [29]
    • 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

Curvature anomalies of the corneatoggle arrow icon


Keratoglobus [31]


Inflammatory conditions of the corneatoggle arrow icon

Keratoplasty (corneal transplantation)toggle arrow icon

Keratoplasty (corneal transplantation) [32]

Referencestoggle arrow icon

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