Cornea Flashcards
6 Layers of the cornea
Epithelium
Anterior limiting lamina
Stroma
Dua’s layer
Posterior limiting lamina
Endothelium
Thickness: Epithelium
55um
Thickness: Anterior limiting lamina
8-10um
Thickness: Stroma
500um
Thickness: Dua’s layer
15um
Thickness: Posterior limiting lamina
8-10um
Thickness: Endothelium
5um
Corneal: Width
11.6mm
Corneal: Anterior height
10.6mm
Corneal: Centre thickness
540um
Corneal: Edge thickness
0.7mm
Corneal: Anterior radius
7.8mm
Corneal: Posterior radius
6.7mm
Corneal: Refractive index
1.376
Corneal: Refractive power
~42D
Corneal Overview
Transparent outer coat
Several layers of connective tissue
Avascular and specialised structure = transparency
Mechanical protection and sensory innervation = blink reflex
What can reduce corneal sensitivity
Systemic diseases like diabetes
What can innervation damage cause
Anaesthesia - loss of reflex lacrimation and lid closure
Corneal innervation
Nerve fibres on cornea unmyelinated for transparency
Schwann cells myelinate nerves towards peripheral cornea
Leaves as bundles to join ciliary nerve from ophthalmic branch of trigeminal nerve
Cell types making up epithelium
Squamous cell - 2 layers
Wing cell - 2 to 3 layers
Columnar cell - 1 layer
Features: Epithelium
Stratified
Non keratinised
5-6 layers
Made up of 3 different cells
What structures are involved in corneal healing
Epithelium
Stroma
Nerves
Lacrimal glands
Tear film
Name the 4 phases of corneal healing
Latent phase
Migration
Proliferation
Attachment
Healing times for superficial damage and full thickness defect
24hrs for superficial
7 days for full defect
At what point does scarring occur
Damage deeper than anterior limiting lamina will heal but scar
Latent phase (5)
Lacrimal glands change tear makeup/quantity
Growth factors released from tears
Damaged cells go through cell death process
Fibres aid adhesion or migrating cells
Desmosome attachments weaken
Migration
Surrounding cells flatten and slide together along wound bed
Miosis does not occur yet
Proliferation
Cells proliferate upwards
Cell division accelerated - new cells move upward
Zonular occlusions form 1st, epithelial 2nd and then glycolax
Attachment
Restoration and attachment of desmosomes and heridesmosomes
Wound closure 2-4 days - full attachment full week
Function: Epithelium
Smooth hydrophilic refracting surface
Metabolic exchange and pathogen/bacteria protection
Rapid regeneration/mechanical protection - blink reflex
Function: Anterior limiting lamina
Anchor site for epithelium
Tough layer for mechanical support
Features: Anterior Limiting Lamina
8-10um thick
Acellular zone with collagen fibres
Posteriorly woven with anterior stroma
Sensoru nerve fibres to innervate epithelium
Layer separates epithelial growth factors to avoid scarring
Function: Stroma
Mechanical strength and stability
Maintains homogeneity for transparency
Regularity of fibre arrangements produce diffraction grating
Features: Stroma
Formed with layers of collagen and fibroblasts between
Collagen fibrils evenly spaced in parallel bands
Layers include keratin sulphates to aid corneal hydration
Location of Dua’s Layers
Between stroma and posterior limiting lamina
Features: Dua’s Layer
Layers of collagen laying in longitudinal, transverse and oblique direction
Made up of 5-8 layers
Very strong ~700mmHg before rupture
Important for glaucoma treatment response and keratoplasty surgery techniques
Function: Posterior limiting lamina
Structural base for endothelium
Features: Endothelium
Single layer
Metabolically active = many mitochondrias
Cannot regenerate
Cell membrane creates barrier to prevent free flow
Vesicles within regulate corneal hydration and aid transport of metabolites from aqueous
Corneal Transparency: Nerves and vessels
Avascular - episcleral loops enter the cornea up to 1mm at limbus
Unmyelinated nerves until 0.5mm from the limbus
Homogenous refractive index - maintained by consistent water content
Corneal Transparency: Features
Regularity of fibrils
Parallel spacing = diffraction grating
Spaced less than then wavelength of light
Light incident normally travels undeviated
Light incident at an angle away from the 4mm centre will have reduced transmission
UVB/UVC mostly absorbed as their wavelength less than fibril spacing