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Cornea

The cornea is the transparent, dome-shaped window covering the front of the eye. It is a powerful refracting surface, providing 2/3 of the eye's focusing power. Like the crystal on a watch, it gives us a clear window to look through. The adult cornea is only about 1/2 millimeter thick and is comprised of 5 layers: epithelium, Bowman's membrane, stroma, Descemet's.

The most common corneal disorders are the following :

Corneal abrasion - a medical condition involving the loss of the surface epithelial layer of the eye's cornea as a result of trauma to the surface of the eye.

  • Corneal dystrophy - condition in which one or more parts of the cornea lose their normal clarity due to a buildup of cloudy    material.
  • Corneal ulcer - an inflammatory or infective condition of the cornea involving disruption of its epithelial layer with    involvement of the corneal stroma.
  • Corneal neo vascularization - excessive ingrowth of blood vessels from the limbal vascular plexus into the cornea,    caused by deprivation of oxygen from the air.
  • Fuchs' dystrophy - cloudy morning vision.
  • Keratitis - inflammation of the cornea.
  • Keratoconus - a degenerative disease, the cornea thins and changes shape to be more like a cone.

Treatment is both Surgical and Non –Surgical

  • Surgical- Includes Refractive eye surgery, Excimer Laser, Corneal Transplant.
  • Non surgical Include – Contact Lenses- both Soft and Rigid.

  • Corneal Abrasion
  • Corneal Dystrophy
  • Corneal Ulcer
  • Keratoconus
  • Corneal Neovascularization












There are two main types of contact lens: ('hydrophilic' or 'hydrogel') soft lenses made of water-containing plastic; and ('rigid gas permeable' or RGP) gas permeable (or 'rigid gas permeable') lenses which are less flexible.

Soft contact lenses- are larger in size than their gas permeable counterparts, cover the whole of the iris (the coloured part of the eye) and cornea (the transparent front part of the eye), and rest on the sclera (the white of the eye). Replacement may be daily, two-weekly, monthly, or in some cases three-monthly or six-monthly.

  • Silicone hydrogels, which allow much more oxygen to pass through to the cornea.
  • Plano cosmetic-'Zero-powered' Coloured and special-effect soft lenses also be used by specialists to mask eye injury or     disfigurement.
  • UV (ultraviolet) inhibitor to help protect the eye.
  • Contact lenses for astigmatism ('toric' lenses).
  • Bifocal and Multifocal lenses are all available in gas permeable materials.
  • RGP lenses normally used for daily wear.
  • Orthokeratology ('corneal reshaping' or 'overnight vision correction' worn overnight and removed during the day.
  • Your eye care practitioner will help you to decide which type of contact lens is best suited to your needs.



Keratoconus

In patients with keratoconus the cornea is cone shaped, keratoconus, derived from the greek word for cornea (‘kerato’) and cone shaped (‘conus’). In patients with keratoconus the cornea is not only cone shaped but the surface is also irregular resulting in a distorted image being projected onto the brain Because the cornea is irregular and cone shaped, glasses do not adequately correct the vision in patients with keratoconus since they cannot conform to the

shape of the eye. Patients with keratoconus see best with rigid contact lenses or Rose K Lenses since these lenses provide a clear surface in front of the cornea allowing the light rays to be projected clearly to the retina.

Keratoconus is most often diagnosed by a cornea specialist who may see typical findings when examining the patient at the slit-lamp. In early forms of the disease there may be no obvious finding on slit-lamp evaluation and the diagnosis is made by corneal topography only.






TOPOGRAPHY IMAGE OF KERATOCONUS








Treatment Options for Keratoconus

COLLAGEN CROSSLINKING (CXL) – to stop the progression of Keratoconus.

CONTACT LENSES: Rose K lenses

INTACS: These are corneal ring segments, used to flat the cone up to 2-3D







PHAKIC INTRAOCULAR LENSES








Intraocular lenses used to correct myopic refractive error

CORNEAL TRANSPLANTS: done as last resort when other options are not of much use

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