Corneal Disease (cont.)

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How is corneal disease diagnosed?

An eye doctor will review the person's medical history and perform a careful examination of the eyes and eyelids. The cornea is examined in detail using a slit lamp microscope. Additional testing may include topography and keratometry (to study the shape of the cornea), pachymetry (to measure the thickness of the cornea), specialized microscopy, assessment of the tear film, and blood tests.

What is the treatment for corneal disease?

Treatment is tailored to the individual disease and the individual patient. Treatments might include medications, laser treatment, or surgery, depending on the condition.

Infections are often treated with medicated eyedrops and, in some cases, oral medication. An abrasion might require temporary patching or a bandage contact lens, depending on the cause. Keratoconus, in which the cornea is flexible and can develop a cone shape, is often managed with special contact lenses. Newer treatments, including corneal crosslinking (riboflavin and ultraviolet-A) and corneal implants, are also options. Advanced cases are treated with a corneal transplant.

Autoimmune disorders are best treated by addressing the underlying disease, and corneal involvement is often managed with anti-inflammatory eyedrops such as steroids. Vitamin A deficiency, which can be seen in patients who have had certain types of bariatric surgery, can be corrected. Allergic eye disease responds well to both topical and oral medication.

A pterygium is a growth on the cornea's surface; this is most commonly seen after chronic sun exposure. They can be removed surgically if they become bothersome. Cancers of the surface of the eye are managed with surgery or in some cases, topical chemotherapy eyedrops or injections.

Dry eye is common and can result in painful erosions of the corneal surface. Aside from lubricating the eyes with artificial tears, addressing the underlying cause is important. In some individuals, dryness is due to lack of tear production, and anti-inflammatory drops such as cyclosporin (Restasis) or steroids may help. In other cases, the dryness is due to evaporation of the tears between blinks. This occurs when the eyelids' oil glands (meibomian glands) are not functioning well. Normally, the oil from these glands coats the eye's surface and prevent tear evaporation. The oil glands' function can be improved with a combination of warm compresses, lid hygiene (for example, dilute baby shampoo lid scrubs), increased intake of omega-3 fatty acids, and in some patients, oral medication.

What are the potential complications of corneal disease?

Many corneal diseases are treatable and have a good prognosis. However, vision loss and chronic pain are potential complications of corneal disease so it is important to review treatment options carefully with an eye doctor.

Is it possible to prevent corneal disease?

Many corneal diseases are preventable by reducing risk factors. For example, good hygiene and regular vaccinations can protect against many infectious diseases. Contact lens wearers are especially susceptible to serious corneal infections so they should clean lenses as directed. Glasses and sunglasses with 100% ultraviolet block can protect against growths that are associated with sun exposure, such as pterygium, and eye surface cancers. Safety glasses should be worn when warranted to prevent trauma. A diet rich in omega-3 fatty acids and sufficient vitamin A may help maintain a healthy tear film, thus minimizing dry eye symptoms. Reviewing one's family's ocular health history is helpful in looking for hereditary conditions. Regular eye examinations are important for detecting eye diseases at their earliest stages.

Medically reviewed by William Baer, MD, Board Certified Ophthalmology

REFERENCES:

Krachmer, Jay H., et al. Cornea: Fundamentals, Diagnosis and Management. 3rd edition. Mosby, 2010.

Reidy, James J. Basic and Clinical Course 2010-2011 Section 8: External Disease and Cornea. Revised edition. American Academy of Ophthalmology, 2010.


Medically Reviewed by a Doctor on 5/20/2015

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