Corneal Opacities – Causes, Symptoms, Preventive, Treatment

By Dr Raghuram Y.S. MD (Ay) & Dr Manasa, B.A.M.S
Cornea is transparent front part of the eye. It covers the parts of the second layer of the eye i.e. iris, pupil and anterior chamber. Cornea alone is responsible for approximately 2/3 of the eye’s total optic power.

It is composed of five different layers. The cornea protects the eye from many foreign substances, dust, germs and ultraviolet rays.
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Accommodation means refocusing the light to have a better view of near objects. This is accomplished by changing the geometry of the lens and happens with synchronization between cornea and lens. Among the disorders which cause loss of vision, corneal opacities are the main.

Corneal opacity stops the light from passing through the cornea to the retina. This also makes the cornea to appear white or clouded.
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Corneal Opacities

Corneal opacities are the eye problems which lead to scarring or clouding of the cornea. This causes decrease in vision.

Light passes through the transparent cornea before reaching the retina situated in the back of the eye. Therefore it is important that the cornea remains clear so that the light can pass through it conveniently.

Corneal opacities can cause irritation of the eye, vision problems and even blindness. Corneal problems are mentioned as the fourth leading cause of blindness following glaucoma, cataract and macular degeneration (age related).
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Prevention of Corneal Opacity

Wearing protective eye-wear – While doing activities which can possibly injure the eyes and damage them, example chopping wood, handling chemicals and power toots etc, one need to take caution and wear goggles or safety glasses so as to protect his eyes. Similarly, while spending time outdoors, one should wear sunglasses.
Correct use of contact lenses – One should properly use the contact lenses in terms of storing, disinfecting, discarding and replacing them.
Regular eye exams – One should have regular examination of the eyes done by an expert eye doctor, especially if he is prone to eye disorders. Many conditions are diagnosed earlier, even before the disease has surfaced.
Be informed about your family history of eye disorders – Corneal dystrophies are hereditary and can cause corneal opacity. You may be at risk of getting dystrophies if one of your family members has an eye disease.
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Causes of corneal opacity

• Injury to the eye / cornea
• Corneal abrasion or scratch
• Infection
• Certain eye diseases
• Swelling of the eye
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Corneal Injuries
When a foreign object gets into the eye corneal injuries occur. They also occur when something strikes the eye. Consequentially cuts or scratches are formed on the cornea. The common causes for corneal injury are –

• Irritation by contact of chemicals
• Objects like sand, dust etc falling into the eye
• Something like a branch of a tree striking the eye
• Radiation injury to the eye caused due to exposure to sun, sun lamps, welding or sun reflected on snow (snow blindness)
• Complications caused due to wearing contact lens
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Small abrasions of cornea heal quickly. Serious wounds may take longer to heal and may also cause pain, redness, irritation and tearing. Deep scars of cornea will cause visual problems.

Treatment

• Patching of the eye
• Using temporary contact lens
• Use of eye drops or ointments

If the problems related to vision persist or if the cornea is permanently damaged, one may need a cornea transplant.
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Corneal Infection
Corneal infection leading to the inflammation of cornea is called keratitis. This is also a cause for corneal opacities.

Many conditions can cause an infection of the cornea. They are as mentioned below –
Conjunctivitis – may be caused by bacteria, virus or any other allergies. This causes minor eye irritation. If it is not treated properly or when conjunctivitis becomes severe / chronic, it may lead to corneal infection. Herpes Zoster – This is caused by the virus which also causes chickenpox. Shingles develop on face, head and neck. It will also affect the cornea. Ocular Herpes – Eye herpes is caused by herpes simplex virus. This condition develops on the eyelid or surface of the eye. It can, in due course of time lead to inflammation of cornea. This is the most common eye infection that is responsible for blindness.
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Treatment of corneal infections include –

• Antibiotic, antibacterial, antifungal or steroid eye drops
• Topical / oral antiviral medications
• Laser surgery (Phototherapeutic keratectomy)
• Corneal transplant
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Corneal dystrophy

These are rare conditions causing corneal changes. They are often inherited. Presence of one among many corneal dystrophies in any one of the family members is a risk factor for the other person to be afflicted by the same. They usually affect both eyes and may lead to loss of vision and blindness. Sometimes they are asymptomatic.
The common types of corneal dystrophies which may contribute to corneal opacities –
Fuch’s dystrophy – This type of dystrophy damages the corneal endothelial cells. This leads to swelling of cornea with formation of blisters, blurring of vision, pain and problems related to vision.
Treatment early on, drops, ointments and special contact lenses may ease symptoms. In later stages, corneal transplant helps in successfully restoring the vision.
Map-dot fingerprint dystrophy – This dystrophy causes small gaps between the outer layer and the rest of the cornea. These are called corneal erosions.
Treatment may include eye drops and ointment, patching the eye and removing the eroded parts of the cornea.
Keratoconus – This is a progressive thinning of cornea. The cornea becomes thin and bulges outward in a cone shape, like a hernia. It causes moderate to severe blurred vision, multiple images, glare and halos at night. It also leads to nearsightedness and astigmatism. Swelling and scarring of cornea too occurs.
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Management of keratoconus  

In mild cases of keratoconus – eyeglasses / special contact lenses are helpful.

In early to moderate cases – glasses and contact lenses, corneal cross-linking are helpful. Procedures like Intacs and a minimum invasive procedure called corneal collagen cross-linking involving treatment with vitamin B2 and UV light helps stabilising the disease. After all non-surgical measures have been tried and no success found, corneal transplant is the option.
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Other causes for corneal opacity

• Irido-corneal endothelial syndrome – affects both iris and cornea, also causes glaucoma.
• Pterygium – is a red vascular growth of tissue on the cornea.
• Stevens – Johnson syndrome – is a skin disorder which may also affect the eyes.
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Symptoms

Certain diseases of the corneal diseases tend to cause opacities and also change the corneal shape.The symptoms depend on cause.

• Redness of the eye
• Swelling of the eye tissues and eyelids
• Tearing of eyes
• Discharges from the eye
• Irritation of the eye
• Blurred vision
• Sensitivity to light
• Sensation of foreign body in the eye
• Cloudy / milky area on the cornea
• Loss of vision
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Risk Factors

• Eye injury
• Foreign body striking the eye
• Vitamin A deficiency
• Measles leading to scarring the eye
• Infection from Herpes simplex virus
• Conjunctivitis and other eye infections
• Use of contact lenses for long time, especially overnight which increases the risk of eye infections and chance of developing corneal opacity
• Keratoconus
• Stevens – Johnson Syndrome
• Congenital corneal abnormalities
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Diagnosis

Corneal opacity is diagnosed by an expert eye doctor (ophthalmologist) after conducting a thorough physical and eye examination.

Corneal opacity may be diagnosed in the presence of the below mentioned symptoms –

• Decrease or loss of vision
• Pain in the eye
• Feeling of foreign substance in the eye
• Presence of redness of the eye
• Excessive tear discharge
• Sensitivity to light
• Cloudy or milky area on the eye (cornea)
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To diagnose opacity, the doctor may instill drops in your eyes to make them numb and dilate the pupils. With the help of a specialized microscope the doctor will focus a light beam of high power into your eyes and examine the cornea and other structures in your eye.

Treatment principles

Corneal opacity is caused due to varying etiologies. The treatment of corneal opacity too varies depending on the cause and severity of the scarring. Below mentioned are the treatment options for corneal opacity.

• Instillation of eye drops containing antibiotics, steroids or both
• Oral medications
• Phototherapeutic keratectomy (PTK), laser surgery
• Corneal transplant

The other treatment options have been discussed alongside the causative factors of corneal opacity.
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Corneal Opacity – Ayurveda

A condition called as ‘Avrana Shukra / Avrana Shukla’ explained in Ayurveda treatises in the context of Krishnagata Rogas i.e. diseases of the cornea, has been compared to corneal opacities. It is said to be caused by vitiated blood and is curable in nature. According to Ayurveda, among 4 disorders occurring in cornea, only this condition is curable.
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In this condition it is said that whiteness occurs in the black of the eye as an effect of conjunctivitis. Even in corneal opacity explained in modern medicine we can find ‘cloudy or white appearance of cornea’ being mentioned as a symptom and also as a risk factor. Similarly, conjunctivitis is also mentioned as a causative factor.

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