CORNEA

Cornea is also a commune in Caraş-Severin County, Romania, see Cornea, Caraş-Severin.

Cornea

Schematic diagram of the human eye. (Cornea labeled at center top.)

Vertical section of human cornea from near the margin. (Waldeyer.) Magnified. 1. Epithelium. 2. Anterior elastic lamina. 3. substantia propria. 4. Posterior elastic lamina. 5. Endothelium of the anterior chamber. a. Oblique fibers in the anterior layer of the substantia propria. b. Lamellæ the fibers of which are cut across, producing a dotted appearance. c. Corneal corpuscles appearing fusiform in section. d. Lamellæ the fibers of which are cut longitudinally. e. Transition to the sclera, with more distinct fibrillation, and surmounted by a thicker epithelium. f. Small bloodvessels cut across near the margin of the cornea.
Gray's	subject #225 1006
Dorlands/Elsevier	c_55/12259559

The cornea is the transparent front part of the eye that covers the iris, pupil, and anterior chamber, providing most of an eye's optical power [1]. Together with the lens, the cornea refracts light and, as a result, helps the eye to focus. The cornea contributes more to the total refraction than the lens does, but, whereas the curvature of the lens can be adjusted to "tune" the focus, the curvature of the cornea is fixed.

The cornea has unmyelinated nerve endings sensitive to touch, temperature and chemicals; a touch of the cornea causes an involuntary reflex to close the eyelid. Because transparency is of prime importance the cornea does not have blood vessels; it receives nutrients via diffusion from the tear fluid at the outside and the aqueous humour at the inside and also from neurotrophins supplied by nerve fibres that innervate it. In humans, the cornea has a diameter of about 11.5 mm and a thickness of 0.5 mm - 0.6 mm in the center and 0.6 mm - 0.8 mm at the periphery. Transparency, avascularity, and immunologic privilege makes the cornea a very special tissue.

In humans, the refractive power of the cornea is approximately 43 dioptres, roughly three-fourths of the eye's total refractive power.

Medical terms related to the cornea often start with "kerat-".

1 Layers of the cornea
2 Diseases and disorders
3 Treatment and management of corneal diseases and disorders
- 3.1 Surgical procedures involving the cornea
- 3.2 Non-surgical procedures involving the cornea
4 References
5 See also

Layers of the cornea

The human cornea, like that of other primates, has five layers. The corneas of cats, dogs, and other carnivores have only four.^[1] From the anterior to posterior they are:

Corneal epithelium: a thin epithelial multicellular layer of fast-growing and easily-regenerated cells, kept moist with tears. Irregularity or edema of the corneal epithelium disrupts the smoothness of the air-tear film interface, the most significant component of the total refractive power of the eye, thereby reducing visual acuity.

Bowman's layer (also erroneously known as the anterior limiting membrane, when in fact it is not a membrane but a condensed layer of collagen): a tough layer that protects the corneal stroma, consisting of irregularly-arranged collagen fibers. This layer is absent in carnivores.^[1]

Corneal stroma (also substantia propria): a thick, transparent middle layer, consisting of regularly-arranged collagen fibers along with sparsely populated keratocytes (If the stroma is damaged, for example by injury or infection, it can lose its transparency, causing vision problems. The corneal stroma consists of approximately 200 layers of type I collagen fibrils.) There are 2 theories of how transparency in the Cornea comes about: 1) The lattice arrangements of the collagen fibrils in the Stroma. The light scatter by individual fibrils is cancelled by destructive interference from the scattered light from other individual fibrils.(Maurice) 2) The spacing of the neighbouring collagen fibrils in the stroma must be < 200 nm for there to be transparency. (Goldman and Benedek)

Descemet's membrane (also posterior limiting membrane): a thin acellular layer that serves as the modified basement membrane of the corneal endothelium

Corneal endothelium: a simple squamous or low cuboidal monolayer of mitochondria-rich cells responsible for regulating fluid and solute transport between the aqueous and corneal stromal compartments. (The term endothelium is a misnomer here. The corneal endothelium is bathed by aqueous humour, not by blood or lymph, and has a very different origin, function, and appearance from vascular endothelia.)

The cornea is composed mostly of dense connective tissue, similar to the surrounding sclera. However, the collagen fibers are arranged in a parallel pattern, allowing light waves to constructively interfere, allowing the light to pass through relatively uninhibited. The cornea is innervated by the long posterior ciliary nerves that branch from the trigeminal nerve's ophthalmic division.

Diseases and disorders

Main article: List of eye diseases and disorders

Treatment and management of corneal diseases and disorders

Surgical procedures involving the cornea

Various refractive eye surgery techniques change the shape of the cornea in order to reduce the need for corrective lenses or otherwise improve the refractive state of the eye. In many of the techniques used today, reshaping of the cornea is performed by photoablation using the excimer laser.

If the corneal stroma develops visually significant opacity, irregularity, or edema, a cornea of a deceased donor can be transplanted. Because there are no blood vessels in the cornea, there are also few problems with rejection of the new cornea.

There are also synthetic corneas (keratoprostheses) in development. Most are merely plastic inserts, but there are also composed of biocompatible synthetic materials that encourage tissue ingrowth into the synthetic cornea, thereby promoting biointegration.

Non-surgical procedures involving the cornea

Orthokeratology is a method using specialized hard or rigid gas-permeable contact lenses to transiently reshape the cornea in order to improve the refractive state of the eye or reduce the need for eyeglasses and contact lenses.

References

^ ^a ^b Merindano MD; Costa J; Canals M; Potau JM, and Ruano D. "A comparative study of Bowman's layer in some mammals: Relationships with other constituent corneal structures." European Journal of Anatomy. Volume 6, Number 3, December 2002.

Daxer A et al. Collagen fibrils in the human corneal stroma: structure and ageing. Invest Ophthalmol Vis Sci 1998;39:644-648.
Daxer A and Fratzl P. Collagen fibril orientation in the human corneal stroma and its implication in keratoconus. Invest Ophthalmol Vis Sci 1997;38:121-129.
Fratzl P and Daxer A. Structural transformation of collagen fibrils in corneal stroma during drying: An X-ray scattering study. Biophys J 1993;64:1210-1214.