Cornea Conditions, Transplants & Treatments
The cornea is the circular window at the front of the eye that refracts light and focuses it on the retina. A healthy cornea is essential for clear vision. Damaged or irregular corneas cannot focus light correctly and result in blurred vision and glare.
Continue reading to learn more about the different injuries and conditions that can affect your corneas.
Corneal Abrasions & Infections
A corneal abrasion is a scratch or cut on the surface of the cornea that often causes blurred vision, stinging, burning, redness, tearing, and light sensitivity. Thankfully, injuries that affect only the surface of the cornea heal quickly after treatment, often within a matter of days. In patients who have recurrent corneal abrasion problems, we offer phototherapeutic keratectomy (PTK) to help resolve the issue.
Sometimes the cornea is damaged after a foreign object enters the tissue, such as from a poke in the eye. Other times, bacteria or fungi from a contaminated contact lens can pass into the cornea and cause a corneal infection. Situations like these can cause painful inflammation and corneal infections known as keratitis.
These eye infections can reduce visual clarity, produce corneal discharges, and even erode the cornea. Corneal infections can also lead to corneal scarring, which can impair vision and may require a corneal transplant. Corneal infections, although relatively infrequent, are the most serious complication of contact lens wear.
Minor corneal infections are commonly treated with anti-bacterial eye drops. If the problem is severe, it may require more intensive antibiotic or anti-fungal treatment to eliminate the eye infection, as well as steroid eye drops to reduce inflammation. Frequent visits may be necessary for several months to eliminate the problem. Generally, the deeper the corneal infection, the more severe the symptoms and complications.
Kremer doctors and staff work hard to quickly see patients with eye emergencies or those who are experiencing severe eye pain. If you are experiencing a corneal abrasion or corneal infection, schedule a consultation with a Kremer eye doctor today.
Keratoconus is a progressive thinning and weakening of the cornea, and is the most common corneal dystrophy in the U.S., affecting one in every 2,000 Americans. It is more prevalent in teenagers and adults in their 20s. Keratoconus arises when the middle of the cornea thins and gradually bulges outward, forming a rounded cone shape. This abnormal curvature changes the cornea’s ability to focus light, producing distortion (astigmatism) and blurriness (nearsightedness) of vision. Keratoconus may also cause swelling and a sight-impairing scarring of the tissue.
Keratoconus usually affects both eyes. At first, people can correct their vision with eyeglasses. As the astigmatism worsens, they must rely on specially fitted contact lenses to reduce the distortion and provide better vision. Although finding a comfortable contact lens is a difficult process, it is crucial because a poorly fitting lens could further damage the cornea and make wearing a contact lens intolerable.
If a patient is not contact lens tolerant, Kremer surgeons can offer the INTACS corneal ring procedure. This is a surgery that one of our corneal specialists introduced to the Delaware Valley. In the procedure, two small, semi-circular ring segments are implanted into the cornea to enable most patients to wear contact lenses again.
If the cornea eventually becomes too scarred or will not tolerate a contact lens, a corneal transplant may be needed. This operation is successful in more than 90 percent of those with advanced keratoconus. Several studies have also reported that 80 percent or more of these patients have 20/40 vision or better after the operation.
Kremer Eye Center is among the few practices in the nation to offer the advanced Corneal Collagen Cross-Linking (CXL) treatment that has helped many Keratoconus patients throughout the tri-state area preserve their vision. CXL is the only FDA approved therapeutic treatment for progressive Keratoconus.
Cornea Collagen Cross-Linking
Cornea collagen cross-linking (CXL) is the only treatment to successfully halt the progression of keratoconus or Post-Lasik ectasia, an eye disease that weakens and thins the cornea, eventually causing severe vision impairment.
How does CXL work?
Your cornea is mostly made up of collagen fibers that are arranged in bundles. The strength and rigidity of the cornea is determined by how strongly these fibers are linked together. In CXL treatment, riboflavin eye drops (vitamin B2) are administered topically in combination with ultraviolet (UV) light, promoting the growth of collagen cross-links within the cornea. The cross-links strengthen the cornea and prevent the worsening of the abnormal shape caused by keratoconus.
Kremer Eye Center is among the few practices in the nation to offer this advanced treatment. We’re proud to help CXL patients throughout the tri-state area preserve their vision. A specific brand CXL device was recently FDA approved in the United States, although the procedure has been studied since 2000 outside of the U.S.
CXL with Riboflavin: The Procedure
First, the doctor administers numbing eye drops to reduce any discomfort. Next, pinpoint punctures are made in the top layer of the cornea. A specific type of riboflavin eye drops is then administered into the eye, where the drops can be absorbed into the cornea for 30 minutes. The eye is then exposed to UV light for 30 minutes. Finally, antibiotic eye drops are administered and a protective bandage-contact lens is applied over the eye.
When performed under the care of an experienced eye surgeon, this treatment can postpone the need for corneal transplant surgery and preserve good vision.
Advantages of CXL Therapy
Cornea collagen cross-linking therapy with riboflavin eye drops offers keratoconus patients many benefits, including:
- Targeting the root of the problem
- Halting the progression of the disease
- Preserving vision
The procedure is also minimally invasive.
CXL Recovery and Results
Patients who undergo this treatment are asked to wear a bandage-contact lens for 5-7 days afterwards. Adherence to post-operative instructions and use of anti-inflammatory eye drops are essential for the success of the procedure.
Patients can usually resume wearing their normal contact lenses one or two weeks after surgery. Some patients may experience frequent changes in their corrective eyewear prescription until the cornea becomes fully stable.
For More Information
For more information on this leading-edge keratoconus treatment, please schedule a consultation with Dr. Michael Aronsky, Dr. Carol Hoffman or Dr. Ketki Soin. You can also visit www.cxlusa.com.
Corneal transplants remove the damaged area of the cornea and replace it with a clear corneal tissue from a donor.
What causes a person to need a corneal transplant surgery?
Many corneal disorders and injuries to the cornea can impair vision. These include:
- Congenital diseases like keratoconus
- Scars from infection or trauma
- Degenerative corneal diseases
- Corneal dystrophies
- Corneal Edema
All of the above cause the cornea to lose its clarity. In many cases, there are no medications, glasses or contact lenses that can improve the clarity of the cornea and provide good vision, so the only option for visual rehabilitation is a corneal transplant surgery.
Although the thought of a corneal transplant surgery may be daunting, it is a truly life-changing procedure to those who need it…restoring vision from blindness. Over 40,000 corneal transplants are performed each year in the United States, making it by far the most common and successful form of transplantation.
For irreversible corneal swelling from Fuchs’ Dystrophy or after cataract surgery we perform endothelial keratoplasties like DMEK (Descemet’s Membrane Endothelial Keratoplasty) and DSEK (Descemet’s Stripping Endothelial Keratoplasty). These types of corneal transplants replace only the back layers of the cornea. Compared to traditional corneal transplants, these endothelial keratoplasties are less invasive and offer a quicker recovery because only part of the cornea is being replaced. In conditions like keratoconus or a deep corneal scar, where most of the cornea is affected, we perform a PK (Penetrating Keratoplasty), a traditional corneal transplant that replaces all the layers of the cornea.
Kremer Eye Center’s fellowship-trained corneal specialists were the first in the region to perform sutureless corneal transplants (DSAEK and DMEK) and, more recently, have become the first in the tri-state area to utilize IEK laser technology (IntraLase-enabled Keratoplasty), providing a more stable graft that speeds patient healing and visual recovery.
For more information, to learn about insurance coverage for cornea transplant surgery, or to schedule an evaluation, please call us at 1-800-694-3937.
Fuchs’ Dystrophy is a hereditary eye disease that affects the cornea and usually tends to show up later in life. It occurs when the endothelial cells, the innermost layer of cells in your cornea, begin to deteriorate. These cells normally keep the cornea clear by continuously pumping out excess fluid from the cornea. When that excess fluid isn’t pumped out your cornea will begin to swell.
Some of the first few signs of Fuchs’ Dystrophy you will notice might be glare with headlights at night or in bright sunlight. Eventually, your vision may become blurry when you wake up and gradually clear up as the day progresses. As Fuchs’ further develops, you will notice your vision staying blurry longer during the day.
Some additional Symptoms:
- Poor vision upon awakening
- Foggy or blurred vision
- Glare and sensitivity to light
- Eye pain
- Difficulty seeing at night
- Seeing colored halos around lights
For early symptoms your doctor can try prescribing an eyedrop and or ointment to try to reduce the corneal swelling. For some people the warm air from a hair dryer, held at arm’s length, also helps reduce the swelling in the cornea.
For irreversible corneal swelling from Fuchs’ Dystrophy we perform endothelial keratoplasties, partial thickness corneal transplants, like DMEK (Descemet’s Membrane Endothelial Keratoplasty) and DSEK (Descemet’s Stripping Endothelial Keratoplasty).
Once you find that your vision is starting to impair your quality of life, it might be time to replace the diseased layer. Discuss with your doctor what treatment options are best for you.
A pterygium is pink, triangle-shaped growth of tissue that starts at the thin tissue of the eye (conjunctiva), covers the white part of the eye (sclera), and extends to the cornea. This growth can gradually expand throughout a person’s life or eventually stop progressing.
Blood vessels within the pterygium can form scar tissue. As the pterygium becomes worse, this scar tissue can cause astigmatism or even distort the surface of the eye. Thankfully, most mild cases of pterygium don’t show symptoms or require treatment.
Some of the signs of pterygium include:
- A gritty feeling in the eye
- A raised red, pink or white lesion in the eye
- Blurry vision
- Burning or itchiness in the eye
Unfortunately, many of these symptoms can be also attributed to other eye diseases, corneal abrasions, or eye irritation. If you experience any of these symptoms, make sure to speak with your eye doctor immediately so that you can receive a proper diagnosis. Be sure to take out your contact lenses right away.
Pterygium is also known as surfer’s eye because it can be caused by excessive exposure to sun and wind. Doctors suspect that UV rays and wind can cause chronic eye irritation from dry climates and dust, resulting in the condition.
If you experience any of the symptoms of a pterygium – or if you have frequent exposure to sun and wind – be sure to contact your doctor immediately. If left unattended, this growth can lead to severe scarring on your cornea, which can ultimately cause vision loss. Although you may not be able to see any visible signs of pterygium, your doctor can detect the condition during a routine eye exam.
Your doctor will likely prescribe a lubricant or eye drops to reduce swelling, redness and other symptoms you may be experiencing if you have a mild case. If the pterygium is large and causing painful symptoms, your doctor may recommend surgical removal to keep it from burdening your sight.
During the surgery, your eyelids will be kept open with a lid holder, and anesthetic eye drops will be used so you won’t feel any pain while the growth is removed. The procedure will only take about 30 minutes. You won’t be able to drive after surgery, so be sure to arrange a ride.
You may need to wear an eye patch for a day or two to protect your eye after surgery, but you should be able to return to your normal activities the next day. You’ll use eye drops for a couple weeks after the procedure to reduce the risk of infection, decrease swelling and prevent regrowth of a pterygium.
If the pterygium causes too much damage to your eye, you may need to undergo a corneal transplant. This will involve removing the damaged cornea and replacing it was a donated corneal graft to restore your vision.
Conjunctivitis (Pink Eye)
Conjunctivitis, also referred to as pink eye, is a common eye ailment that causes inflammation and infection of the conjunctiva, the thin, transparent layer of tissue that lines the inner surface of the eyelid and covers the sclera (white part of the eye).
Pink eye can occur in one or both eyes. One sure sign that you have a form of conjunctivitis is if the white of your eye looks pink or itches. Other symptoms include discharge, watering, increased sensitivity to light, a gritty feeling in one or both eyes, an itchy or burning sensation and swollen eyelids.
There are many forms of conjunctivitis, most of which are contagious and spread rapidly in schools, public places and at home. These different types are caused by different factors.
The various forms of conjunctivitis include the following:
- Viral: The common cold virus causes this type of pink eye and produces a watery discharge. It’s contracted through exposure to sneezing or from your own mucous membranes. It typically improves on its own after seven to 10 days but is highly contagious up to that point.
- Bacterial: This form can be caused by many types of bacteria, including Staphylococcus and Streptococcus, and produces a thick, yellow discharge. Bacterial conjunctivitis is most typically passed between children or adults because of physical contact and poor hygiene.
- Allergic: This form of conjunctivitis isn’t contagious because it’s caused by a person’s own reaction to a substance such as smoke, chlorine in swimming pools, or ingredients in cosmetics and other products that come in contact with the eyes. It’s most common in people who have seasonal allergies and causes itching and inflammation of the eyes and a watery discharge.
If you’re dealing with any of these symptoms, it’s crucial that you see your doctor immediately. Make sure to create a list of all your symptoms so you can discuss them with your doctor.
Your doctor will perform a comprehensive eye examination. He or she may want to take a sample of your eye discharge to test it. Although there’s no treatment for viral conjunctivitis, you’ll need prescription for antibiotic eye drops to treat the infection of the bacterial form. Allergic conjunctivitis can often be treated with allergy eye drops.
How to Reduce Risk
Because pink eye can be contagious, you’ll need to be cautious to reduce your risk of spreading it to others. Remove your contacts immediately and wear glasses instead until you recover. Be sure to throw out the contact lenses you were wearing and use a new pair when you feel better.
You should also throw out the makeup you used while infected with pink eye. You could catch pink eye again if there are still germs on the makeup or anything else you used on or close to your eyes.
Avoid physical contact with others, especially if you know someone has pink eye. Don’t share makeup or towels to reduce the risk of spreading infection.