What types of health care specialists diagnose and treat corneal disease?
Vision problems are diagnosed and treated by eye doctors (optometrists and ophthalmologists). For more advanced corneal conditions, particularly those requiring surgery, an ophthalmologist (medical doctor/eye surgeon) or a corneal specialist (an ophthalmologist who has undergone additional fellowship training) would provide treatment. Additional specialists such as oculoplastic surgeons (ophthalmologists who specialize in eyelid and orbital surgery), rheumatologists, infectious disease and allergy specialists, and others may be consulted when the cornea is secondarily affected by other medical conditions.
How do health care professionals diagnose corneal disease?
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 medical testing that can provide information needed to make a diagnosis may include topography and keratometry (to study the shape of the cornea), pachymetry (to measure the thickness of the cornea), specialized microscopy (providing detailed pictures to assess the health of the endothelial cells, or to identify infectious agents), and assessment of the tear film. In some individuals, cultures, biopsies, or blood tests are also necessary.
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 treated with medicated eyedrops (antibiotics, antivirals, and antiparasitics) and, in some cases, oral medication. Herpetic stromal keratitis is a recurring swelling that develops after a herpes eye infection and is managed with anti-inflammatory steroid eyedrops.
An abrasion might require temporary patching or a bandage contact lens, depending on the cause and extent of the injury.
Keratoconus, in which the cornea can take on a distorted 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 keratoconus diseases are treated with anterior lamellar keratoplasty or corneal transplant surgery.
Chronic swelling from Fuchs' dystrophy or other conditions that damage the cornea's endothelial cells are managed initially with salty eyedrops or ointments that help prevent accumulation of fluid within the cornea. If the condition worsens, an endothelial lamellar keratoplasty (a type of partial thickness transplant surgery) may be indicated.
Research is under way to develop an artificial cornea for transplantation.
Autoimmune disorders are best treated by addressing the underlying disease. Corneal involvement is often managed with anti-inflammatory eyedrops such as steroids; however, steroid-sparing immune-modulating medications are sometimes preferable, particularly when other parts of the body are also involved.
Eye problems caused by vitamin A deficiency, which can be seen in patients who have had certain types of bariatric (weight loss) surgery, can be corrected with supplements.
Allergic eye disease responds well to both topical and oral allergy 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 cyclosporine (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 prevents 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.