CORNEA

ANATOMY AND PHYSIOLOGY

 ANATOMY OF CORNEA

Physical characteristics:
 Transparent
 Avascular
 Forms anterior 1/6th of the outer fibrous coat of the
eyeball
Dimensions
 Anterior surface: Elliptical in shape
11.7mm horizontally
11 mm vertically
 Posterior surface: Circular in shape
11.7mm Diameter
 Thickness: Central 0.52mm
Peripheral 0.67mm
 Radius: Anterior curvature 7.8mm
Posterior curvature 6.5mm
 Refractive power: 43D (3/4th of total)
 Refractive index:1.37
Histology
 Six layers
1. Epithelium
2. Bowman’s membrane
3. Substantial propria/stroma
4. Dua’s layer
5. Descement’s membrane
6. Endothelium
1. Epithelium
 Stratified squamous Nonkeratinized
 50-90micrometer in thickness
 5-6 layer
 Consist of flattened surface cells
wing cells
Basal cell layer
Basement membrane
2. Bowman’s membrane
 8-14micrometer in thickness
 Acellular
 Contains condensed collagen fibrils type 1 & 5 +
proteoglycan and glycoproteins.
 Condensed part of superficial stroma
 Resistant to infection & injury
 Don’t regenerate once damaged
3. Stroma
 500micrometer thickness (90% of total)
 Consist of keratocytes & extracellular matrix
 Extracellular matrix consist of collagen namely type1,3,5,6,7
& glycosaminoglycans namely keratin sulphate &
chondroitin sulphate
 Lamina arrange parallel to each other and to corneal plane,
and also continue with scleral lamellae at limbus to form
peripheral collagen ring
 This arrangement help in transparency and maintaining
shape
4. Dua’s layer
15micrometer thickness
Despite thin, very strong and impervious to air
 5. Descement’s membrane
 Appears at 2nd month of gestation
 Thickness: at birth-3 micrometer
. At adulthood- 10-12 micrometer
 Act as basal lamina of corneal endothelium
 Very resistant to chemical agents, trauma, infection,
pathological process & enzymatic degradation.
 Has regenerative power
 Peripherally end at anterior limit of trabecular
meshwork at schwalbe’s line
6. Endothelium
 Single layer of flat polygonal cells
 Cell density: at birth – 6000 cells/mm^2
. At adulthood – 2400-3000 cells/mm^2
 In adult cell looses their ability to devide
 Defect left by dying cells is filled by enlargement of
remaining cells- POLYMEGATHISM
 Cell diameter: at birth – 18-20micrometer
 at increase age – up to 40 micrometer
Blood supply
 Cornea is an avascular structure.
 The limbal region contains a vascular arcade which
supplies the cornea with blood components.
 The vascular arcade is formed by the anastomosis b/w
the Anterior cilliary artery and branches of external
carotid artery.
 It invade periphery for about 1mm & provide
nourishment to cornea.
Nerve supply
 Cornea is one of the most heavily innervated tissue in the
body.
 Innervational density is highest near the centre & gradually
decrease towards the periphery.
 Trigeminal nerve -> ophthalmic division -> nasocilliary
nerve -> long cilliary nerve.
Corneal physiology
Main functions of cornea:
1. To act as a powerful refractive
2. To protect intraocular content
3. Absorption of topically applied drugs
Corneal metabolism & Source of
nutrients
 Cornea requires energy for normally metabolic
activities, maintaining transparency & dehydration.
 Most actively metabolising layers are epithelium and
endothelium.

 SOURCE OF NUTRIENTS:
1. O2 : mainly from atmosphere through tear film and
limbal capillary through epithelium and some from
aqueous humor through endothelium
2. Glucose: from aqueous
3. Amino acid: passive diffusion from aqueous
Factors affecting corneal transparency
1. Corneal epithelium and Tear film
2. Arrangement of stromal lamina
3. Avascular structure
4. Relatively dehydrate
5. IOP
 Drugs permiability across the CORNE
 Factors affecting drugs permiability:
1. Lipid and water solubility of drug
2. Molecular size, wt & concentration of drug
3. Ionic forms of the drug
4. PH of the solution
5. Tonicity of the solution
6. Surface active aaents
7. Pro- drugs
Effects of contact lens wear on corneal
physiology

 Contact lens shift the balance from aerobic to anerobic

metabolism -> increase lactate and co2 production.
 Leads to acidosis -> stromal hydration

 Deletrerious effects of contact lens :

1. Epithelial thinning
2. Reduction in the hemidesmosome density
3. Reduction in anchoring fibrils
4. Reduce adhesion of the epithelium to the basement
membrane
5. Severe cases produce epithelial edema & punctate
CORNEAL wound healing
CORNEAL ULCER
 definition
Discontinuation in normal epithelial surface of cornea
associated with necrosis of surrounding corneal tissue
Causative agents

Bacterial Viral Fungal Protozoal

Staph aureus HSV 1 & 2 Aspergillus Acanthamoeba
Strepto HZV Fusarium
pneumonia
Peudomonas Cephalosporiu
m
N. Meningitidis Candida
N. Gonorrhoea Cryptococcus
E. Coli Histoplasma
C..deptheriae Blastomyces
Actinomyces Coccidioides
Nocardia
Mycobacterium
Etiology

A) corneal epithelial damage:

 Corneal abrasion

 Epithelial drying

 Necrosis of epithelium

 Desquamation of epithelial cells

 Epithelial damage
Pathogenesis

Once the damaged corneal epithelium is

invaded by offending organism, below decribed
changes seen
Depending upon the circumstances the course of
corneal ulcer may take one of the three forms:

1. Ulcer may become localized & get healed :

When there is good immunity and early &
effective treatment given

2. Penetrate deep leading to corneal perforation:

When ulcer reaches up to descement's membrane -->

membrane bulges out as descemetocele --> at this stage any
exertion done by the patient --> corneal perforation.
Immediately after perforation aqueous escape, IOP falls & lens
iris diaphragm moves forward.

3. Spread fast to involve the whole cornea as sloughing corneal

ulcer and anterior staphyloma
When the agent is highly virulent or body's
immune response is very poor , the whole
cornea sloughs except at margin

Exudate block the pupil and cover iris surface--

> false cornea
Over this exudate conjunctival or corneal
epithelium rapidly grows --> pseudocornea

this can't withstand IOP thus bulge forward

along with iris tissue
--> called anterior staphyloma
Symptoms
• Pain
• FB sensation
•
• Watering
•
• Photophobia
•
• Blurring of vision
•
• Redness
Bacterial Viral Fungal Protozoal

Staph & strepto: oval HSV: Dry looking greyish Epithelial

yellowish white 1) epithelial keratitis white with elevated roughening and
densely opaque ulcer Punctate epithelial rolled out margins irregularities
surrounded by clear keratitis Pseudodendrites
cornea Dendritic ulcer formation
Geographic ulcer Epithelial &
subepithelial
curvilinear opacities
Pseudo : irregular 2) stromal keratitis Delicate feathery Stromal
sharp ulcer with Disciform keratitis finger like extension keratoneuritis
thick greenish Stromal nectrotic Pachy and sattelite
mucopurulent keratitis stromal infiltrate
exudate, diffuse 3)metaherpetic Ring filtrate
necrosis & keratitis Ring abscess
semiopaque
surrounding cornea
E.coli: shallow ulcer HZO: A sterile immune
& ring shaped Epithelial keratitis ring
corneal infiltrate Nummular keratitis
Disciform keratitis

Sterile hypopyon Sterile hypopyon

Hypopyon corneal Satellite lesions

ulcer
Complications of corneal ulcer.
Toxic iridocyclitis
Secondary glaucoma
Descemetocele
Perforation of corneal ulcer.
Corneal Scarring
Lab Investigations
Routine lab Ix: Hb, TLC, DLC, ESR, blood sugar, urine RM

Microbiological Ix:
Material obtained by scrapping the base and margins of
the corneal ulcer for
Gram and giemsa stain
10% KOH wet preparation
Calcofluor white
Culture on blood sugar
Culture on sabourad’s agar
Treatment
Non specific treatments
Cycloplegic drugs (1% atropine eye ointment or drops)
Systemic analgesic and antiinflammatory drugs
Vitamins (A, B complex and C)
To prevent secondary glaucoma 0.5% timolol
For persistant epithelial defect (lubricating eye drops,
bandage soft contact lens)
Hot fomentation
Dark goggles
Penetrating keratoplasty
Bacterial Viral Fungal Protozoal
Topical: Topical: Topical: Topical:
FF Acyclovir 3% eye Natamycin5% , clotimazole
cefazoline5%plus ointment amphotericin Chlorhexidine+
FF tobramycin Topical antibiotic B0.1% & neomycin
1.3% drops fluconazole 0.2% Hexamidine
Or For aspergillus & +PHMB
FF vancomycin fusarium
5%

Topical eyedrops Nystatin PHMB BD for 1

instilled at every 1 ointment 3.5% for year as long term
hourly candida prophylactic

Systemic: Systemic: Systemic: Systemic:

Usually not Oral Ketoconazole or Oral
required antiviral( acyclovi voriconazole or ketoconazole
Cephalosporin & r800mg 5times a fluconazole for 2- 200mg BD
aminoglycoside day ×10 days 4 weeks in severe
given in severe Systemic steroid cases
cases Amitriptyline
pain reliever
Thank you