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Treatment of external corneal diseases and trauma including corneal transplantation

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The cornea is the clear dome in front of the colored part of the eye and pupil. You can compare it to the clear windshield of your car. It is responsible for 60-65% of the normal refractive power of the eye. That is, the eye’s ability to focus images onto the retina. There are too many conditions to list all of them here. However, the most common conditions will be discussed along with their appropriate care.

One of the most common conditions that affect the cornea, particularly the surface integrity of the cornea, is the dry eye syndrome. There are numerous causes, but it has been commonly treated by artificial tear drops in the past. These are available over the counter and are quite good at relieving symptoms, but none offer a cure. The dry eye syndrome is more commonly seen in females and is associated with aging. However, it is also prevalent in other systemic conditions such as rheumatoid arthritis and Sjogren’s syndrome. Convincing evidence in the recent past has shown that these inflammations are associated with the major tear gland of the eye. Over time, this inflammation slowly destroys the glandular production of tears and the dryness could become irreversible.

Patients with dry eye syndrome, particularly in the more advanced stages, commonly complain of blurred vision, sensitivity to light, a dry scratchy feeling and in some instances over-tearing. The periodic excessive tearing is simply a reflex from the surface of the eye being irritated, stimulating the somewhat healthy tear gland and producing an overabundance of tears in response to the surface irritation. In some individuals, the lack of sufficient tear film can become so severe that scar tissue is formed on the cornea, resulting in decreased visual acuity. The key is to get to this inflammatory process before a mild dry eye becomes severe.

With recent research, a drug has been developed to block the inflammatory process in the tear gland, thereby allowing the tear gland to rejuvenate if addressed soon enough. The gland then would begin producing tears at a normal rate, restoring the normal, healthy integrity of the corneal surface as well as the rest of the eye. This medication is called Restasis, which is form of general therapeutic drug used in the past for other systemic problems. It has proven to be quite effective in treating dry eye syndrome, restoring a normal, viable tear film. It is commonly prescribed to be instilled in the eye one drop every twelve hours daily for six months. At the end of this period of time, and if the eye shows significant improvement, many times the dosage can be reduced to once a day. However, a patient should be cautioned that discontinuation of the Restasis without consulting our office could result in recurrence of the dry eye syndrome. It is important to treat the syndrome as early as possible, because it can give rise to other external ocular diseases such as viral, bacterial and fungul infections. The eye uses healthy tear film to help pump debris and bacteria out of the eye. When the tear film is no longer adequate due to dry eye syndrome, these conditions can occur.

Conjunctivitis is another condition that affects the surface of the eye. It can be bacterial, viral, allergic, fungal or chemical in nature. Depending on the etiology of the conjunctivitis (pink eye), appropriate medications are available by prescription only. At Moulton Eye Clinic, we can diagnose the offending agent and prescribe the necessary treatment. Obviously, the sooner the patient is seen the better for the eye. These infections can give rise to corneal ulcers, which is a much more serious problem if not treated quickly.

The cornea can also be adversely affected with incorrect use of contact lenses. It has been our experience that the most common complication is corneal ulceration caused by overwear. Over time, there is deficient delivery of adequate tear film and necessary oxygen to the corneal surface, causing pain, sensitivity to light, blurred vision, tearing, etc. Obviously, the treatment here is to decrease or even discontinue wearing the contact lenses for a period of time. Such ulceration is seen mostly in extended wear soft contact lens wear.

Keratoconus is an inherited condition of the cornea, characterized by a slow, progressive steepening of the central cornea. Early treatment would involve hard, or gas permeable, contact lenses but over time corneal transplantation is necessary. At Moulton Eye Clinic, we have been offering this surgical service since 1979. It is highly successful, not only for keratoconus, but other conditions that require surgical intervention. As with any transplanted tissue, the procedure may have to be repeated at least once, because there is always a risk of rejection of the transplanted tissue. Corneal transplantation can be repeated as many times as necessary in order to restore and maintain good vision.

There are growths that can develop on the cornea that begin in the clear mucous membrane of the eye which lines the white structure of the eye. When these membranes cross over onto the clear cornea, they are known as pterygia. These are not cataracts. They need to be removed if they are active, or they will grow totally over the clear cornea resulting in blindness.

Trauma to the eye can also affect the cornea, as well as a variety of burns, misdirected eyelashes that can scratch the cornea, chronic infections, congenital corneal dystrophies or degenerative processes of the cornea. In many of these instances, corneal transplantation is indicated in order to restore vision. Needless to say, it is important to see an eyecare professional to diagnose and treat such conditions.