The cornea is the clear layer in the front of the eye that acts as a barrier to the outside world.
There are many diseases of the cornea including infections (which are often called ulcers), abnormal shape (ectasia such as keratoconus), traumatic scars, dystrophies (abnormal deposits which can affect vision including Fuch’s), recurrent erosions, dryness, swelling (also called edema), and many more. We can take care of all of these problems at Raleigh Eye Center.
Keratoconus is a progressive disease that typically affects both eyes. In the teenage years (or earlier in severe cases), the cornea begins to thin and become shaped more like a cone than a ball. This progression usually stops when patients are in their forties.
The most important thing for the patient is to stop rubbing the eyes. Eye rubbing has been demonstrated to increase the chances of progression of keratoconus. It is important to see an eye doctor and take very precise photographs of the cornea to assess the severity of the disease. Early, progressive keratoconus is now treated with an in-office procedure named cross-linking. Advanced keratoconus can require a cornea transplant. Often, hard contact lenses are used to give patients their best possible vision.
Recurrent corneal erosions (RCE) are when the cornea repeatedly gets scratches. This typically happens overnight where the cornea can stick to the eyelid. Patients with this often are afraid to open their eyes in the morning. The most common causes are from previous trauma (such as a fingernail) or from an irregular surface. Treatment includes lubrication, sodium chloride drops/ointment, bandage contact lenses, and sometimes an in-office procedure.
An ulcer is an infection on the cornea, causing a white spot to be seen on the clear part of the eye. This is often from poor contact hygiene or from a scratch. These are most of the time caused by bacteria. Small infections can be treated with a prescription antibiotic. Severe infections often are treated with custom-made antibiotics, and a sample is sent to a laboratory for further analysis.
A pterygium is a benign growth on the front of the eye. These are common in patients who work or spend a lot of time outdoors, as they originate from sun and wind damage. They tend to slowly grow over time. Lubricating drops and occasionally a short course of steroid drops can be used for comfort. If they are too large (which can cause decreased vision), they can be surgically removed.
Fuch’s dystrophy is a disease of the inner layer of the cornea, named the endothelium. These cells often begin to prematurely die during the patient’s forties and can become visually significant in the patient’s sixties. It is important to receive the diagnosis prior to cataract surgery and discuss your individual risk, as any surgery may worsen the effects of Fuch’s. Mild swelling can be treated with drops. Severe swelling is best treated with surgery.
Organ donation can give the gift of sight! One benefit of the cornea is that there is no need for tissue matching. The new cornea is sutured in place using material thinner than a human hair. The most common reasons for a transplant are severe keratoconus, severe corneal infection, trauma, and scarring. On average, a transplant lasts about 20 years, and the surgery can be repeated.
If the disease is confined to the back layers of the cornea (Fuch's dystrophy, corneal edema, some cases of transplant failure), then we now have the ability to only transplant the disease layers of the cornea. Preserving the front surface of the eye leads to much improved visual outcomes and quicker recovery. That being said, these thinner grafts are held in place by a gas bubble, so patients need to be in bed rest for a few days after the surgery.
Our Raleigh ophthalmologists suggest annual eye exams in order to receive the most effective treatment. Contact us at Raleigh Eye Center today to schedule your appointment.
Our ophthalmology center is proud to provide cornea disease treatment in Raleigh, NC and surrounding cities, including Apex, Cary, Chapel Hill, Durham, Fuquay-Varina, Garner and Wake Forest.