Is Your Cornea Damaged? What Causes It & When Surgery Might Be Necessary

The cornea is the transparent front “window” of your eye. This dome-shaped structure covers the iris, the pupil, and the anterior chamber. It is also necessary for clear vision.

This is because the cornea serves as a lens that focuses light onto the light-sensitive tissue at the back of your eye, the retina. Aside from that, it serves as a shield against things like dust and germs for the delicate structures of the eye.

However, like all shields, the cornea itself is exposed and therefore vulnerable to damage. It can be scratched or even infected. 

Cornea damage may be easy to set aside at first, but it can progress rapidly and may even lead to permanent scarring and vision loss. This is why people with a scratched cornea or some other issue are advised to seek medical attention as soon as possible.

In this article, we explain some of the chief causes and symptoms of corneal damage to help you differentiate between minor problems and ones that may require professional care.

Understanding Corneal Damage 

Corneal damage refers to any disruption to the smooth and transparent surface of the cornea, or to its underlying structural integrity. 

Sharp and focused vision requires this part of the eye to be clear and maintain a specific curvature or shape. Anything that damages it to change that can result in vision problems.

Corneal damage severity varies greatly, ranging from scratches that can quickly heal by themselves to deep wounds that may require surgery.

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Types of Corneal Problems

• Minor abrasions - Also called corneal scratches. These are superficial injuries to the outermost layer of the cornea, known as the epithelium. These can heal fairly quickly because the epithelium is capable of quick regeneration.
• Corneal infection - Also called keratitis. This is a serious condition where something infects the corneal tissue. A cornea infection can be bacterial, viral, fungal, or even parasitic. It is generally indicated by inflammation in the area and can destroy tissue, leading to scarring.
• Structural and degenerative damage - This is when a condition changes the cornea’s shape and structure in a way that harms its function. A good example is keratoconus, where the cornea progressively thins and bulges out into a cone shape.
• Corneal ulcers and scars - An ulcer is an open sore or deep infection on the cornea. It can come from a poorly managed scratch of a severe corneal infection. Permanent scarring to the cornea can impair vision by creating a cloudy patch in the otherwise-transparent cornea.

Common Causes of Corneal Problems

Most corneal issues can be categorised by their cause. Identifying the root cause is often the key to providing effective and prompt treatment to prevent permanent scarring or vision loss.

1. Physical trauma - Everyday activities leading to minor accidents, such as inadvertently poking the eye with a finger. Improper contact lens use is also common.
2. Corneal infections - These are ophthalmic emergencies that require immediate attention. They are often caused by microorganisms breaching the corneal barrier, whether through an existing injury or poor hygiene.
3. Underlying conditions - Some health and ocular conditions can affect the cornea, like corneal degenerative diseases, chronic dry eyes, autoimmune conditions, or even previous eye surgery (some of which may weaken the cornea).

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Signs and Symptoms to Watch For

Some corneal problems can progress rapidly from minor irritations to vision-threatening ones. This means recognising early symptoms is crucial and can help you seek professional help as soon as possible.

Here are some signs that you need medical help:

• Pain and discomfort - Superficial scratches often cause sharp and acute pain, whereas deeper ones may involve more intense and throbbing aches.
• Blurred or distorted vision - This can often come from swelling or infection preventing the smooth passage of light. Corneal scarring can cause it too.
• Redness - A common sign of inflammation, either from injury or an active infection.
• Photophobia - This is light sensitivity, or a heightened discomfort in bright environments.
• Tearing or watery eyes - This is a common protective reflex of the eye when it is trying to flush out irritating foreign bodies or particles.
• Discharge - A thick and yellow or greenish discharge may be a sign of a bacterial infection.
• White or grey spots - This is a sign of an ulcer or scarring in your cornea.
• Blepharospasm - This refers to involuntary, forceful eyelid closure. It can cause difficulty keeping the eye open and may be triggered by corneal irritation.
  
  

Treatments for Corneal Conditions

The appropriate treatment for corneal damage depends on the type of damage, its cause, and its severity. 

Minor Scratched Cornea Management

Most superficial damage to the outermost layer of the cornea will heal by itself in 24 to 72 hours. This is why management is chiefly about promoting comfort and preventing infection.

This may require the use of lubricating eye drops or antibiotic eye drops. A bandage contact lens may also be applied under ophthalmic supervision for comfort and to promote epithelial healing. 

Eye patching is generally not recommended for corneal abrasions, as it can slow healing and increase infection risk.

Patients should also avoid touching the affected eye, even with contact lenses.

‍Managing Corneal Infections

This is an emergent condition that merits immediate consultation with an eye specialist. Treatment will depend on the exact cause of the infection.

It often involves antibiotic eye drops for bacterial infections, antiviral medication for viral ones, or antifungal drops for fungal keratitis. Delaying treatment raises the risk of developing corneal ulcers or scars.

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Advanced Cornea Damage and Surgery

When vision is already severely impaired due to scarring or some other issue, surgical intervention may be necessary. This is generally considered only when other treatments have failed or have been found unsuitable.

Options include corneal transplants, lamellar keratoplasties, and corneal cross-linking. Learn more about these procedures on our corneal surgery services page.

When to Seek Medical Help 

In eye health, the difference between a mild problem and a sight-threatening one can be as small as a few hours of difference in the start of treatment. If you experience any of these, we recommend a professional evaluation as soon as possible:

• Persistent or worsening eye pain
• A sudden decline or blurring of vision clarity
• Redness of the eye with discharge 
• A visible white or grey spot on the cornea
• After eye trauma or chemical exposure

Early intervention is the most effective way to prevent escalation of more easily treatable injuries into serious ones.

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Why Early Detection Matters

The cornea has surprising regenerative ability for its outermost layer. However, this ability to heal itself is limited in its deeper layers.

Once significant scarring sets in those parts, the opacity can usually be corrected only by surgery. Delaying treatment for even a day may transform a condition from one that could have been resolved by eye drops into one that significantly impairs your vision.

An example is a minor corneal scratch. If treated incorrectly or allowed to develop into an infection, it can lead to a permanent scar on the cornea.

The risk is especially high for contact lens wearers due to the constant contact with the cornea and the possibility of hygiene lapses leading to infections. 

Seek Help for Your Corneal Problems

The cornea is a delicate but essential component of the visual system. Without it, clear sight is not possible.

This means that caring for the cornea is vital if one wishes to protect one’s vision. If you believe that you have one of the symptoms we noted above, seek an expert assessment before symptoms worsen. 

You can also seek an appointment with one of our eye doctors at ERS Suntec City. We can provide you with a thorough examination and treatment recommendations based on your diagnosis.