ANATOMY AND

PHYSIOLOGY OF THE
ANTERIOR SEGMENT
ANATOMY
 CORNEAL DIMENSIONS
(after Hogan et al., 1971)

10.6 mm
11.7 mm

11.5 mm
 CORNEAL SHAPE

• Meniscus lens
• Not symmetrical
• Not a solid of rotation about any axis
• Front apical radius 7.8 mm K= 43.27 D
• Back apical radius 6.5 mm -6.15 D
• Actual refractive index, cornea = 1.376
- Not optically homogenous
- nground substance = 1.354, ncollagen = 1.47
 Contact lens dimensions

• BOZR
• Peripheral Curves
• Optic Zone Diameter
• Overall Diameter
• Custom changes
TRANSVERSE SECTION OF THE CORNEA
 EPITHELIUM

• 50 microns thick
• 5-layered structure
- Squamous cells (surface)
- Wing cells
- Columnar cells (basal)
• Cell turnover (basal to surface ≈ 7 days
 Contact lens induced changes

• Temporary morphological changes

• Epithelial erosions
• Delayed healing
• Epithelial edema
• Epithelial dysplastic changes
• Stem cell deficiency
 BOWMAN’S LAYER

• Acellular
• Differentiated anterior stroma
• Mainly collagen, some ground substance
• Collagen fibrils randomly dispersed
 STROMA

• 0.50 mm thick
• 90% of corneal thickness, mostly collagenous lamellae
• Contains 2-3% keratocytes (fibroblasts) and about 1%
ground substance
• Thin keratocytes of 10 microns diameter
 Contact lens induced changes

• Increased Thickness
• Keratocytic hyperactivity
• Alteration of lamellar disfigurement
 DESCEMET’S MEMBRANE

• 10-12 µm
• Structureless
• Slightly elastic
• Secreted by the endothelium
• Very regularly arranged stratified layer
• Functions as basement layer of endothelium
 ENDOTHELIUM

• Single layer
• 500,000 mainly hexagonal cells
• 18-20 µm diameter
• 5 µm thick
• Non-replicating
 Contact lens induced changes

• Polymegathism
• Endothelial drop out
Which is the most dreadful
majorly anatomical
complication of Contact
lenses?
PHYSIOLOGY
 CORNEAL PERMEABILITY

WATER
• Endothelial permeability is greater than
that of the epithelium

OXYGEN
• Derived from the atmosphere

CARBON DIOXIDE
• Permeability is 7X that of oxygen
 CORNEAL PERMEABILITY OTHER
SUBSTANCES

• Sodium: endothelium greater than the epithelium by

100X
• Glucose and amino acids: metabolically active
• Fluorescein
• Less in Endothelium than Epithelium
 OXYGEN SUPPLY TO THE CORNEA

Tear film Endothelium

Epithelium Descemet’s
A
Q
A
U
T
E
M
U
O
S O2 Stroma O2 O
U
P
S
H
E Terminal H
R vessels U
E
M
Recurrent O
vessels R
CONTACT LENSES ARE A BARRIER TO OXYGEN
AND CARBON DIOXIDE TRANSMISSION
CONTACT LENSES ARE A BARRIER TO OXYGEN
AND CARBON DIOXIDE TRANSMISSION
 SOURCES OF GLUCOSE
CORNEAL EPITHELIUM

• Aqueous humor (90%)

• Limbal blood vessels and tears (less than 10%)
 Contact lens induced changes

• Neovascularization
• Corneal Edema (Hyperosmolarity)
• Reduced Corneal Sensitivity
 CORNEAL TRANSPARENCY: STROMA

• Transmits 90% of incident light

• Potentially a non-transparent layer
• Fibrils: n=1.47
• Ground substance: n=1.354
• Regular fibril spacing of 60nm
 CORNEAL SWELLING

• Lactate and metabolite accumulation -osmotic gradient

causes water imbibition
• Hydrophilicity of GAGs causes a natural water
imbibition
• Swelling during sleep is due to:
- Hypoxia (50%)
- Lower tear osmolarity
- Increased temperature and humidity
 Contact Lens induced changes

• Change in refractive index of intra and

extracellular spaces
• Sattler’s veil
• Haloes
• Wavefront Abberometry
 ENDOTHELIAL PUMP

• Each cell pumps its own volume every 5 minutes

• Active transport mechanism
• Na+ + K+ + ATPase-dependent pump
• Glucose fueled
 CORNEAL INTEGRITY

requires:
OXYGEN
• 15% - 20.9% for regular function
• 13.1% to prevent suppression of epithelial
mitosis
• 8% to prevent sensitivity loss
• 5% to prevent glycogen depletion
Thanks