Anatomy of cornea

 The cornea is a transparent,

 avascular, watch-glass like structure.
 It forms anterior one-sixth of the outerfibrous coat of the eyeball.

Dimensions

 The anterior surface of cornea is elliptical

 horizontal diameter of 11.7 mm and
 vertical diameter of 11 mm.
 The posterior surface of cornea is circular
 average diameter of 11.5 mm.
 the cornea has a refractive index of 1.376

Thickness

 centre is about 0.52mm

 periphery it is 0.7 mm.

Radius of curvature.

 The central 5 mm area of thecornea forms the powerful refracting surface of,the eye.
 The anterior and posterior radii ofcurvature of this central part of cornea are 7.8 mm
and 6.5 mm, respectively.

Refractive power
 .approximately 43 dioptres.

Histology

Histologically, the cornea consists of five distinct layers.

 Epithelium,
 Bowman’s membrane,
 substantia propria (corneal stroma)
 Dua’s layer
 Descemet’s membrane
 Endothelium
1. Epithelium.

 It is of stratified squamous type and becomes continuous with the

epithelium of bulbar conjunctiva at the limbus.
 It consists of 5-6 layers of cells.
 The deepest (basal) layer is made up of columnar cells,
 2-3 layers of wing or umbrella cells and the most superficial two layers
are of flattened cells.

2. Bowman's membrane.

 This layer consists of acellular mass of condensed collagen fibrils.

 It is about 14μm in thickness
 binds the corneal stroma anteriorly with basement membrane of the
epithelium.
 It is not a true elastic membrane but simply a condensed superficial part
of the stroma.
 It shows considerable resistance to infection.
 It does not regenerate

3. Stroma (substantia propria).

 This layer is about 0.5 mm thick
 cornea (90% of total thickness).
 Lattice arrangement
 It consists of collagen fibrils (lamellae) embedded in hydrated matrix of
proteoglycans.
 The lamellae are arranged in many layers. In each layer they are not only
parallel to each
 other but also to the corneal plane and become continuous with scleral
lamellae at the limbus.
 The alternating layers of lamellae are at right angle to each other
 It contain keratocytes, wandering macrophages, histiocytes and a few
leucocytes.

4. Descemet's membrane (posterior elastic lamina).

 The Descemet's membrane is a strong homogenous layer which bounds

the stroma posteriorly.
 It is very resistant to chemical agents, trauma and pathological processes.
 . consists of collagen and glycoproteins
 It can regenerate.
 Normally it remains in a state of tension and when torn it curls inwards
on itself.
 It appears to end at the anterior limit of trabecular meshwork as
Schwalbe's line (ring).

5. Endothelium.

 It consists of a single layer of flat polygonal (mainly hexagonal) cells

which on slit lamp biomicroscopy appear as a mosaic.
 The cell density of endothelium is around 3000 cells/mm2 in youn adults,
which decreases with the advancing age.
 There is a considerable functional reserve for the endothelium.
 corneal decompensation occurs only after more than 75 percent of the
cells ar4 lost.
 The endothelial cells contain 'active-pump'mechanism.
 It does not regenerate

Blood supply

 Cornea is an avascular structure.

  Small loops derived from the anterior ciliary vessels invade its periphery
for about 1 mm. Actually these loops are not in the cornea but in the
subconjunctival tissue which overlaps the cornea.

Nerve supply

 Cornea is supplied by anterior ciliary nerves which are branches of

ophthalmic division of the 5th cranial nerve.
 After going about 2 mm in cornea the nerves lose their myelin sheath and
divide dichotomously and form three plexuses — the stromal,
subepithelial and intraepithelial.

APPLIED PHYSIOLOGY

The two primary physiological functions of the cornea are

(i) act as a major refracting medium;
(ii) protect the intraocular contents.
Cornea fulfils these duties by maintaining its transparency and
replacement of its tissues.

Corneal transparency

The transparency is the result of :

 Peculiar arrangement of corneal lamellae (lattice theory of Maurice),
 Avascularity,
 Relative state of dehydration, which is maintained by barrier effects of
epithelium and endothelium and the active bicarbonate pump of the
endothelium.

Source of nutrients

1. Solutes

 (glucose and others) enter the cornea by either simple diffusion or active
transport through aqueous humour and by diffusion from the perilimbal
capillaries.

2. Oxygen

 derived directly from air through the tear film.

 This is an active process undertaken by the epithelium.
Metabolism of cornea

 The most actively metabolising layers of the cornea are epithelium and
endothelium,
 the former being 10 times thicker than the latter requires a
proportionately
larger supply of metabolic substrates.
 Like other tissues, the epithelium can metabolize glucose both aerobically
and anaerobically into carbon dioxide and water and lactic acid,
respectively. Thus, under anaerobic conditions lactic acid accumulates in
the cornea.