Diseases of Cornea

Definition

• Corneal diseases refer to a group of conditions affecting the cornea, the clear dome-shaped surface at the front of the eye.

Types

• Keratoconus
  • Pathology: Thinning of the cornea leading to conical protrusion.
  • Clinical features:
    • Gradual loss of vision.
    • Distorted or irregular astigmatism.
    • Eye sensitivity.
    • Discomfort.
  • Investigations: Keratometry, Corneal topography.
  • Complications: Glaucoma, Cataract.
  • Management: Spectacles, Contact lenses, Keratoplasty.
• Fuchs' endothelial dystrophy
  • Pathology: Progressive degeneration of the endothelial layer.
  • Clinical features:
    • Bilateral, age-related corneal edema.
    • Decreased vision.
    • Visual disturbances.
  • Investigations: Slit-lamp biomicroscopy, Corneal endothelial cell count.
  • Complications: Cataract, Glaucoma.
  • Management: Spectacles, Contact lenses, Keratoplasty.
• Herpes simplex keratitis
  • Pathology: Viral infection of the cornea.
  • Clinical features:
    • Recurring episodes of corneal inflammation.
    • Ulceration.
    • Scarring.
  • Investigations: Slit-lamp biomicroscopy, Corneal scrapings.
  • Complications: Endothelial keratitis, Corneal perforation.
  • Management: Antiviral medication, Corticosteroids, Keratoplasty.

Causes

• Genetics.
• Viral infections (Herpes simplex).
• Trauma.
• Aging.
• Autoimmune disorders (Fuchs' endothelial dystrophy).

Clinical Features

• Vision loss.
• Eye sensitivity.
• Distorted vision.
• Corneal ulcers.
• Scarring.

Investigations

• Slit-lamp biomicroscopy.
• Corneal topography.
• Keratometry.
• Corneal endothelial cell count.
• Corneal scrapings.

Complications

• Glaucoma.
• Cataract.
• Endothelial keratitis.
• Corneal perforation.

Management

• Spectacles.
• Contact lenses.
• Keratoplasty.
• Antiviral medication.
• Corticosteroids.

Treatment

• Herpes simplex keratitis: Antiviral medication (Acyclovir, Valacyclovir), Corticosteroids.
• Fuchs' endothelial dystrophy: Spectacles, Contact lenses, Keratoplasty.
• Keratoconus: Spectacles, Contact lenses, Keratoplasty.

Homoeopathic Therapeutic Medicines

• Keratoconus: Arsenic album 6, Rhus toxicodendron 6.
• Herpes simplex keratitis: Arsenic album 6, Cantharis 6.
• Fuchs' endothelial dystrophy: Calcarea carbonica 6, Pulsatilla 6.

Corneal Anatomy and Refractive Role

1. The cornea is the transparent, dome-shaped surface at the front of the eye.
2. It is composed of five layers: epithelium, Bowman's layer, stroma, Descemet's membrane, and endothelium.
3. The cornea refracts light, allowing it to enter the eye and focus on the retina.
4. It accounts for approximately 2/3 of the eye's total optical power.

Etiology and Clinical Features of Keratitis

1. Keratitis is an inflammation of the cornea.
2. Types of keratitis:
   • Viral Keratitis: caused by herpes simplex virus, usually presenting with dendritic ulcers.
   • Bacterial Keratitis: caused by bacterial infection, often presenting with pain, blurred vision, and a corneal ulcer.
   • Fungal Keratitis: caused by fungal infection, typically presenting with chronic keratitis and a corneal ulcer.
   • Acanthamoeba Keratitis: caused by Acanthamoeba parasite, often presenting with chronic keratitis and a corneal ulcer.
3. Clinical features:
   • Redness and swelling of the eye
   • Blurred vision
   • Pain or sensitivity to light
   • Discharge or crusting on the eyelids
   • Corneal ulcers or lesions

Corneal Ulcer and Corneal Abrasion

1. Corneal Ulcer: a break in the corneal surface, often caused by bacterial or fungal infection.
2. Corneal Abrasion: a superficial injury to the cornea, usually caused by a foreign object or trauma.
3. Clinical Features:
   • Severe pain
   • Blurred vision
   • Redness and swelling of the eye
   • Discharge or crusting on the eyelids
   • Corneal ulcers or lesions

Management of Keratitis, Corneal Ulcer, and Abrasion

1. Medical Treatment: antibiotics, antivirals, antifungals, or anti-inflammatory medications may be prescribed.
2. Surgical Treatment: corneal transplant or patching may be necessary in severe cases.
3. Home Care: apply topical antibiotics or antivirals, use artificial tears, and avoid rubbing the eyes.

Homoeopathic Management of Corneal Diseases

1. Conium Maculatum: for corneal ulcers and inflammation.
2. Hydrastis Canadensis: for eye infections and inflammation.
3. Calendula Officinalis: for corneal ulcers and abrasions.
4. Aconitum Napellus: for sudden onset of eye pain and inflammation.
5. Belladonna: for severe eye pain and inflammation.

Note: Homoeopathic medicines should be used under the guidance of a qualified homoeopathic practitioner.