The cornea is the eye’s outermost layer. It is the clear, dome-shaped surface that covers the front of the eye. The cornea helps focus light as it passes through the eye. An unhealthy cornea can distort and cloud vision. Permanent damage to the cornea may require a corneal transplant.

What is a corneal transplant? Is it safe? A corneal transplant involves replacing a diseased or scarred cornea with a new one. When the cornea becomes cloudy, light cannot enter the eye to reach the light-sensitive retina. Poor vision or blindness may result.

The first step in a corneal transplant is to find a donor cornea. Currently there is no wait for a donor cornea in the state of Washington through the Northwest Lions Eye Bank. The donated cornea is thoroughly tested for infectious disease, and for its suitability for transplantation.

In corneal transplant surgery, the surgeon removes the central portion of the cloudy cornea and replaces it with a clear cornea. A trephine, an instrument like a cookie cutter, is used to remove the cloudy cornea. The surgeon places the new cornea in the opening and sews it with a very fine suture. The suture stays in for months or even years until the eye heals properly (removing the suture is quite simple and can easily be done in our office). Following surgery, eye drops to help promote healing will be needed for several months. Most patients return home the same day of surgery. A friend or family member will need to drive you home after the procedure.

Corneal transplants are very common in the United States; about 40,000 are performed each year. The chances of success have risen dramatically because of technological advances, such as less irritating sutures or threads, which are often finer than a human hair; and the surgical microscope. Corneal transplantation has restored sight to many who, a generation ago, would have been blinded permanently by corneal injury, infection, or inherited corneal disease or degeneration.

What problems can develop from a cornea transplant?
Even with a fairly high success rate, problems can develop, such as rejection of the new cornea, corneal swelling, and infection. Warning signs of a problem are decreased vision, increased redness of the eye, increased pain, and increased sensitivity to light. If any of these last for more than six hours, you should immediately call your ophthalmologist. Most complications can be successfully treated if medication is administered at the early sign of symptoms.

Are there alternatives to a corneal transplant?
Phototherapeutic keratectomy (PTK) is one of the latest advances in eye care for the treatment of corneal dystrophies, corneal scars, and certain corneal infections. Only a short time ago, people with these disorders would most likely have needed a corneal transplant. By combining the precision of the excimer laser with the control of a computer, doctors can vaporize microscopically thin layers of diseased corneal tissue and etch away the surface irregularities associated with many corneal dystrophies and scars. Surrounding areas suffer relatively little trauma. New tissue can then grow over the now-smooth surface. Recovery from the procedure takes a matter of days, rather than months as with a transplant. The return of vision can occur rapidly, especially if the cause of the problem is confined to the top layer of the cornea. Studies have shown close to an 85 percent success rate in corneal repair using PTK for well-selected patients.

EXTERNAL DISEASE

Conjunctivitis
Conjunctivitis is the term used to describe inflammation of the conjunctiva. Many refer to it as “pink” eye. A thin, membrane called the conjunctiva covers the white part of the eye. The conjunctiva has fine blood vessels, but when it becomes irritated or inflamed, the blood vessels enlarge and become more prominent and the eye turns red.

There are many different sources of eye irritation that can cause conjunctivitis.
The most common are:

• infections
• allergies
• environmental irritants

Infectious conjunctivitis can be caused by a bacteria or virus. Bacterial infections, such as staphylococcus or streptococcus, cause a red eye that is associated with considerable amounts of discharge. Some bacterial infections are more chronic and may produce little or no discharge, except for mild crusting of the eyelashes in the morning.

Viruses are also common causes of conjunctivitis. Some viruses produce the familiar red eyes, sore throat, and runny nose of a common cold. Others may infect only one eye. Viral conjunctivitis usually produces a watery discharge and lasts from one to two weeks.

Infectious conjunctivitis, whether bacterial or viral, can be very contagious. Frequent hand washing is recommended to help to prevent spread of the infection.

Some allergies, like hay fever, may produce a chronic redness and itching. Any type of conjunctivitis is aggravated by dryness of the eyes or environmental irritants, such as smoke.

Other Causes of Red Eyes
A red eye can occur with other eye diseases that can lead to blindness unless recognized and treated. An evaluation by an eye physician is important to avoid confusing them with conjunctivitis. This is especially important if pain, blurred vision, or severe light sensitivity is present, since these symptoms are not typically found in simple conjunctivitis.

Contact us if symptoms worsen or persist.

Pterygium
A pterygium is a triangular-shaped tissue growth on the cornea. Some pterygia grow slowly throughout a person's life, while others stop growing after a certain point. A pterygium rarely grows so large that it begins to cover the pupil of the eye.

A pterygium usually has no symptoms, and many do not require treatment. However, some pterygia become red and inflamed from time to time. A large or thick pterygium may be more irritating than painful. Occasionally, a large pterygium will begin to change the shape of the cornea and cause vision changes (astigmatism).

Although it is uncertain what causes pterygia, many doctors believe ultraviolet (UV) light from the sun may be a factor. Wearing protective eyeglasses, sunglasses, and/or hats with brims is suggested in sunny climates.

If a pterygium becomes red and swollen or chronically irritated, it can be surgically removed. Lubricants can also help reduce the redness and provide relief from the irritation.

Blepharitis
Blepharitis is a chronic inflammation of the eyelids and is one of the most common disorders of the eye. Oils and other secretions build up on the eyelid surface and eyelashes, resulting in red, flaking or crusting of the eyelids. Other symptoms can include a sandy, gritty sensation, with burning, itching and/or redness. Although blepharitis is a chronic problem, applying warm compresses and lid scrubs can help control it. In some cases, it may be necessary to prescribe an antibiotic ointment.

• Warm compresses – soak a clean washcloth in very warm water, squeeze out the excess water, and then press it against your closed eyelids for approximately five minutes. You may need to rewarm the cloth several times. This will help to soften and loosen the debris on the eyelids.


• Lid scrubs – following the warm compresses, pull your eyelid away from your eye and gently clean the eyelid margin (at the base of your lashes) with the edge of the washcloth using a side-to-side motion. You may use solution with a small amount of baby shampoo mixed with an equal amount of water to cleanse your eyelids or a pre-packaged eyelid scrub solution.

The above treatment should be repeated two to four times daily for the first two or three weeks. As your symptoms improve, you can decrease the frequency as necessary to maintain your comfort level. Remember this is a chronic condition and stopping treatment altogether may result in a recurrence of symptoms.