Physiology of Cornea

Corneal transparency:

Cornea has to remain transparent to function as a refractive medium, while retaining all the
tough fibrous properties needed to provide protection to the vital intraocular contents.
It achieves transparency by the following 4 ways:
o Avascularity of cornea (except for the small loops which invade the periphery)
o State of relative dehydration (hydration is 80%; relatively dehydrated compared to
the aqueous humor posteriorly and the tear film anteriorly; epithelium tight
junctions and the endothelial metabolic pump mechanism)
o Absence of myelinated nerve fibres (cornea is densely innervated by non-myelinated
nerve fibres)
o Presence of certain water-soluble proteins of keratocytes called Corneal Crystallins
o Arrangement of collagen fibrils in the corneal stroma:
Lattice theory of Maurice: Regular lattice arrangement of collagen fibrils in
the corneal stroma, leads to destruction of scattered light by
destructive/mutual interference.
Minimal separation theory of Goldmann: Collagen fibrils in the corneal
stroma are separated by less than 1/3 the wavelength of light. In order to
cause scattering of light due to interference with the light transmission, the
separation has to be more than 1/3 the wavelength of light. So there is no
scattering.
Every corneal disease which results in loss of corneal transparency, acts through 3 main
pathogenic mechanisms:
o Corneal edema:
Increase in hydration of cornea due to disturbances in the normal
physiological mechanisms which maintain the relative dehydration
i.e. an imbalance between the factors which lead to the hydration of cornea
(Stromal swelling pressure because of hypertonicity of stromal collagen,
salts, proteoglycans and IOP) and the factors which prevent such a
hydration (epithelial barrier action and endothelial metabolic pump action)
Conditions which can either raise the IOP, or cause damage to the
endothelium and epithelium can all cause corneal edema and loss of
transparency and present clinically with diminution of vision and coloured
halos.
o Corneal vascularization
Invasion of blood vessels into the cornea due to distrubances in the normal
physiological mechanisms which maintain the avascularization
i.e Vasoinhibitory substances in the cornea and Compact arrangement of
corneal lamellae which prevent invasion of the blood vessels from the
surrounding limbus
Inflammatory conditions which release vasostimulatory factors as well as
conditions causing long-standing corneal edema because of loosening of the
compactness of the cornea can all cause neovascularization and result in
loss of transparency
o Corneal opacification
Nutrition and Metabolism:

Corneal has energy and protein synthesis requirements due to 2 processes:

o Rapid turnover and mitosis of corneal epithelial cells
o Metabolic pump action (Na+/K+ATPase) of the endothelium
The nutrition of cornea is derived from mainly 3 sources-
o Aqueous humour
o Exudation from the prelimbal vessels
o Pre-corneal tear film
Metabolic substrates (Glucose and others) enter by diffusion from the prelimbal capillaries
and by active transport/diffusion from the aqueous humor
Oxygen is derived mainly from the air (through the tear film), though some may reach the
superficial corneal layers through prelimbal capillaries and the deeper corneal layers through
aqueous humor
Like other tissues, the corneal epithelium can metabolize glucose both aerobically (Krebs
and HMP shunt) and anaerobically (glycolysis)