OPHTHAL PG EXAM NOTES- DO/DNB/MD/MS

Cornea- Anatomy and Physiology

Q.1 Describe briefly anatomy of cornea and its clinical significance? (5) 2019

Q.2 Factors responsible for Transparency of cornea. (3) 2019

Q.3 Anatomy and Physiology of corneal endothelium. (3) 2016

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Anatomy of Cornea
- Cornea is a transparent, avascular, watch-glass like structure
- It forms anterior one-sixth of the outer fibrous coat of the eyeball

1. Gross structures
a. Anterior surface of cornea (elliptical)
Horizontal diameter - 11.7mm
Vertical diameter - 10.6mm
Radius of curvature - 7.8mm
b. Posterior surface of cornea (circular)
Diameter – 11.5mm
Radius of curvature – 6.5mm
c. Thickness of cornea (approx.)
Centre - 0.5mm
Periphery- 0.7mm
limbus - 1.1mm
d. Refractive Index – 1.36
Anterior +48D
e. Refractive power Total - +43D
Posterior -5 D
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2. Fine structure
A. Epithelium
- Stratified squamous non keratinised
- 50-90 µm thickness
- 5-6 layers
- basal layer - Columnar cells
- linked by desmosomes
- linked to BM by hemidesmosomes
- Next 2-3 layer- wing cells
- most superficial 2 layers - Flattened squamous cells
- have microplicae and microvilli
- shed into tear film with in a week
Clinical significance
- Weak attachment between basal cells of epithelium and BM causes
Recurrent corneal epithelial erosion
- Microvilli of outermost cells facilitate the attachment of the mucin layer of tear film
which helps to maintain the tear film stability
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Limbal epithelium
- Corneal stem cells are located at the corneoscleral limbus
in the Palisade of vogt
Clinical significance
1. Stem cell defect causes
- Chronic epithelial defect
- Conjuctivalization of cornea
B. Bowman layer
- Acellular layer of condensed collagen fibrils
- 8-14µm thick
- Binds the corneal stroma with corneal epithelium
- Not a true elastic membrane but a superficial part of stroma

Clinical Significance
- If it get destroyed then it does not get regenerate again

- It provide resistance for infection and injury

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C. Stroma (Substantia propria)
- Makes upto 90% of corneal thickness
- 400-500µm thickness
- Arranged in regularly oriented layer of collagen fibrils(lamallae)
- Spacing of collagen fibrils maintained by proteoglycan
ground substance
- Lamellae arranged in many layers and contains modified
fibroblast (keratocyte)

Clinical significance
- Maintenance of the regular arrangement and spacing of the
collagen fibers is critical to optical clarity
- The stroma can scar but cannot regenerate following damage

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D. Pre- Descemet’s membrane

- Also K/a Dua’s layer- discovered by Harminder Dua in 2013

- 15µm thick acellular structure
- located anterior to the Descemet’s membrane
Important characteristic
- This layer is very strong and impervious to air
E. Descemet’s membrane
- Strong discrete sheet composed of a fine latticework of collagen.
- 10µm thickness
- 2 zones – Anterior banded zone- deposited in utero
- Posterior non banded zone- laid down throughout life
by the endothelium
- has regenerative potential
Clinical significance
1. large corneal ulcer – can cause Descemetocele which maintain the integrity of eye ball
2. In keratoconus – break in the DM causes Acute hydrops

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F. Endothelium

- monolayer of polygonal or hexagonal cells

- maintains relative dehydration state of cornea throughout life
by pumping of excess fluid out of the stroma
- young adult cell density – 3000 cells/ mm2
- 0.6% cells decreases per year
- Cells cannot regenerate but neighbouring cells enlarge
to fill the space of lost cells
Clinical significance
If cell density decreases <500 cells/mm2

causes corneal edema

Transparency of cornea is impaired

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Physiology of corneal endothelium
- According to pump leak hypothesis- Dual function of the corneal endothelium
1. It allow leakage of solutes and nutrients from the aqueous humor to the more superficial
layer of the cornea
2. Also pumping water in the opposite direction from the stroma to the aqueous
- Nutrition of corneal endothelium must occur via diffusion of glucose and other solutes from the
aqueous humor
- Corneal endothelium transport water from stroma to the anterior chamber by active and
passive ion exchanger ( Na+/K+ ATPase pump and carbonic anhydrase)
- Endothelium is enriched with mitochondria
- So Oxydative activity 5-6 times higher than epithelium
- All three forms of carbohydrate metabolism occurs in the endothelium
- Collective action of sodium and bicarbonated ion pumps
causes passive secondary movement of water
- Higher Intraocular pressure(>50mmHg) causes loss of function of Sodium/ potassium ATPase pump
causes corneal Oedema
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Transparency of cornea
Factor responsible for corneal transparency are
A. Anatomical factors
1. Corneal epithelium and tear film
- Cause Homogeneity of the refractive index throughout the epithelium
2. Maurice theory
- Proposed that the cornea is transparent because the uniform collagen fibrils are
arranged in a regular lattice so that scattered light is destroyed by destructive interference
- Fibrils are regularly arranged in a lattice
If separated by less than a wavelength of light
Then the cornea will remain transparent
3. Theory of Goldman et al.
- Concluded that the lattice arrangement is not a necessary condition for stromal
transparency
- They postulated that the cornea is transparent because the fibrils are small in relation to the
light and do not interfere with light transmission unless they are larger than one half a
wavelength of light
4. Avascularity of cornea
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B. Physiological factors
- Keeps the cornea in a relative state of dehydration
- These factors are
1. Barrier function of epithelium and endothelium
2. Endothelial pumps
- Plays a predominant role in controlling fluid transport due to several enzyme system
(a) Na+/k+ ATPase pumps
(b) Bicarbonate – dependent ATPase
(c) Na+/H+ pump
- Thus it is most important factor in maintaining corneal dehydration

3. Evaporation from corneal surface

4. Normal IOP
5. Swelling pressure- of the stroma which counters the imbibition effect of IOP
6. corneal crystallins
- water soluble proteins of keratocytes
- Also contribute to corneal transparency at the cellular level
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