Corneal transplant causes / Cloudy, swollen, uneven cornea - A State of Sight #110

When the clear cornea covering the front of the eye is no longer functioning properly, a corneal transplant may be needed to restore vision. Watch this episode of A State of Sight with Isaac Porter, MD to learn about some of the primary reasons a corneal transplant may be needed.

Welcome to A State of Sight. I’m Isaac Porter and this is your update in ophthalmology and eye care from Raleigh. Today, I would like to explain three of the main reasons people may need a corneal transplant.
Remember that the cornea is the clear shield that covers the front of the eye. In order to see clearly, the cornea must be clear, thin, and have a nice smooth shape. When light is coming into the eye, this is the first part where the light hits the eye (along with the tear film), so it’s very important for good vision.
If the cornea becomes cloudy, a corneal transplant may be needed. This could happen if there is a scar or a serious infection that may leave whitening of the cornea. Then light can’t pass in very well. In severe cases of infection, we may do a corneal transplant in order to save the eye rather than restore vision. With an ulcer the cornea may become very thin or could even perforate.
If the cornea is swollen, patients may need a corneal transplant. In order to be clear, the cornea must be thin. If the cells on the back of the cornea (endothelium) don’t work like they should, swelling could result. It’s the responsibility of these cells to pump water out of the cornea back into the eye to keep the cornea thin and clear.
In Fuch’s dystrophy, the endothelial cells don’t work very well and the cornea can become swollen. In people who have had cataract surgery or multiple operations on their eye, these inner layers may die off and the cornea can become swollen. Along with the swelling, there could be blisters on the surface that can be painful. Both of these situations could also benefit from a corneal transplant.
If the cornea has an uneven shape, vision can be blurred. Particularly, we see this with keratoconus, where instead of the cornea being a nice, round, dome shape, it turns into more of a cone shape. This can cause an astigmatism or distortion of the vision. An irregularly shaped cornea can be also seen in patients who have had an injury or a scar on the eye. Even if the scar isn’t very cloudy or blocking vision, it may cause an uneven curve of the cornea with distortion and may require a transplant as well.  
There are other reasons, but these are probably the main ones. If you have any questions about corneal transplantation, please post and we will be happy to answer them. Hopefully, we will see you again soon, next time on A State of Sight.