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Cornea

The cornea is the transparent, dome-shaped anterior portion of the outer fibrous coat of the eye, covering the iris, pupil, and anterior chamber, and serving as the eye's primary optical interface by refracting light to focus images on the retina while acting as a protective barrier against external threats such as pathogens, trauma, and dehydration.^[1] It is avascular, deriving its oxygen primarily from atmospheric air via tear film diffusion and nutrients from the aqueous humor, which enables its remarkable clarity essential for vision.^[2] Structurally, the cornea measures approximately 11.7 mm horizontally and 10.6 mm vertically in adults, with a central thickness of about 0.5–0.6 mm, and consists of five primary layers that contribute to its mechanical strength, transparency, and refractive properties.^[3] The outermost epithelium is a non-keratinized stratified squamous layer, 5–6 cells thick, that regenerates rapidly and forms a tight barrier to prevent entry of foreign substances, microbes, and fluid while allowing nutrient absorption.^[4] Beneath it lies Bowman's layer, a thin, acellular collagenous sheet that provides structural support and resists swelling or scarring.^[1] The stroma, comprising roughly 90% of the corneal thickness, is a dense, organized lattice of collagen fibrils arranged in lamellae, maintained by keratocytes, which ensures optical transparency through precise spacing that minimizes light scattering.^[3] The posterior layers include Descemet's membrane, a resilient basement membrane secreted by the endothelium, and the single layer of endothelial cells, which actively pump ions and fluid from the stroma to the anterior chamber via Na+/K+-ATPase pumps, thereby regulating hydration and preserving deturgescence for clarity.^[4] Some anatomical models recognize a sixth layer, Dua's layer, a distinct acellular band within the posterior stroma that enhances tensile strength.^[5] Functionally, the cornea provides about two-thirds of the eye's total refractive power (approximately 43 diopters),^[6] working in concert with the lens to converge light rays, and its smooth, curved surface minimizes aberrations for sharp vision.^[7] It also contributes to the tear film stability, aiding in lubrication and further protection, while its dense innervation by the ophthalmic branch of the trigeminal nerve enables the corneal reflex to shield the eye from harm.^[2] Transparency is maintained by the absence of blood vessels, regular stromal collagen alignment, and endothelial deturgescence, but disruptions can lead to opacity, as seen in conditions like keratitis or dystrophy.^[1]

Anatomy

Gross Anatomy

The cornea is the transparent, dome-shaped anterior portion of the eye's outer fibrous tunic, forming a convex continuation of the opaque sclera and covering the iris and pupil to allow light entry into the anterior chamber.^[8] Positioned at the front of the globe, it occupies roughly the anterior one-sixth of the ocular surface, providing structural integrity and the primary refractive interface for vision.^[1] In adults, the cornea exhibits a horizontally oval shape, with a horizontal diameter of approximately 11–12 mm and a vertical diameter of 9–11 mm.^[9] Its thickness varies regionally, measuring about 0.5–0.6 mm at the center and increasing to 0.6–0.8 mm peripherally due to the thickening of its stromal layer.^[10] The anterior surface has a radius of curvature of roughly 7.8 mm, while the posterior surface is steeper with a radius of about 6.8 mm, resulting in a prolate aspheric form that enhances optical performance.^[11] This geometry accounts for approximately 40–44 diopters of the eye's total refractive power, comprising two-thirds of the overall focusing capability.^[2] The cornea interfaces with adjacent structures at its periphery, where it junctions with the sclera at the limbus—a narrow transitional zone approximately 1 mm wide that demarcates the corneal and scleral boundaries.^[12] The overlying conjunctiva, which covers the sclera, merges with the corneal surface at the limbus, facilitating a smooth epithelial transition.^[12] Anteriorly, the cornea is coated by the precorneal tear film, a thin multilayered fluid that maintains hydration, provides refractive smoothness, and protects against environmental insults.^[2]

Layers and Microstructure

The human cornea consists of five primary histological layers, each contributing to its overall microstructure and transparency: the epithelium, Bowman's layer, stroma, Descemet's membrane, and endothelium.^[1] These layers are arranged from anterior to posterior, with the cornea being notably avascular throughout, relying on diffusion from the tear film and aqueous humor for nutrient supply.^[13] The outermost layer, the corneal epithelium, is a stratified squamous non-keratinized epithelium approximately 50 μm thick, comprising 5–6 layers of cells divided into superficial (2–3 layers), wing (2–3 layers), and basal cells.^[2] Basal cells are cuboidal and mitotically active, anchored to the underlying basement membrane via hemidesmosomes, while superficial cells are flattened and connected by tight junctions to provide a barrier; the epithelium is regenerative, with stem cells located at the limbal region.^[14] Beneath the epithelium lies Bowman's layer, an acellular, condensed layer of randomly oriented type I and III collagen fibrils, measuring 8–12 μm in thickness.^[13] This layer serves as a protective interface, transitioning abruptly from the epithelial basement membrane to the more organized stromal collagen.^[1] The stroma constitutes about 90% of the corneal thickness (approximately 450–500 μm), forming the bulk of the tissue with an avascular matrix populated by sparse keratocytes (fibroblast-like cells) embedded in a highly organized extracellular matrix.^[15] Its transparency arises from parallel lamellae of uniformly thin, orthogonal type I collagen fibrils arranged in approximately 200–300 stacked layers, with minimal extracellular proteoglycans maintaining uniform interfibrillar spacing.^[13] Some anatomical models recognize an additional layer, Dua's layer (also known as the pre-Descemet's layer), a distinct acellular band of 10–15 μm thickness located at the posterior limit of the stroma. Composed of 5–8 tightly packed lamellae of type I collagen with minimal elastin, it provides significant tensile strength to the cornea and is impervious to air.^[16] Descemet's membrane is the elastic basement membrane secreted by the endothelium, initially 3–4 μm thick in youth but thickening progressively with age to 10–12 μm or more due to banded collagen deposition.^[1] It consists of an anterior non-banded zone and a posterior banded zone with hexagonal lattice-like collagen fibers.^[2] The innermost endothelium is a single monolayer of flattened, polygonal (typically hexagonal) cells, about 4–5 μm thick, with limited regenerative capacity in adults.^[4] These cells feature tight junctions and contain numerous mitochondria, reflecting their role in maintaining corneal hydration through active transport mechanisms.^[1]

Innervation and Vascular Supply

The cornea receives its sensory innervation primarily from the long ciliary nerves, which are branches of the ophthalmic division of the trigeminal nerve (cranial nerve V1).^[17] These nerves enter the corneal stroma from the periphery and branch extensively to form a dense sub-basal nerve plexus beneath the basal epithelium, from which free nerve endings extend into the epithelium.^[18] These sensory endings detect mechanical, thermal, and chemical stimuli, mediating protective reflexes such as blinking and lacrimal gland stimulation for tear production.^[17] The corneal epithelium exhibits the highest nerve density of any human tissue, with approximately 7,000 free nerve endings per square millimeter.^[19] This extraordinary innervation density, which is 300 to 600 times greater than that of the skin, underscores the cornea's acute sensitivity to protect its surface integrity.^[19] The cornea is completely avascular, lacking blood vessels throughout its structure to preserve optical transparency by minimizing light scattering from vascular elements.^[2] Nutrients such as glucose and amino acids diffuse primarily from the aqueous humor anteriorly through the stroma, while oxygen is obtained mainly from the tear film and atmospheric exposure; additional solutes reach the peripheral cornea via perilimbal capillaries.^[20] Lymphatic drainage is absent in the cornea, consistent with its avascular nature.^[21] Immune surveillance is instead maintained by resident antigen-presenting cells, including Langerhans cells in the epithelium, which detect and respond to pathogens without relying on lymphatic transport.^[22]

Development and Physiology

Embryonic Development

The development of the cornea originates from interactions between the surface ectoderm and neural crest-derived mesenchyme during early human embryogenesis. At approximately the fourth week of gestation, the optic vesicle induces the overlying surface ectoderm to form the lens placode, marking the initiation of lens and corneal development.^[23] By the fifth week, the lens placode invaginates and detaches to form the lens vesicle, while the surface ectoderm differentiates into the corneal epithelium, a multilayered structure that initially remains in close apposition to the lens.^[2] Neural crest cells then migrate in successive waves into the periocular region: the first wave occupies the space between the lens vesicle and epithelium to initiate stromal formation, the second wave contributes to the endothelial layer, and the third wave supports iris and trabecular meshwork development.^[24] Key developmental events follow this foundational stage. Around the third month of gestation (approximately week 12), the hyaloid artery—which provides transient vascular supply to the lens and retina—begins to regress as the retinal vasculature emerges, ensuring the cornea's eventual avascularity.^[25] By the 20th gestational week, the cornea attains transparency, driven by the organized deposition of extracellular matrix in the stroma and the establishment of regular collagen fibril spacing that minimizes light scattering.^[26] This transparency is essential for fetal visual development and coincides with eyelid fusion, which protects the maturing ocular surface until birth.^[27] Postnatal maturation refines the corneal structure. The endothelial cell density starts high at birth, approximately 5,000 cells/mm², and progressively decreases to adult levels of around 2,500 cells/mm² due to limited proliferative capacity and natural attrition.^[28] Bowman's layer, an acellular condensation of collagen beneath the epithelium, forms postnatally from processes of superficial stromal keratocytes, typically completing around 6 months of age and contributing to epithelial-stromal adhesion.^[29] Defects in neural crest migration can lead to congenital anomalies like Peters anomaly, characterized by central corneal opacification, iridocorneal adhesions, and lens-cornea synechiae due to failed separation of the lens vesicle from the endothelium.^[24]

Optical Physiology

The cornea serves as the primary refractive element of the eye, contributing approximately two-thirds of its total optical power, equivalent to about 43 diopters.^[30] This high refractive power arises from the cornea's anterior curvature and its refractive index of 1.376, which contrasts sharply with the surrounding air (index 1.000) and aqueous humor (index 1.336).^[30] Unlike the crystalline lens, the cornea maintains a fixed curvature and does not undergo active changes during accommodation; instead, it provides a stable refractive base that works in tandem with the lens to focus light onto the retina.^[31] The cornea's optical efficacy stems from its transparency and precise light refraction, enabled by the organized arrangement of collagen fibrils in the stroma, which creates a graded refractive index across the tissue.^[32] According to lattice theory, the uniform diameter and regular spacing of these fibrils—typically 25–35 nm in diameter with inter-fibril distances of about 55–60 nm—minimize light scattering by ensuring destructive interference of scattered waves, thus preserving clarity.^[33] This structural regularity is complemented by deturgescence, where the endothelial layer actively pumps ions to maintain stromal hydration at approximately 78% water content, preventing swelling that could disrupt fibril organization and induce opacity.^[30] Additionally, the cornea's prolate aspheric shape, characterized by a negative asphericity (Q value around -0.26), inherently corrects for spherical aberration, producing minimal positive spherical aberration compared to a spherical surface.^[34] This geometric feature balances the positive spherical aberration from the lens, optimizing overall image quality on the retina without additional muscular adjustments.^[34]

Protective and Metabolic Functions

The corneal epithelium serves as the primary physical barrier against environmental threats, with its superficial layer forming tight junctions that prevent the ingress of pathogens, allergens, and mechanical trauma into deeper tissues.^[35] These junctions, composed of proteins such as claudins and occludins, create a selective permeability seal that maintains the integrity of the underlying stroma while allowing nutrient diffusion.^[36] Complementing this, the tear film's mucin layer, primarily secreted by conjunctival goblet cells, enhances adhesion to the epithelial glycocalyx, providing lubrication and trapping particulates to reduce shear forces and microbial attachment during blinking.^[37] In response to injury, the cornea exhibits robust wound healing mechanisms to restore barrier function swiftly. Epithelial defects heal rapidly through proliferation and migration of cells derived from limbal stem cells located at the corneoscleral junction, enabling coverage of small wounds within hours to days and preventing secondary infections.^[38] Deeper stromal injuries trigger keratocytes—quiescent stromal fibroblasts—to activate into myofibroblasts, which deposit extracellular matrix for remodeling, though excessive fibrosis can temporarily compromise transparency until resolution.^[39] Due to its avascular nature, the cornea relies predominantly on anaerobic glycolysis for energy production, with approximately 85% of glucose metabolism occurring via this pathway in epithelial and endothelial cells to generate ATP under low-oxygen conditions.^[40] The endothelium maintains stromal dehydration through active transport via Na+/K+-ATPase pumps, which expel fluid at a rate of 10-15 μl/cm²/hour, countering passive leakage from the aqueous humor to preserve corneal thickness and clarity.^[41] The cornea balances immune surveillance with minimal inflammation to safeguard transparency. Resident antigen-presenting cells, such as dendritic cells in the epithelium and stroma, detect and process pathogens but promote immune privilege by inducing regulatory T cells rather than robust effector responses, thereby limiting vascularization and opacity-inducing inflammation.^[42] A unique protective mechanism involves the blink reflex, mediated by trigeminal nerve afferents, which mechanically clears debris and distributes tears for lubrication approximately 15-20 times per minute under normal conditions.^[17]

Disorders and Clinical Significance

Common Disorders

Keratitis represents one of the most prevalent corneal disorders, characterized by inflammation of the corneal tissue that can lead to significant visual impairment if severe. Infectious keratitis is primarily caused by bacterial pathogens such as Pseudomonas aeruginosa in contact lens wearers, viral agents like herpes simplex virus (HSV), or fungal organisms, often entering through epithelial defects from trauma or poor hygiene. Symptoms typically include acute eye pain, photophobia, redness, tearing, and blurred vision due to corneal edema and infiltrates. ^[43] ^[44] ^[45] Sterile, or non-infectious, keratitis arises from mechanical irritation, such as prolonged exposure from incomplete eyelid closure or overwear of contact lenses, leading to epithelial breakdown without microbial invasion. These cases present with similar symptoms of pain, photophobia, and foreign body sensation, though less likely to form ulcers. Emerging research highlights the potential role of the ocular surface microbiome in predisposing to non-infectious keratitis, where dysbiosis may exacerbate inflammation in conditions like dry eye syndrome by altering immune homeostasis on the cornea. ^[43] ^[46] Keratoconus is a progressive ectatic disorder involving corneal thinning and bulging into a cone-like shape, typically onsetting in adolescence or early adulthood. Its etiology involves a combination of genetic and environmental factors, including chronic eye rubbing and atopy. Candidate genes such as VSX1 and SOD1 have been investigated, but their causative role remains unconfirmed across studies. This leads to irregular astigmatism, distorted vision, and increased light sensitivity as the corneal curvature steepens asymmetrically. ^[47] ^[48] ^[49] Corneal dystrophies encompass a group of hereditary conditions affecting specific corneal layers, with Fuchs' endothelial dystrophy being the most common in older adults, characterized by progressive endothelial cell failure and formation of guttae (excrescences) on the Descemet membrane. Lattice dystrophy, another stromal variant, results from amyloid protein deposits forming branching, glass-like lines in the corneal stroma. Both manifest with symptoms of blurred or hazy vision, glare, and recurrent epithelial erosions, worsening over time due to stromal haze and edema. ^[50] ^[51] Dry eye syndrome exerts a notable impact on the cornea through diminished tear film stability and inadequate lubrication, which can cause superficial punctate erosions and compromise the epithelial barrier. Reduced tear production or rapid evaporation leads to increased friction during blinking, resulting in corneal surface damage, stinging sensations, scratchiness, and fluctuating blurry vision. ^[52] ^[53] Corneal trauma, including abrasions and chemical burns, constitutes a major category of acute disorders, where mechanical scratches from foreign bodies disrupt the epithelium, causing immediate pain, tearing, and light sensitivity. Chemical burns vary in severity; acid injuries cause superficial coagulation necrosis, while alkali burns penetrate deeper due to saponification of cell membranes and proteins, leading to liquefactive necrosis, limbal stem cell loss, and prolonged inflammation. ^[54] ^[55]

Diagnostic Approaches

Diagnostic approaches to assessing corneal health, structure, and function rely on a combination of clinical examinations and advanced imaging techniques to evaluate transparency, thickness, curvature, cellular integrity, and surface integrity. These methods enable early detection of abnormalities such as opacities, thinning, ectasias, endothelial dysfunction, and epithelial defects, which are critical for timely intervention. Slit-lamp biomicroscopy serves as the cornerstone of corneal evaluation, providing magnified visualization of the corneal layers, detection of opacities, and assessment of the endothelium through specular reflection from the posterior surface.^[56]^[57]^[58] By adjusting the slit beam's angle and width, clinicians can identify subtle changes in stromal clarity or endothelial guttae, often enhanced by specular microscopy integration for detailed reflection analysis.^[59]^[60] Pachymetry measures corneal thickness, essential for assessing edema or thinning, with the normal central corneal thickness averaging approximately 540 μm in healthy adults.^[61] This can be performed using ultrasound pachymetry, which provides contact-based measurements, or non-contact optical coherence tomography (OCT), offering high-resolution data without anesthesia.^[62] Variations in thickness, such as increased values in edema or decreased in ectasias, guide risk stratification for conditions like glaucoma or refractive surgery.^[63] Corneal topography and keratometry map the corneal curvature to detect irregularities, particularly ectasias like keratoconus, by analyzing anterior surface elevation and power.^[64] Placido disc-based systems project concentric rings onto the cornea to assess mires for asymmetry, while Scheimpflug imaging provides tomographic data on both anterior and posterior surfaces, improving ectasia detection through posterior elevation maps.^[65]^[66] These techniques quantify steepening or thinning, with indices like the inferior-superior value aiding in early diagnosis.^[67] In vivo confocal microscopy enables non-invasive, high-resolution imaging of corneal cellular structures, particularly the endothelium, where cell density below 2,000 cells/mm² signals increased risk of decompensation.^[68] This laser scanning method visualizes hexagonal endothelial cells, pleomorphism, and polymegathism, correlating well with specular microscopy for quantitative analysis in diseased states.^[69]^[70] Vital staining assesses epithelial integrity by highlighting defects and devitalized tissue. Fluorescein dye, applied topically, pools in epithelial erosions or ulcers under cobalt blue illumination, delineating surface breaks.^[71] Rose bengal, a fluorescein derivative, stains devitalized or mucin-deficient cells pink, offering superior detection of subtle ocular surface damage compared to fluorescein alone.^[72]^[73] Anterior segment OCT provides detailed cross-sectional views of the cornea, surpassing traditional methods by quantifying layer-specific thickness, opacities, and stromal details with micrometer resolution.^[74] This non-contact imaging modality visualizes the full corneal depth, including the endothelium and Descemet's membrane, facilitating precise evaluation of pathologies like dystrophies or post-surgical changes.^[75]^[76]

Treatment Options

Treatment of corneal conditions often begins with non-surgical approaches aimed at addressing infection, inflammation, epithelial integrity, and structural stability. Pharmacological interventions are a cornerstone, particularly for infectious keratitis. For bacterial keratitis, topical fluoroquinolone antibiotics such as gatifloxacin 0.3% are commonly prescribed due to their broad-spectrum activity against gram-positive and gram-negative pathogens, demonstrating comparable efficacy to fortified antibiotics in clinical trials while offering the convenience of monotherapy.^[77] Viral keratitis, such as herpes simplex virus epithelial keratitis, is managed with topical antivirals like ganciclovir 0.15% gel or trifluridine 1% solution, which exhibit similar effectiveness in resolving dendritic lesions and promoting epithelial healing.^[78] Topical corticosteroids, such as prednisolone acetate, may be used adjunctively to control inflammation in non-infectious or post-infectious scenarios, but their application requires caution due to the risk of potentiating corneal melting through inhibition of collagen synthesis and increased ulceration potential, particularly in active infections.^[79] For dry eye syndrome, which can compromise the corneal surface and lead to epitheliopathy, artificial tear lubricants provide symptomatic relief by supplementing the tear film and reducing evaporation, while punctal plugs occlude the lacrimal drainage points to retain natural tears and enhance ocular surface wetting.^[80] These conservative measures have been shown to alleviate symptoms, stabilize the tear film, and repair superficial corneal lesions in moderate cases.^[81] In instances of persistent epithelial defects, such as those from trauma or neurotrophic keratitis, therapeutic bandage contact lenses facilitate healing by protecting the denuded stroma, promoting epithelial migration, and alleviating pain, often outperforming traditional patching in accelerating re-epithelialization.^[82] Specialty contact lenses offer vision rehabilitation for structural irregularities without invasive intervention. In keratoconus, where progressive thinning causes irregular astigmatism, scleral lenses vault over the cornea to create a smooth refractive surface with a fluid reservoir, improving visual acuity and comfort for patients intolerant to standard lenses.^[83] Orthokeratology lenses, worn overnight, temporarily reshape the corneal epithelium to correct mild irregular astigmatism, providing spectacle-free daytime vision and potentially slowing progression in early disease.^[84] Corneal collagen cross-linking (CXL) serves as a non-surgical adjunct to stabilize progressive ectatic disorders like keratoconus by inducing stromal stiffening through riboflavin (vitamin B2) sensitization followed by ultraviolet-A (UVA) irradiation at 365 nm, a method expanded in FDA approval in 2016 for epithelium-off application in patients aged 14 and older. In October 2025, the FDA approved Epioxa (riboflavin 5'-phosphate ophthalmic solution) for epithelium-on CXL to treat keratoconus in patients aged 13 and older, offering a non-invasive alternative without epithelial removal.^[85] This photochemical process increases corneal biomechanical strength by up to 300% without altering the anterior curvature significantly, halting ectasia in over 90% of treated eyes based on long-term follow-up studies.^[86]^[87] Nutritional deficiencies contributing to corneal pathology, such as vitamin A deficiency leading to xerophthalmia and keratomalacia, are addressed through oral supplementation with high-dose retinol (e.g., 200,000 IU for children over 12 months), which reverses night blindness and corneal xerosis within weeks when initiated early.^[88] Emerging biologic therapies, including amniotic membrane extracts in eye drop formulations, provide anti-inflammatory benefits by modulating cytokine expression and promoting epithelial repair in inflammatory corneal conditions refractory to standard treatments.^[89] If non-surgical options fail to control progression, escalation to surgical interventions may be necessary.

Surgical Interventions and Transplantation

Surgical interventions for corneal disorders primarily involve procedures aimed at repairing or replacing damaged tissue to restore optical clarity and function. Phototherapeutic keratectomy (PTK) utilizes an excimer laser to ablate superficial corneal opacities and irregularities, effectively treating conditions such as corneal dystrophies, recurrent erosions, and band keratopathy by removing micrometers of tissue with high precision while preserving deeper layers.^[90]^[91] For stromal pathologies not involving the endothelium, deep anterior lamellar keratoplasty (DALK) replaces the anterior cornea down to Descemet's membrane, minimizing rejection risk by retaining the recipient's healthy endothelium and offering improved tectonic stability compared to full-thickness procedures.^[92]^[93] Corneal transplantation, or keratoplasty, encompasses full-thickness and partial-thickness techniques tailored to the affected layer. Penetrating keratoplasty (PK) involves excising and replacing the entire corneal thickness, commonly used for advanced keratoconus, scars, or perforations, with clear graft success rates exceeding 90% in the first year postoperatively.^[94] Endothelial keratoplasty, including Descemet stripping endothelial keratoplasty (DSEK) and Descemet stripping automated endothelial keratoplasty (DSAEK), targets Fuchs' endothelial dystrophy by replacing only the dysfunctional endothelium and Descemet's membrane with a thin donor stromal layer, achieving rapid visual rehabilitation and lower suture-related complications.^[95]^[96] Donor corneas are sourced from accredited eye banks, where tissue is rigorously screened for viability and infectious risks before preservation in media like Optisol-GS, allowing storage for up to 14 days at 2-6°C to maintain endothelial cell density.^[97] Human leukocyte antigen (HLA) matching is not routinely performed for most corneal transplants due to the cornea's immune privilege, though it may be considered in high-risk cases.^[98] Postoperative complications include graft rejection, most frequently affecting the endothelium in PK and endothelial keratoplasties, as well as astigmatism from irregular wound healing or suture tension.^[99] Standard management involves topical corticosteroids to suppress inflammation and prevent rejection, tapered over months based on clinical response.^[100] Recent advances enhance precision and accessibility in these procedures. Femtosecond laser-assisted PK, adopted widely since the 2010s, enables customized, zigzag incisions for better wound apposition, reducing astigmatism and accelerating recovery.^[101] Bioengineered corneas, such as hydrogel-based implants, are in clinical trials; as of 2025, ongoing clinical trials and pre-clinical advancements, such as positive FDA meetings in February 2025 and collaborations like Pantheon Vision with Eyedeal Medical in March 2025, demonstrate promising progress in bioengineered corneal implants for integration and transparency restoration in patients with stromal defects, potentially alleviating donor shortages.^[102]^[103]^[104]^[105] Global corneal tissue shortages persist, affecting millions in developing regions, but initiatives like those from the Lions World Vision Institute facilitate international distribution and training to increase supply and equity.^[106]^[107]

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Aug 25, 2023 · Keratitis is the inflammation of the cornea and is characterized by corneal edema, infiltration of inflammatory cells, and ciliary congestion.
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May 27, 2025 · Bacterial keratitis is an infection of the cornea (the clear dome ... Symptoms of bacterial keratitis include: Eye pain; Eye redness ...
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The ocular microbiome/microbiota plays an important role in the regulation of homeostasis both in health and disease.
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Apr 12, 2024 · Keratoconus likely arises from a multifactorial etiology, with both genetic and environmental factors contributing to its development.[15].
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Evidence of genetic etiology includes familial inheritance, discordance between dizygotic twins, and association with other known genetic disorders.
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Dec 6, 2024 · These cornea changes can cause vision problems. Symptoms of Fuchs' dystrophy include: Blurry vision that's worse in the morning and gets ...
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Aug 7, 2023 · Patients with corneal dystrophy range from being asymptomatic to displaying symptoms such as painful corneal erosions, photophobia, and visual ...
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Dry Eye | National Eye Institute
### Summary: Impact of Dry Eye Syndrome on the Cornea
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The pathophysiology of dry eye disease: What we know and future ...
Dry eye is a chronic inflammatory disease that can be initiated by numerous extrinsic or intrinsic factors that promote an unstable and hyperosmolar tear film.Missing: impact | Show results with:impact
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Corneal Injury - StatPearls - NCBI Bookshelf
Exposure-related burns of the eye can be categorized into chemical (acid and alkali burns), radiation burns from ultraviolet (UV) sources, and thermal burns.
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An update on chemical eye burns - PMC - PubMed Central
Lime is a much more common cause of chemical burns, but comparatively less toxic. It produces calcium soaps after penetration of the corneal epithelium, ...
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Jun 11, 2023 · A slit lamp is an optical instrument with a high-intensity illumination source that can project as a slit.
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Cornea and anterior eye assessment with slit lamp biomicroscopy ...
This first part reviews a description of slit lamp biomicroscopy (SLB), endothelial specular microscopy, confocal microscopy, and ultrasound biomicroscopy ...
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Specular Microscopy - StatPearls - NCBI Bookshelf - NIH
In corneal edema, the specular reflection is masked and hampers visualization of the corneal endothelium. Eye banks also need to assess the donor's corneal ...
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Imaging the Corneal Endothelium in Fuchs Corneal Endothelial ...
Slit-lamp biomicroscopy The specular reflection from the posterior corneal surface can be enhanced by setting the slit-beam arm at an angle of 60° from the ...
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Central Corneal Thickness and Glaucoma Risk: The Importance of ...
Feb 15, 2025 · Based on the Goldmann applanation tonometry (GAT), the average CCT is approximately 530–540 µm. ... With this in mind, abnormal CCT readings can ...
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Apr 6, 2025 · Pachymetry and anterior segment optical coherence tomography (AS-OCT) quantify corneal thickness and edema, aiding in disease staging.
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The average thickness is 515 μm in the center of the cornea. In the paracentral region, the thickness varies from 522 μm lower to 574 μm upper. In the ...
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Oct 31, 2024 · General Principles · Placido Disc Reflection for curvature analysis · Scanning Slit elevation evaluation · Scheimpflug principle based assessment.
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Corneal topography is a diagnostic tool for cornea, cataract, and refractive surgeons, evaluating the anterior and posterior surfaces of the cornea.Missing: human | Show results with:human
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Aug 13, 2021 · Cornea and anterior eye assessment with placido-disc keratoscopy, slit scanning evaluation topography and scheimpflug imaging tomography.
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Evaluation of the Endothelial Cell Density and the Central Corneal ...
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In vivo confocal microscopy of the corneal endothelium
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In vivo Confocal Microscopy for Corneal and Ocular Surface ...
Jun 7, 2025 · Corneal endothelial density measured by IVCM correlates well with specular microscopy, even in moderate corneal edema cases (Figure 9).<|separator|>
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Jun 23, 2025 · Vital staining of the cornea and conjunctiva. Acta Ophthalmol ... Comparison of fluorescein and rose bengal staining. Ophthalmology ...
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Apr 5, 2023 · Rose bengal is a derivative of fluorescein and is used to detect ocular surface damage. It was initially theorized that rose bengal stains dead ...
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Rose bengal is a iodinated derivative of fluorescein that stains degenerating, devitalized, and dead epithelial cells in a bright pink color. Due to its ...Missing: defects | Show results with:defects
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Anterior Segment Optical Coherence Tomography - EyeWiki
Technology. Optical coherence tomography (OCT) is a high resolution cross-sectional imaging modality initially developed for retinal imaging. Anterior segment ...
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Applications of Anterior Segment Optical Coherence Tomography in ...
Anterior segment OCT (AS-OCT) enables the precise visualization of anterior segment structure; thus, it can be used in various corneal and ocular surface ...
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Anterior Segment OCT - High Resolution Imaging in Microscopy and ...
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Comparison of Topical Gatifloxacin 0.3% and Ciprofloxacin 0.3% for ...
Purpose. To compare the bacteriologic and clinical efficacy of gatifloxacin and ciprofloxacin for the treatment of bacterial keratitis. ; Design. Prospective, ...
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Both artificial tears and punctal plugs relieved dry eye symptoms, repaired corneal lesions, enhanced tear film stability, and improved contrast sensitivity.
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Dry Eye Treatment at Moran Eye Center - University of Utah Health
Placing punctal plugs helps keep more of your own tears on the surface of your eye, increases moisture, and reduces dry eye symptoms.
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The Use of Bandage Contact Lens for Epithelial Healing in Corneal ...
Bandage contact lens was proven to be superior in treating corneal abrasion compared to the traditional pressure patching. The BCL outcome shows faster healing ...
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Irregular Corneal Astigmatism and Scleral Lenses
Scleral lenses are a great non-surgical solution for irregular astigmatism that can provide excellent vision correction.
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Keratoconus can cause irregular astigmatism and corneal scarring, both of which can make vision correction with glasses or soft lenses nearly impossible.
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Jul 13, 2016 · The riboflavin component acts as a photoenhancer, enhancing corneal collagen cross-linking in conjunction with the UVA light source. • Drug ...
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Jul 20, 2025 · Recommended Vitamin A deficiency treatment regimens are described in the following table. Treatment can be adjusted as needed based on ...Disease Entity · Pathophysiology · Diagnosis · Clinical Signs
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Excimer laser phototherapeutic keratectomy (PTK) has been found to be an effective treatment for a variety of superficial corneal disorders.Preoperative Evaluation · Technique · Post procedure management
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Nov 12, 2013 · PTK offers patients an alternative to lamellar or penetrating keratoplasty for the correction of corneal opacities and surface irregularities.
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Deep Anterior Lamellar Keratoplasty
Sep 1, 2007 · Deep anterior lamellar keratoplasty (DALK) is a surgical procedure for removing the corneal stroma down to Descemet's membrane.
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Deep anterior lamellar keratoplasty (DALK) has emerged as a transformative approach in managing corneal pathologies, notably keratoconus (KC), ...
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The overall corneal graft survival rates at 1, 5, 10, 15, and 20 years were 91%, 66.8%, 55.4%, 52%, and 44%, respectively.
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Jan 4, 2025 · DSEK Procedure Advantages · Less Invasive, smaller surgical incisions · No corneal-graft sutures · Faster visual recovery · Less risk of sight ...
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Purpose: To determine 5-year outcomes of Descemet stripping endothelial keratoplasty (DSEK) for Fuchs' endothelial corneal dystrophy (FECD).
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Substantial changes likely in eye banking, corneal transplantation ...
Jul 20, 2017 · Optisol GS, which remains the most popular corneal preservation media in the world, was developed in my laboratory, and I hold patents on ...
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National Eye Institute Supported Randomized Controlled Trials
The CCTS were designed to evaluate the effect of donor-recipient histocompatibility matching (HLA-A, HLA-B, and HLA-DR antigens) and cross-matching on the graft ...
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Jun 11, 2023 · Timely steroid administration and suture management in decreasing suture-related vascularization and rejection.History and Physical · Evaluation · Treatment / Management · Postoperative and...
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Penetrating Keratoplasty - EyeWiki
Jun 29, 2025 · Topical steroid drops should be started postoperative to prevent inflammation and lower the risk of rejection.
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Femtosecond laser-assisted corneal transplantation - PMC
Femtosecond laser (FSL) enable customization of the thickness and shape of the graft has been used for trephination of both donor and recipient corneas.
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Aug 11, 2022 · We describe a cell-free engineered corneal tissue, bioengineered porcine construct, double crosslinked (BPCDX) and a minimally invasive surgical method for its ...
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May 17, 2024 · We propose Kuragel as a regenerative treatment for patients suffering from corneal defects including thinning, by restoration of transparency and thickness.
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Lions World Vision Institute | So The World Can See
Lions World Vision Institute is the largest combined eye bank, tissue recovery and ocular research center in the world.Programs · For Eye Banks · Career Opportunities · Corneal Contouring / CAIRS
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Corneal Surgery, Transplant Tissue, and Eye Banking
Jul 18, 2023 · Worldwide, there is a shortage of HCT – with 53.3% of countries without practical access, and another 35.7% with satisfactory access (Gain et al ...