Introduction - corneal clouding

Corneal edema (corneal swelling) results from damage to the pump cells on the back of the cornea ( corneal endothelial cells ), which leads to the penetration of fluid into the cornea.
As a result, there is then a thickening and clouding of the cornea, associated with corresponding reduction in vision.
In the advanced stage of corneal edema, small blisters on the surface of the cornea may burst, resulting in pain, photosensitivity, and an increased risk of infection from bacterial corneal ulcers.

Recognition of corneal clouding

What are the symptoms of corneal opacity?

Especially when the corneal opacities lie in the center of the cornea, they can lead to veiled or blurred vision. This limits vision and sometimes the image is distorted.

How is a corneal opacity diagnosed?

By means of anamnesis (questioning the patient), an eye test and an enlarged view of the eye, an examination is made for the exact determination of the corneal disease.

Treating a corneal clouding

How is a corneal opacity treated?

Conservative therapy can not resolve corneal opacities and corneal scars in many cases, so long-term treatment will result in transplantation of a donor cornea.
Donor corneas are assigned by so-called corneal banks.

With longer-term planned cornea transplantations, this can cause long waiting times, but an emergency operation ( keratoplasty à chaud ) bypasses the waiting list in order to preserve the eye.
The donated organ preparations come from deceased people who have consented to the transplant during their lifetime.

The corneas are examined before the operation for diseases and pretreated for surgery.
Corneal transplantation ( perforating keratoplasty ) is performed in local anesthesia with eye drops or by injection behind or next to the eyeball ( retro or parabulbar anesthesia ) or under general anesthesia.
Under observation through the surgical microscope, the cornea of ​​the patient is first cut out before the correspondingly tailored donor cornea is then fastened with sutures.
The thread material is normally removed after one year.
After the operation anti-inflammatory and antibiotic drops or eye creams are used.

Can the laser help?

In most cases, when the disease is already very advanced, a corneal transplant is the only way to prevent the threat of blindness.

However, if the disease is diagnosed at an early stage and only superficial layers of the cornea are scarred, therapy with the laser may be useful.

  • In the so-called "phototherapeutic keratectomy (PTK)" the scarred layers are heated and removed by local application of laser. By removing the affected layers, the turbidity can be reduced.

You might also be interested in the following articles:

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Corneal opacities can in most cases be eliminated only by laser therapy or surgical treatment.

In rare cases, it may be useful to treat emerging symptoms using homeopathy. However, homeopathy should always represent only a complementary method for surgical therapy.

  • Medications such as eyebright (Euphrasia) can counteract irritation or inflammation.
  • For the prevention of corneal opacities, remedies such as Apis mellifica or Graphites can help. However, an application should always be discussed with the attending physician.

What are the causes of corneal opacity?

The most common causes of corneal clouding are swelling ( edema ) or scarring on / on the cornea.
Corneal scars are often seen as white opacities on the eye.
They can occur after deep corneal injuries, deep inflammation of the cornea (usually due to herpes viruses), after corneal ulcers, in advanced keratoconus or, in rare cases, as a hereditary metabolic disorder ( stromal corneal dystrophy ).

Corneal clouding after cataract surgery

A cataract (cataract) is a clouding of the eye lens, resulting in a reduction in visual acuity. The most effective treatment for cataract is surgery in which the lens is removed and replaced with an artificial lens.

As a rule, cataract surgery is associated with low risks, but rarely can it also lead to turbidity of the cornea. Injuries during the operation, inflammation or mechanical influences, the corneal layers can change scarred and cloudy. However, these go back in most cases independently.

Corneal clouding due to contact lenses

Contact lens wearers belong to the risk group for the occurrence of corneal opacities. The constant mechanical manipulation of the cornea by the contact lens can lead to scarred changes.

In addition, contact lens wearers are at an increased risk for corneal inflammation, especially in the absence of hygiene and infrequent lens changes. The inflammation may also favor the occurrence of corneal opacities. Therefore, contact lens wearers should be checked regularly by the ophthalmologist.

Course of corneal clouding

What is the expected course of corneal opacity?

Corneal opacities are usually detected by the patient very late, which is why they are often diagnosed at an advanced stage. In the case of the patient, they often first manifest themselves with reduced visual acuity and increased sensitivity to glare.
Severe corneal clouding may result in progressive turbidity and ultimately blindness without treatment.

  • In early stages, laser therapies can prevent progression and lead to healing.
  • In more advanced stages, cornea transplantation can help maintain vision over the long term. However, both the laser treatment and the surgical therapy carries its own risks and it can lead to renewed clouding.

In order to start early with the treatment, it is therefore advisable to visit the ophthalmologist early in case of vision problems. If corneal clouding is a side effect of surgery or injury, it usually heals on its own.

What is the prognosis for corneal clouding?

Usually, the donor cornea heals easily and retains its clear state.
Often, the vision after surgery is much better than before, or at least a threatening progressive deterioration can be prevented.
In about 10% of cases of corneal transplantation, however, there are incompatibility reactions, under which a strong clouding of the donor cornea may occur.

In such rejection reactions, another cornea transplant should be performed. To prevent such reactions, cortisone-containing drugs are given as eye drops after surgery.

What complications can occur with corneal opacity?

Nearby structures can be damaged by the procedure and allergic reactions can not be ruled out. Rarely, bleeding / rebleeding is possible.

Inflammations, healing disorders and excessive scarring occur in isolated cases.
Also, re-clouding has been observed, so reoperation has been necessary.
Rarely, retinal damage can also develop, and in the case of particularly severe complications, blindness or loss of the affected eye is possible.
Often there is a refractive error after a cornea transplantation.

Is corneal clouding curable?

In most cases, corneal opacity heals automatically. In a progressive haze, laser therapy can lead to healing in early stages. In more advanced stages, corneal transplantation can help to prevent blindness.

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