Corneal injury: Clinical and molecular aspects

Abstract

Currently, over 10 million people worldwide are affected by corneal blindness. Corneal trauma and disease can cause irreversible distortions to the normal structure and physiology of the cornea often leading to corneal transplantation. However, donors are in short supply and risk of rejection is an ever-present concern. Although significant progress has been made in recent years, the wound healing cascade remains complex and not fully understood. Tissue engineering and regenerative medicine are currently at the apex of investigation in the pursuit of novel corneal therapeutics. This review uniquely integrates the clinical and cellular aspects of both corneal trauma and disease and provides a comprehensive view of the most recent findings and potential therapeutics aimed at restoring corneal homeostasis.

Keywords: Corneal trauma; Diabetic keratopathy; Fuchs' dystrophy; Keratoconus; Regenerative medicine.

Figure 1.

Corneal scarring after corneal laceration. Rigid gas-permeable contact lens has been fitted to improve vision.

Figure 2.

Severe laceration of eyelids and globe after an assault.

Figure 3.

Corneal foreign body.

Figure 4.

Corneal epithelial defect in patient with poorly controlled diabetes mellitus.

Figure 5.

Cone shaped cornea seen in keratoconus.

Figure 6.

Fuchs’ endothelial dystrophy on slit-lamp examination with guttata.

Figure 7.

Examples of different corneal transplant procedures. Normal cornea shown in A with epithelium (yellow), Bowman’s layer (green), stroma (blue), Descemet’s membrane (purple), and endothelium (red). Not drawn to scale. Transplanted cornea is indicated by light blue, with types of keratoplasty as follows: Penetrating keratoplasty (B), Superficial anterior lamellar keratoplasty (C), Deep anterior lamellar keratoplasty (D), and Descemet’s membrane endothelial keratoplasty (DMEK) (E).