CORNEA

5 layers: -
1. Epithelium
2. Bowman's Membrane
3. Stroma (thickest)
4. Descemet's Membrane
5. Endothelium

Note: New layer discovered between stroma and descemet's membrane. It is called Pre-descemet's Layer (PDL)
or Dua's layer. It is the 6th layer
· Injury to Bowman's membrane is irreversible & heals with a corneal scar.
· Damage to endothelium is also irreversible & causes corneal edema.
· Descemet's Membrane → Strongest layer
- only 1 organism that can penetrate intact membrane – Fungi

® Most important layer – Endothelium

o Maintains corneal transparency
o Pumps aqueous out of cornea
o No. of pumps depends on no. of cells in endothelium
o Each cell has 1.5 X 106 pumps.
o Normally endothelial cell count is 3000/mm2
o Each year no. of cells keep on decreasing
o Critical density – min no. of cells reqd. to keep cornea clear is 500 cells/mm2
If no. of cells ↓ than this –corneal edema
o For corneal donation min cells reqd – 2000 cells/ mm2
 KERATOPLASTY (CORNEAL TRANSPLANT)

® Two Types
o PK (penetrating Keratoplasty)
o LK (Lamellar Keratoplasty)
® Penetrating Keratoplasty (PK)
o Full thickness keratoplasty
o All 5 layers taken
® Lamellar keratoplasty (LK)
o Partial thickness keratoplasty
o Only outermost layers (Epithelium & bowman's membrane) are transplanted
o Sometime stromal layer
Note – Corneal transplants have the highest rate of success among all other organ transplants as cornea has
no blood supply so no rejection occurs
® LK is more successful than PK because max. rejections take place against endothelium
Indications →
® Pseudophakic Bullous Keratopathy
o Damage to endothelium during cataract surgery
® Corneal scars
® Non healing ulcers
Preservative Media
® MK media – preservation time - 4 days (96 hours)
o Cheap - so commonly used
® Optisol-GS media –
o Preservation time – 7-10 days
C/I of Donations
® Infectious diseases
o HIV
o Hep B
o Rabies
o Septicemia
o Prions
® Head & Neck Cancers
KERATITIS
Bacterial Keratitis
m/c bacterial keratitis –
- In world – Staph Aureus
- In India – Streptococcus Pneumonia
a/k/a ulcus serpens / hypopyon corneal ulcer
® m/c contact lens induced ulcer caused by – Pseudomonas
® Bacteria which can penetrate intact epithelium
o Corynebacterium
o Neisseria
o Haemophilus
o Listeria
 o Shigella
Mnemonic: It'S LUNCH
Symptoms
- Pain
- Redness
- Watering

ACANTHAMOEBA KERATITIS
® H/o contact lens wear
® Cleaning contact lens with water
® Pain out of proportion to signs d/t radial keratoneuritis
® Ring shaped ulcer
® Epithelial stippling
® Rx – DOC – PHMB (Poly Hexa Methylene Biguanide)
o It is a swimming pool cleanser
- Propamidine

FUNGAL KERATITIS
® More damage less symptoms
® Cause –Fusarium (m/c), Aspergillus
® Predisposing factors - Injury with organic matter
and prolonged use of topical steroids
® Finger like projections with feathery margins
& satellite lesions
® Non sterile Hypopyon
® DOC- Natamycin

VIRAL KERATITIS
® Dendritic ulcers caused by HSV
® Stained by fluorescence dye
® Only true dendrites are found
® loss of corneal sensation so these ulcers are painless
® Disciform keratitis (disc of edema)
o Antigen antibody reaction
o d/t stromal involvement
o Rx – steroids (only keratitis where steroids can be used)
® Nummular keratitis
o Seen in HZO (Herpes Zoster Ophthalmicus)
o Hutchinson's Rule - if pt. develops vesicles on the tip of nose, the eye will definitely be involved
as both are supplied by same branch of nasociliary nerve.
® Rx – Acyclovir (DOC)
- Famciclovir
- Valacyclovir
KERATOCONUS
® F>M
® Cornea becomes conical & thin
® Frequent change of glasses in young patients
® Munson's sign – Notching of lower lid on looking down
® Vogt's striae
o Vertical folds on corneal stroma
® Fleischer Ring (In epithelium)
Note – do not confuse with the KF ring seen in Wilson ds.
It is present in descemet's membrane

® Rx – Corneal collagen cross linking with Riboflavin (CCCR)

o a/k/a CXL
o It increase no. of collagen bonds making cornea stiff
o Thus prevents progression of keratoconus

Corneal Stromal Dystrophies

® Congenital B/L Corneal opacities
® Not asstd. with systemic d/o
Granular Lattice Macular
AD AD AR
Spares limbus Spares Limbus Involved
Clear intervals Clear Hazy
Good vision Good Poor vision
Highest Recurrence even after
Sx
Rx-Keratoplasty Rx-Keratoplasty Rx-Keratoplasty