What is Corneal Ulcer and Keratitis?
Corneal surface and its structure is very delicate. Any injury or infection or cornea can lead to damage leading to loss of corneal tissue. The break in the continuity of cornea is called as corneal ulcer. Inflammation of corneal (keratitis) is the response of corneal tissues to any harmful stimuli such as infection/allergy/injury/ulcer. Inflammation is a protective attempt by the damaged cornea.

Corneal ulcer and keratitis occur together in many cases. Common symptoms produced are:

• Pain
• Reduced Vision
• Inability to open eyes in bright light
• Redness
• Watering
• Swelling of the eyelid

My doctor has advised corneal scrapping, what is it?

In cases of infections of cornea, small amounts of superficial corneal tissue is removed (Scrapping) and evaluated for presence of type of infection and the organism causing it. This helps in starting the medication specific to the type of infection which promotes early recovery.

What is Corneal Abrasion / Tear?

Any injury (blunt/sharp object) causing damage to the superficial layers of the cornea leads to corneal abrasion. It is similar to any scratches over the skin of hand due to injury. The patient will have burning of eyes, redness, sensitivity to light, blurred vision and watering. The healing of corneal abrasion generally takes place with 24-48 hours with commencement of appropriate medications.

Corneal tear is caused by a sharp object like wire/blade/iron rod which causes cutting of deeper layers of cornea (like a knife cuts the butter). When the injury is full thickness it can lead to severe damage to the intra-ocular parts of the eye (iris/lens/etc). Any full thickness corneal tear can lead to permanent vision loss.

Is Corneal Ulcer / Keratitis / Tear dangerous?

YES. Any case of corneal ulcer / keratitis / tear needs URGENT treatment. If left untreated or if treatment is delayed, these may lead to permanent damage to cornea and loss of vision.

Why do I need many medications and longer duration of treatment?

Corneal Diseases require multi-modality of medications which help in reducing the symptoms and curing the disease. Also these diseases take a very long duration of treatment and frequent follow-ups. The most important factor for early healing and recovery is patient’s compliance to use medications religiously as per the instructions.

My Corneal Ulcer/Keratitis/Tear is healed, but still my vision is less?

As the cornea is a very sensitive tissue, slightest harm can lead to severe reaction leading to loss of transparency of cornea. Thus most cases will have some residual visual loss. Early and mild cases may improve with medications. Long standing and severe cases heal by scarring and may require corneal transplantation.

What is a pterygium?

Pterygium is a pale yellow/pink/red growth of the conjunctiva (layer covering the white of the eye) on to the cornea. It can occur in one or both eyes. When small it doesn’t cause any symptoms. When it is large/thick, I may cause irritation, burning, redness, dryness, watering and decreased vision.

Why does pterygium occur?

There are no known causes of pterygium but generally people who are exposed excessive sunlight (UV light), wind, sand, dust, smoke have more chances to develop pterygium

Can it be treated with eye drops / tablets?

NO. Pterygium is a degenerative disease and it doesnot regress with medications. The only treatment is surgical removal.

What is the treatment of pterygium?

At present, the most commonly performed surgical procedure is Pterygium Excision with Autoconjunctival Grafting. With this procedure, there are 90% chances of complete cure.

Can pterygium reoccur?

YES. Patients who are predisposed to pterygium, who work long hours in sunlight can have recurrence of pterygium. The recurrence rate with the best surgical treatment is 10%. But if adequate precautions are taken, recurrence rates can be reduced.

How to prevent formation of pterygium?

Using protective sunglasses while going in sunlight is the most important factor which can prevent pterygium formation.

Treatment Options of Corneal Diseases

• Medical Management: All cases of corneal ulcers and keratitis (mild to moderate) are first treatment with medications. Medications are meant to reduce the infection load, the inflammation, to improve symptoms and to initiate the corneal healing process. Very aggressive and intensive medical therapy is essential. The patient’s relative has to proper understand the frequency of medications and instill the drops as per the instructions.
  Careful scrapping and identification of infectious agent (bacteria/fungi) is done and infection targeted therapy is started. The medications are given for a long duration for complete removal of infection/inflammation. Most cases respond to medical management dramatically. At Dr Agarwal’s Eye Hospital, we strive to provide the best quality medications to our patients. Antibiotics are freshly prepared so that they have maximum potency.
• Surgical Options: Advanced and non-healing cases of corneal ulcer/keratitis generally require surgical line of management along with the medications. Also corneal tears do require closure of the tear with sutures.

Corneal Surgeries performed at Dr Agarwal’s Eye Hospital

• Corneal Tear Repair: In case of a corneal tear, adequate and proper corneal suturing is done. The sutures help to maintain the shape and integrity of the eye. These sutures are generally removed after 2-3 months. Visual recovery depends on the extent of the injury and the healing process.
• Corneal Transplantation: When the loss of corneal transparency is the cause of visual loss, corneal transplantation is the method of choice of treatment.
  • Full Thickness (Penetrating Keratoplasty): When whole thickness of cornea is affected with or damaged due to the corneal disease, a full thickness corneal transplantation is done. The damaged cornea of the patient is completely removed and a healthy cornea from a donor eye is transplanted.
    
    
    
  • Deep Anterior Lamellar Keratoplasty: This is performed in those cases in which the anterior/outer cornea is damaged but the inner cornea is healthy. Preserving the inner cornea increases the chances of visual recovery.
  • Descemet Stripping / Descemet Membrane Endothelial Keratoplasty: Cases in which inner corneal layer is damaged are treatment with DSEK/DMEK. The anterior healthy cornea is preserved.
  • Intalase Enabled Keratoplasty: This is a New Technological Advancement for Full Thickness Corneal Transplantation. Instead of cutting the cornea with scissors, the cornea is cut with Femtosecond Laser, which gives accurate and precise cuts, proper positioning of the donor cornea and excellent post-operative results.
    
    Photograph from OSNSuperSite article on IEK by Dr. Agarwal & Dr. Jacob
    
    
• Limbal Stem Cell Transplanation: Patients who have poor ocular surface healing(specially cornea) and cases with recurrent pterygium are benefited with Limbal Stem Cell Transplantation.
• Amniotic Membrane Grafting: Patients who have extensive ocular surface damage (cornea and conjunctiva) are now being treated with Amniotic Membrane Transplantation which tends to restore the near normal ocular surface anatomy and physiology.
• Keratoprosthesis: Patients who are blind due to irreversible and extensive damage to ocular surface specially cornea and in whom corneal transplantation will not be successful / cannot be done, are implantation with a Keratoprosthesis. It is a bio-synthetic implant which restores the vision up to a certain extent.