ANATOMY AND
PHYSIOLOGY OF CORNEA
Dr. Joseph John
CORNEA
Transparent anterior part of the eyeball
Smooth convex outer surface &
concave inner surface
Sclera overlaps cornea all around
periphery
Junction b/n two is limbus or sulcus
sclerae
Dimensions of cornea
surface shape
Horizont Vertical
al
diamete
diamete r
r
Radius
of
curvatur
e
ANTERIOR
elliptical
11-12mm
9-11mm
7.5-8.8mm
POSTERIOR
rounded
11.5mm
11.5mm
6.5-6.8mm
Thickness of cornea varies
from.52mm in centre to .65-1.1mm in
periphery.
Index of refraction
Corneal
index of refraction is 1.376
Tear film index of refraction is 1.336
Average ant.central region refractive
power of +48.8D
Aqueous humour ref.index is also
1.336 resulting in corneal
post.surface of -5.8D
So resultant average power is +48.8[5.8] ie+43D which is 70% of total
ocular refractive power.
Weight
of a fresh cornea-180mg
Elasticity:
stretch by 0.25% in normal IOP
Strength:
approximately 5kg/sq.cm before
rupture
anterior
surface is steepest centrally and
flatter &asymmetric peripherally[flatter
more in nasal & above]
central
3-4 mm is nearly spherical,which is
the optical zone
Layers
15 microns thick
6th layer
Duas
layer
Harminder S. Dua, MD, PhD, from
the University of Nottingham in
the United Kingdom, and
colleagues discovered the layer
by examining the separation that
often occurs along the last row of
keratocytes during the big bubble
(BB) technique.
Epithelium
outermost layer ;continuous with conjunctival
epithelium
stratified, non-keratinized squamous
approximately 50-90 m thick [10% of
total],constant over entire corneal surface.
extensive intercellular complexes (desmosomes
and tight junctions)
Rapid renewal;turn over takes 5-7 days
cellular components like langerhans cells seen
near limbus,not in centre
functions
1) to form a barrier between the
environment & stroma of the
corne[fluid loss,pathogen,abrasive
pressure]
2)light refraction & transmittance
[smooth ,wet apical surface
along with tear film & its
transparency-scarcity of cell
organelles & enzyme crystallins]
3)survival over an avascular bed
Sub-layers of the Epithelium
superficial
flattened cells
polygonal or wing cells
basal columnar cells
basement membrane
Basal lamina consists of collagen & glycoprotein
constituents integrated structurally with
underlying bowmans layer
To which it is firmly attached by an array of short
anchoring filaments
BOWMANS LAYER
Anterior limiting membrane
Lies deep to corneal epithelium
Non cellular , amorphous layer with randomly
arranged fine fibrils
Ends ubruptly in the periphery which delineates
anterior junction b/n cornea & limbus marked
clinicaly by summits of marginal arcades of limbal
capillaries
Gets seperated from corneal epithelium after
death
Resistant to injury & infection
Once destroyed ,will not regenerate,gets replaced
by scar tissue
STROMA- SUBSTANTIA PROPRIA
Contributes to bulk of cornea - 500 micrometer thick
Around 200-250 regularly arranged lamellae of collagen
bundles
Lie in proteoglycan ground substance with small population
of keratocytes
Lamellae are in layers which are parallel to each other &
with corneal surface & run from limbus to limbus
ULTRA STRUCTURE - STROMA
Each stromal lamella comprise of a band of collagen fibrils
arranged parallel to each other
Unique uniformity of fibril diameter & regular seperation
,both within & b/n lamellae
Orderly arrangement of collagen fibrils is responsible for
transparency of corneal stroma
Keratocytes which are few in number occupy 2.5 -5% of
stromal volume are responsible for synthesis of stromal
collagen & proteoglycan. Long thin flattened cells appear as
stellate cells when viewed from corneal surface. Seen
within lamellae as well as b/n lamellae
DESCEMETS MEMBRANE
Posterior
limiting layer
Basal lamina of corneal endothelium
Strong resistant sheet , sharply defined
Plane of seperation from stroma is used in
lamellar keratoplasty
Thickens with age
Major protein is type 4 collagen
Descemets membrane can be reformed
after degeneration
ULTRASTRUCTURE-DESCEMETS
Anterior fibrillar layer & posterior granular layer
Increase in size with age is due to growth of
granular layer
Fibrils also contribute to trabecular meshwork at
the iridocorneal angle
Corneal Endothelium
Single
layer of flat polygonal mostly
hexagonal cells in a mosaic pattern
In adults,it has hardly any ability to
divide.
Total 5,00000 cells,cell density
decreases with age
2500 to 3000 endothelial cells/sq
mm
does not regenerate
It
shows
polymegathism[hetyerogeneity in cell
size]&polymorphism[heterogeneity in
cell shape with age& .as a result of
trauma,infection
Cells are closely interdigitated with
jn.complexes[zonulae
occludens&macula adherens]
Cell
are attached to descemets memb.
by hemidesmosomes.
Endothelial Barrier
basis
of barrier function is the
existence of tight junctions and
gap junctions between
endothelial cells
prevents influx of aqueous to the
stroma
leaky barrier allows glucose,
amino acids, etc. to enter the
stroma but not bulky fluid .
Endothelial pump
most
important function of endothelium is
regulate water content of corneal stroma.
Endothelial cells have ion transports which
counteract the imbibition of water into
stroma
Active Enzyme systems:
Na+ - K + ATPase
Carbonic Anhydrase
Na+ - H+ pump
Bicarbonate dependent ATPase
Mechanism:
Na+
- K + ATPase and Na+ - H+ pump
actively secretes Na+ into aqueous
CO2 and H2O generate HCO3 - by means
of CAse and is secreted into aqueous
This creates an osmotic gradient (2 3
mOsm), coupled with the ions water
moves from corneal endothelial cells to
aqueous humor.
This balances swelling pressure of
corneal stroma
Blood supply
Avascular
Small
loops from ant.ciliary
arteries enterits periphery for
about 1mm
Invaded
by new vessels in
infections& inflammations
Corneal Nutrition
oxygen
requirement for metabolic activities
comes from atmospheric oxygen dissolved
in the tear film
Closed
eyelids: oxygen enters the tear film
from the superficial conjunctival capillaries
carbon
dioxide and other metabolic end
products are similarly removed across the
tear film, the corneal endothelium, or
through the limbal capillaries
Glucose
(aqueous) - main source of energy
Corneal Sources of
Oxygen
atmospheric
oxygen dissolved in
the tear film
aqueous humor and limbal
circulation
minimal oxygen requirement to
maintain clarity: 7-15 mmHg
oxygen when eyes are open: 155
mmHg
oxygen when eyes are closed: 55
mmHg
Corneal Innervation
most
densely innervated surface
epithelium in the body
richly supplied with sensory nerve
endings that generally subserve touch
and pain
major nerve supply: long ciliary nerve
from the ophthalmic division of the
trigeminal ganglion
presence of autonomic sympathetic
nerves originating from the superior
cervical ganglion
Corneal Reaction to Injury
Epithelium:
immediate repair
Bowmans layer: none
Stroma: keratocyte activated to
produce ECM and collagen
Descemets Membrane:
resecreted by endothelial cells
Endothelium: cell migration over
defect
Foetal
embryology
cornea is hydrated &transluscent
Epithelium-surface
ectoderm
Stroma&bowmans
layer-mesenchymal
cells between surface
ectoderm&developing lens.
Endothelium&descemets
membneuroectodermal in origin &derived from
neural crest at margin of optic cup.
Transparency of cornea
Transparency
is the quality or
state of transmitting light
without appreciable scattering so
that bodies lying beyond are
entirely visible.
factors
1)PHYSICAL
epithelium & endothelium
smooth tear film
arrangement of stromal fibres.
avascularity of cornea
cellular factors
absence of myelin sheath for corneal
nerves
2)PHYSIOLOGICAL
Relative dehydration
Epithelium and Endothelium
They
act as barrier preventing movement of water and ions into
stroma
Epithelium
provides greatest resistant to electrolyte diffusion, by
means of cells ,outermembrane&tight jn
Endothelium
is 200 times more permeable than epithelium to
electrolytes but is 10 times more resistant than stroma
The
resistance is created by means of interdigitation of cell
borders and increasing the distance substance must travel
Endothelium
also shows pump mechanism which help in
maintaining corneal hydration
Tear film
It
forms a homogenous layer over
cornea
It
acts as a lubricant
Fills
up small surface irregularities of
surface
Abnormalities
transparency
can affect corneal
Arrangement of stromal Lamellae
Over
the years many theory has been
proposed to explain transparency
Based on,
The arragement of collagen fibrills
The refractive index of the collagen
fibrills
The ref.index of extrafibrillar material
The ratio of these two refractive
indices
All play a major role in determining the
extent of light scattered by the stroma
Maurice theory[1957]
Collagen
fibrils are arranged in a
regular lattice in which
interfibrillary distance <wave
length of light
Scattered light is destroyed by
destructive interference.
Goldmann &benedek
theory[1967]
Lattice
arrangement not
required.
Fibrils wont affect transmission
of light unless they are >1/3rd of
wavelength
Refractive elements <2000A do
not scatter light.
Corneal avascularity
Chemical
theory
[meyer
&chafre]:sulfate ester of
hyaluronic acid acts as VIF
Campell&michaelson:release
of a
VSF,thought to be a vasoactive
amine at site of inflammation
MECHANICAL
[Cogan]-blood vessels
cant jnvade cornea due to its
compactness
COMBINED
[maurice
et al]Both
VSF&compactness of corneal
stroma
Hydration of cornea
Relative
state of dehydration;H 2O content
is 3.5gm/dry wt which is about 78%.
Its kept constant by
1)factors drawing water into cornea
IMBIBITION PRESSURE
2)factors preventing inflow of water
BARRIER ACTION
3)factors drawing water into cornea
ACTIVE PUMP
4)Evaporation of water from surface
COMPOSITION OF HUMAN CORNEA
WATER
COLLAGEN
TYPE 1
TYPE 3
TYPE 4
TYPE 6
-78 %
-15%
- 50-55%
- 1%
- 8-10 %
-25-30%
OTHER PROTEIN
- 5%
KERATAN SULPHATE - O.7
%
CHONDROITIN/DERMATANO.3%
HYALURONIC ACID
+
SALTS
1%
Thank you
