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Cornea Diseases and Treatments
The cornea is the clear part of the front of the eye. The cornea is responsible for focusing light onto the retina to produce clear images. When a person has a corneal disease, it can cause discomfort, blurred vision, and potentially vision loss. Corneal diseases require treatment by a highly experienced ophthalmologist.
At San Francisco Eye Institute, we provide expert consultation on corneal diseases and collaborate with you to find the best solution. We can often approach a diagnosis first with conservative treatment, such as with medications, and are skilled to offer surgical intervention when necessary.
Fuchs’ Dystrophy
Fuchs’ dystrophy is a cornea disease characterized by corneal swelling caused by the endothelium layer of the cornea dying off. Endothelium cells distribute fluid over the cornea to keep it clear, and when these cells die it causes fluid accumulation, swelling, puffiness, and vision changes.1
Symptoms of Fuchs’ Dystrophy
Early stages of Fuchs’ dystrophy may not present with any symptoms. Some people may experience blurry or hazy vision in the morning, but it can improve throughout the day as the eye fluid dries.
In later stages, Fuchs’ dystrophy may present symptoms such as:
- A gritty or sandy feeling in the eyes
- Sensitivity to light
- Increased eye problems in humid weather
- Vision that is very blurry or hazy
Treatment for Fuchs’ Dystrophy
In early stages, Fuchs’ dystrophy is treated with medicated eye drops or ointment to help reduce swelling. Patients may also find relief by blowing warm air onto their faces with a hair dryer, drying the surface of the cornea.
When Fuchs’ dystrophy progresses to the point that vision is impaired and/or the cornea is scarred, a corneal transplant may be necessary (see below).
Pterygium
A pterygium is a raised, wedge-shaped growth that appears on the conjunctiva, the clear outer layer of the eye. Pterygia are benign, but can cause irritation, redness, and the sensation that a foreign body is in the eye. A pterygium may form as a result of prolonged wind or sun exposure, which is why this condition is sometimes referred to as “surfer’s eye.” Exposure to dust, inflammation, and excessive dryness may also cause pterygia.2
Symptoms of Pterygium
Symptoms of pterygium may include:
- Redness of the conjunctiva (the white part of the eye)
- Swelling of the conjunctiva
- A yellow bump or spot on the conjunctiva
- Eyes that feel dry, sandy, or burning
- The sensation that something is in the eye
- Blurred vision
Treatment for Pterygium:
In many cases, our ophthalmologists can treat a pterygium with lubricating or steroid eye drops. This will help alleviate any redness, swelling, and discomfort.
When a pterygium grows larger, it could begin to affect the vision. This requires removal by an experienced eye surgeon, sometimes followed by a thin tissue transplant to the area to help prevent regrowth.
Keratoconus
In a healthy eye, the cornea is dome-shaped and it focuses and bends (refracts) light rays onto the retina to form clear images. In an eye impacted by keratoconus, the cornea is cone-shaped. This distortion causes the cornea to thin out and become weaker, eventually impairing the ability of the cornea to properly focus light. Keratoconus causes blurry and distorted vision.3
At San Francisco Eye Institute, we use Pentacam as an advanced diagnostic and imaging tool. This helps us diagnose keratoconus cases in their early stages as well as accurately assess the progression of keratoconus.
Symptoms of Keratoconus
In its early stages, symptoms of keratoconus may be mild or barely noticeable. They may include:
- Vision that is mildly blurred
- Vision distortions, like straight lines appearing wavy
- Sensitivity to light
- Glare
- Redness
- Swelling
As keratoconus progresses, patients may experience:
- Increasingly distorted vision
- Inability to wear contact lenses
- Streaking or flaring
- Halos
- Ghost images
Keratoconus Treatment
When a patient has mild keratoconus, prescription eyeglasses can help improve vision. Hard contact lenses can also help improve focus.
When keratoconus is progressed, it may be treated with corneal cross-linking or a corneal transplant.
Corneal Cross-Linking (CXL)
At San Francisco Eye Institute, our ophthalmologists are highly experienced in performing corneal cross linking to stop the progression of keratoconus and corneal ectasia (weakening of the corneas after refractive surgery). Corneal cross-linking is a minimally invasive, outpatient treatment where prescription eye drops are used with UV light therapy to make the corneas stronger and thicker.
Corneal Transplant (Keratoplasty)
In cases where a corneal disease causes irreparable damage to the eye and impedes vision, a corneal transplant may be the optimal treatment. During a corneal transplant, or keratoplasty, all or part of the cornea is replaced with donor corneal tissue. There are different types of corneal transplants, distinguished by the layer or layers of cornea that are replaced during the procedure.4
Types Of Corneal Transplants
Penetrating Keratoplasty (PK)
Penetrating keratoplasty (PK) is sometimes referred to as a full thickness corneal transplant. In this procedure, the entire diseased cornea is removed and replaced with donated corneal tissue. This type of corneal transplant may be performed on patients with certain eye diseases or patients who have rejected a previous corneal transplant.
Descemet Stripping Automated Endothelial Keratoplasty (DSAEK)
This is the most common type of corneal transplant. Here, roughly one fifth of the cornea, including the inner layer called the endothelium and the middle layer called the stroma, is replaced. The damaged corneal tissue is removed through a small incision and replaced with donated tissue.
Descemet’s Membrane Endothelial Keratoplasty (DMEK)
In this type of corneal transplant, the Descemet’s membrane and endothelium are replaced. Since the donor tissue is thinner with this transplant, it may require a shorter recovery than other types of corneal transplant.
AvaGen™ Genetic Eye Testing
San Francisco Eye Institute is pleased to offer AvaGen, first genetic eye test that is targeted for early detection of keratoconus and corneal dystrophies. This innovative test is a valuable tool that will allow us to identify patients who can benefit from early treatment of keratoconus and other corneal conditions. AvaGen uses a simple mouth swab to give a definitive diagnosis. Since treatments like corneal cross-linking work to deliver the best results when used early, this early-intervention testing can help us prevent vision loss for patients who may have otherwise waited for a diagnosis and treatment. AvaGen may be recommended for patients with a family history of keratoconus or corneal dystrophy, as well as patients with steep corneal curvature and high astigmatism.
Contact San Francisco Eye Institute
If you suffer from a corneal disease, it is important that you seek treatment from an ophthalmologist who has extensive experience in diagnosing and treating these types of conditions. To learn more about your cornea disease treatment options, please contact us to schedule a consultation.
1 American Academy of Ophthalmology. What Is Fuchs’ Dystrophy? Available: https://www.aao.org/eye-health/diseases/what-is-fuchs-dystrophy. Accessed December 6, 2021.
2 American Academy of Ophthalmology, What Is a Pinguecula and a Pterygium (Surfer’s Eye)? Available: https://www.aao.org/eye-health/diseases/pinguecula-pterygium. Accessed December 2, 2021.
3 American Academy of Ophthalmologists. What is Keratoconus? Available: https://www.aao.org/eye-health/diseases/what-is-keratoconus. Accessed December 2, 2021.
4 American Academy of Ophthalmology. About Corneal Transplantation. Available: https://www.aao.org/eye-health/treatments/about-corneal-transplantation. Accessed December 6, 2021.
The doctors at San Francisco Eye Institute have either authored or reviewed and approved this content.
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