Treatment of Corneal External Diseases
Clemson Eye’s Dr. Justin Roman specializes in treatment of cornea external diseases. The cornea is the clear, outer surface of your eye responsible for focusing power. If a cornea is damaged, the light that enters the eye is distorted causing the image you see to be blurry. A cornea may become damaged in several ways, including injury, disease, infection or previous eye surgery. Sometimes damage to the cornea is mild enough that it may be repaired to restore vision. If not, a corneal transplant may be necessary.
What are common conditions that affect the cornea?Allergies: The most common allergies that affect the eye are those related to pollen, particularly when the weather is warm and dry. Symptoms in the eye include redness, itching, tearing, burning, stinging, and watery discharge, although usually not severe enough to require medical attention. Antihistamine decongestant eyedrops effectively reduce these symptoms. Rain and cooler weather, which decreases the amount of pollen in the air, can also provide relief. Keratitis is an inflammation of the cornea. Noninfectious keratitis can be caused by a minor injury, or from wearing contact lenses too long. Infection is the most common cause of keratitis. Infectious keratitis can be caused by bacteria, viruses, fungi or parasites. Often, these infections are also related to contact lens wear, especially improper cleaning of contact lenses or overuse of old contact lenses that should be discarded. Minor corneal infections are usually treated with antibacterial eye drops. If the problem is severe, it may require more intensive antibiotic or antifungal treatment to eliminate the infection, as well as steroid eye drops to reduce inflammation. Dry Eye is a condition in which the eye produces fewer or lower quality tears and is unable to keep its surface lubricated. The main symptom of dry eye is usually a scratchy feeling or as if something is in your eye. Other symptoms include stinging or burning in the eye, episodes of excess tearing that follow periods of dryness, discharge from the eye, and pain and redness in the eye. Sometimes people with dry eye also feel as if their eyelids are very heavy or their vision is blurred.
What are Corneal Dystrophies?A corneal dystrophy is a condition in which one or more parts of the cornea lose their normal clarity due to a buildup of material that clouds the cornea. These diseases:
- Are usually inherited
- Affect both eyes
- Progress gradually
- Don’t affect other parts of the body, and aren’t related to diseases affecting other parts of the eye or body
- Happen in otherwise healthy people
- Glare, which affects vision in low light
- Blurred vision that occurs in the morning after waking and gradually improves during the day
- Distorted vision, sensitivity to light, difficulty seeing at night, and seeing halos around light at night
- Painful, tiny blisters on the surface of the cornea
- A cloudy or hazy looking cornea
- Anterior corneal puncture, which help the cells adhere better to the tissue
- Corneal scraping to remove eroded areas of the cornea and allow healthy tissue to regrow
- Laser surgery to remove surface irregularities on the cornea
What Other Diseases can Affect the CorneaHerpes Zoster (Shingles) is a reactivation of the varicel-la-zoster virus, the same virus that causes chickenpox. If you have had chickenpox, the virus can live on within your nerve cells for years after the sores have gone away. In some people, the varicel-la-zoster virus reactivates later in life, travels through the nerve fibers, and emerges in the cornea. If this happens, your eye care professional may prescribe oral anti-viral treatment to reduce the risk of inflammation and scarring in the cornea. Shingles can also cause decreased sensitivity in the cornea. Corneal problems may arise months after the shingles are gone from the rest of the body. If you experience shingles in your eye, or nose, or on your face, it’s important to have your eyes examined several months after the shingles have cleared. Herpes of the eye, or Ocular Herpes, is a recurrent viral infection that is caused by the herpes simplex virus (HSV-1). This is the same virus that causes cold sores. Ocular herpes can also be caused by the sexually transmitted herpes simplex virus (HSV-2) that causes genital herpes. Ocular herpes can produce sores on the eyelid or surface of the cornea and over time the inflammation may spread deeper into the cornea and eye, and develop into a more severe infection called stromal keratitis. There is no cure for ocular herpes, but it can be controlled with antiviral drugs. Iridocorneal Endothelial Syndrome (ICE) is more common in women and usually develops between ages 30¬-50. ICE has three main features:
- Visible changes in the iris, the colored part of the eye
- Swelling of the cornea
- Glaucoma ICE is usually present in only one eye. It is caused by the movement of endothelial cells from the cornea to the iris. This loss of cells from the cornea leads to corneal swelling and distortion of the iris and pupil. This cell movement also blocks the fluid outflow channels of the eye, which causes glaucoma. There is no treatment to stop the progression of ICE, but the glaucoma is treatable. If the cornea becomes so swollen that vision is significantly impaired, a corneal transplant may be necessary. A Pterygium is a pinkish, triangular tissue growth on the cornea. Some pterygia (plural for pyterygium) grow slowly throughout a lifetime, while others stop growing. A pterygium rarely grows so large that it covers the pupil of the eye. Pterygia are more common in sunny climates and in adults 20-40 years of age. It’s unclear what causes pterygia. However, since people who develop pterygia usually have spent significant time outdoors, researchers believe chronic exposure to UV light from the sun may be a factor. To protect yourself from developing pterygia, wear sunglasses, or a wide-brimmed hat in places where the sunlight is strong. If you have one or more pterygia, lubricating eye drops may be recommended to reduce redness and soothe irritation. Because a pterygium is visible, some people might want to have it removed for cosmetic reasons. However, unless it affects vision, surgery to remove a pterygium is not recommended. Even if it is surgically removed, a pterygium may grow back, particularly if removed before age 40. Stevens-Johnson Syndrome (SJS), also called erythema multiforme major, is a disorder of the skin that also affects the eyes. SJS is characterized by painful blisters on the skin and the mucous membranes of the mouth, throat, genitals, and eyelids. Often, SJS begins with flu-like symptoms, followed by a painful red or purplish rash of blisters that spread. SJS can cause severe conjunctivitis, iritis (an inflammation inside the eye), corneal blisters and erosions, and corneal holes. In some cases, SJS can lead to significant vision loss. The most commonly cited cause of SJS is an allergic reaction to a drug or medication, particularly sulfa drugs. It is also associated with viral infections. Treatment for the eye may include artificial tears or lubricating eye drops, antibiotics, or corticosteroids. About one third of those who develop SJS will have one or more episodes of the disease. SJS occurs twice as often in men as in women, and most often affects children and young adults under 30, although it can develop at any age.
What Treatments are there for Advanced Corneal Disease?Laser Surgery: Phototherapeutic keratectomy (PTK) is a surgical technique that uses UV light and laser technology to reshape and restore the cornea. PTK has been used to treat recurrent erosions and corneal dystrophies, such as map-dot-fingerprint dystrophy and basal membrane dystrophy. PTK helps delay or postpone corneal grafting or replacement. Corneal transplant Surgery removes the damaged portion of the cornea and replaces it with healthy donor tissue. Corneas are the most commonly transplanted tissue worldwide. More than 47,000 corneal transplants were performed in the U.S. in 2014. In the past, the standard approach to corneal transplants was to surgically replace the entire cornea with donor tissue, a technique known as penetrating keratoplasty. This is called a full thickness transplant, and may still be the only option for people with advanced keratoconus and scarring, severe herpetic scarring, or traumatic injury that affects the whole cornea. However, most people who need a cornea transplant undergo a newer procedure called lamellar keratoplasty. This is called a partial thickness transplant. In this procedure, the surgeon selectively removes and replaces the diseased layer(s) of the cornea and leaves the healthy tissue in place. Replacing only diseased layers with a donor graft leaves the cornea more structurally intact and leads to a lower rate of complications and better visual improvement. Anterior Lamellar Keratoplasty removes damaged stromal tissue and replaces it with healthy stroma from a donor. This procedure is used for:
- Severe corneal scarring
- Corneal dystrophies that affect the stroma
- Fuchs’ Dystrophy
- Post-catract edema
- Corneal failure after surgery for cataract, glaucoma or retinal detachment
Our Cornea Specialist
Dr. Justin Roman has been on the Clemson Eye team since August of 2017. Dr. Roman completed a year long corneal fellowship and specializes in many corneal procedures such as LASIK eye surgery, corneal transplants, corneal cross-linking and more. Schedule an Appointment with Dr. Roman today.