Dulles Eye Associates

tel:  (703) 723-9633  |  fax:  703-723-9772

CORNEA ANATOMY AND DISEASE

 

Welcome to the portion of our website dedicated to the cornea.  Though smaller than an M&M this is a crucial part of our visual system and many entities that disturb the cornea may result in sub-optimal vision.  Our surgeon at Dulles Eye Associates Dr. Ahmed Nasrullah is fellowship trained in diagnosis and management of Corneal disease and surgery.  Our Surgeons are the premier corneal surgeons in Loudoun and Fairfax Counties performing thousands of corneal surgeries a year. A brief description of the cornea and cornea disease can be found below.

CORNEAL LAYERS

 

The corneal epithelium is the outermost layer of the cornea and is responsible for providing protection against injury and infection.  The surface of the epithelium is very smooth and provides support for the tear film, which is what is irregular in patients with DRY EYES.  A CORNEAL ABRASION is a minor but very painful eye injury.  When an abrasion occurs, the corneal epithelium is disrupted exposing underlying corneal nerves.  However, the epithelial layer can heal in only a few hours making it one of the fastest healing parts of the body.

The corneal stroma makes up about 90% of the thickness of the cornea and is the bulk of the corneal tissue.  It is clear and allows us a window to see out of the eye.

 

Descemet's membrane is the scaffold that holds the endothelium in place.  The endothelium contains the cells that pump fluid out of the cornea.  FUCHS’ DYSTROPHY is a disease characterized by an unhealthy endothelium and, because these cells do not regenerate, this leads to swelling of the cornea and loss of clarity.  DSAEK (Descemet's Stripping Automated Endothelial Keratoplasty), is an advanced technique involving replacing only the back layers of the cornea, instead of full-thickness corneal transplant surgery.

 

CORNEA DISEASE

• Keratoconus

• Fuchs' Dystrophy

• Herpes Zoster (Shingles)

• Dry Eye Syndrome

• Pterygium

 

Keratoconus

 

• Keratoconus is a corneal condition where the normal round shaped cornea develops a thinning area leading to a “bulged” or ectatic shape.  In simple terms, this means that the cornea, instead of being round like a soccer ball, the cornea becomes oblong like a football. This distortion usually begins in the late teens or early twenties and can progress over time.  As the keratoconus progresses, the cornea bulges and thins, becoming irregular and sometimes forming scars.

 

Signs and Symptoms

 

These can range from blurry vision to significant distortion.  Occasionally glasses can not correct the vision and a patient will need a rigid contact lens to obtain suitable vision.  It is not uncommon for each eye in one person to progress at different stages and one eye have a more severe distortion than the other.

 

How is Keratoconus Treated?

 

o Initially glasses or contact lenses may suffice to obtain good vision.

o INTACS® prescription inserts are used for keratoconic patients who are contact lens intolerant or patients who are unable to achieve suitable vision with glasses or contacts.  Placing INTACS® in the periphery of the cornea causes the center of the cornea to flatten to a more normal dome shape. The goal of INTACS® is to provide the patient with improved functional vision and better comfort with contact lenses or glasses. In many cases, INTACS® can delay or even eliminate the need for cornea transplant.

o Corneal Collagen Crosslinking (CXL) as an alternative treatment for patients with mild to moderate, progressive keratoconus.  This procedure is not FDA approved at this time.

o CORNEAL TRANSPLANT may become necessary if disease has progressed and optimal vision can not be obtained with other modalities.   A donated cornea is used to replace the diseased tissue and sutures are placed to allow healing.  The rehabilitation time can range from a few months to a year.  Though most of the cornea is involved in keratoconus in some circumstances, if the lower layers are intact, a DALK (DEEP ANTERIOR LAMELLAR KERATOPLASTY) can be performed by our surgeons at Dulles Eye Associates.  A DALK can leave the lower layer intact allowing for quicker healing and less rejection.  Only a few surgeons in the country are trained and able to perform this surgery due to the technical difficulty.

 

Fuchs’ Dystrophy

 

Fuchs' corneal dystrophy is an inherited disease of the endothelial layer of the cornea. It affects both eyes, causes corneal swelling and loss of vision, and may need to be treated with corneal transplant surgery.   Those with Fuchs’ Dystrophy are more likely to have complications from cataract surgery as well and cataract surgery may advance the progression of Fuchs’ Dystrophy.   Fortunately with the advancement of surgical techniques we can now replace only the diseased layer leaving the rest of the cornea intact, a procedure known as DSAEK (DESCMENTS STRIPPING AUTOMATED ENDOTHELIAL KERATOPLASTY).  This allows for quicker healing and less risk of rejection. The surgeons at Dulles Eye Associates are the only cornea and fellowship trained eye surgeons in Loudoun county and of a handful of surgeons in Fairfax county trained and performing this advanced surgery.  We are the referral center for many ophthalmologists in Northern Virginia, Maryland, District of Columbia, and West Virginia.  They have considerable experience in recognizing Fuchs' Dystrophy and managing this condition. Our physicians perform the newer DSEK procedure, versus a full-thickness transplant for most Fuchs' patients.

 

Herpes Zoster Ophthalmicus (Shingles)

 

Shingles can affect many parts of the body.  When this virus affects the upper face it may infect the eye and mainly the cornea.  If a person has viral lesions on one side of the face and scalp it is imperative to be evaluated by an ophthalmologist to ensure no active eye disease is occurring.  This is even important if there are no eye symptoms since the eye can loss sensation in light of this infection.  If the cornea is involved it is likely that your eye care professional will refer you to a cornea specialist like Dr. Ahmed Nasrullah to manage the corneal involvement since it does require advanced level of management.  If the virus causes severe scarring surgical intervention may be necessary.

 

Dry Eye

 

Dry eyes are one of the most common eye conditions that affect patients in the Northern Virginia region including Loudoun and Fairfax counties.

 

Signs and Symptoms

 

Most patients describe a sandy, gritty, foreign-body sensation, in one or both eyes, that often becomes more pronounced as the day progresses. Some patients may have severe "burning" sensation in the eye when exposed to wind or a particularly dry or irritating environments, such as dry heat, warm or smoke-filled rooms. Sensitivity to light may also be reported.  During your eye exam our doctors can examine the tear film and perform tests to determine what modality would best treat your symptoms

 

Pterygium and Pterygium Surgery

 

A pterygium is an abnormal growth of elastoid (sun exposed) cells that begin to encroach and scar the cornea.  Pterygium surgery involves removal of the abnormal tissue from the sclera and cornea of the eye. Today’s techniques in the hands of an experienced surgeon offer a significantly higher success rate than conventional surgery.  Our surgeons at Dulles Eye Associates perform NO-STICH PTERYGIUM SURGERY WITH AN AUTOGRAFT, the latest technology in pterygium surgery. Under light sedation and local anesthesia the abnormal corneal tissue is removed and replaced with a thin graft of normal tissue. Over the next 2-3 weeks, the eye gradually returns to a normal appearance.  No stiches means quicker healing and less discomfort.

 

 

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