ANATOMY AND

PHYSIOLOGY OF CORNEA
Dr. Joseph John

CORNEA
Transparent anterior part of the eyeball
Smooth convex outer surface &
concave inner surface
Sclera overlaps cornea all around
periphery
Junction b/n two is limbus or sulcus
sclerae

Dimensions of cornea
surface shape

Horizont Vertical
al
diamete
diamete r
r

Radius
of
curvatur
e

ANTERIOR

elliptical

11-12mm

9-11mm

7.5-8.8mm

POSTERIOR

rounded

11.5mm

11.5mm

6.5-6.8mm

Thickness of cornea varies

from.52mm in centre to .65-1.1mm in
periphery.

Index of refraction
Corneal

index of refraction is 1.376

Tear film index of refraction is 1.336
Average ant.central region refractive
power of +48.8D
Aqueous humour ref.index is also
1.336 resulting in corneal
post.surface of -5.8D
So resultant average power is +48.8[5.8] ie+43D which is 70% of total
ocular refractive power.

Weight

of a fresh cornea-180mg

Elasticity:

stretch by 0.25% in normal IOP

Strength:

approximately 5kg/sq.cm before

rupture

anterior

surface is steepest centrally and

flatter &asymmetric peripherally[flatter
more in nasal & above]

central

3-4 mm is nearly spherical,which is

the optical zone

Layers

15 microns thick

6th layer
Duas

layer
Harminder S. Dua, MD, PhD, from
the University of Nottingham in
the United Kingdom, and
colleagues discovered the layer
by examining the separation that
often occurs along the last row of
keratocytes during the big bubble
(BB) technique.

Epithelium

outermost layer ;continuous with conjunctival

epithelium
stratified, non-keratinized squamous
approximately 50-90 m thick [10% of
total],constant over entire corneal surface.
extensive intercellular complexes (desmosomes
and tight junctions)
Rapid renewal;turn over takes 5-7 days
cellular components like langerhans cells seen
near limbus,not in centre

functions
1) to form a barrier between the
environment & stroma of the
corne[fluid loss,pathogen,abrasive
pressure]
2)light refraction & transmittance
[smooth ,wet apical surface
along with tear film & its
transparency-scarcity of cell
organelles & enzyme crystallins]
3)survival over an avascular bed

Sub-layers of the Epithelium

superficial

flattened cells
polygonal or wing cells
basal columnar cells
basement membrane

Basal lamina consists of collagen & glycoprotein

constituents integrated structurally with
underlying bowmans layer
To which it is firmly attached by an array of short
anchoring filaments

BOWMANS LAYER

Anterior limiting membrane

Lies deep to corneal epithelium
Non cellular , amorphous layer with randomly
arranged fine fibrils
Ends ubruptly in the periphery which delineates
anterior junction b/n cornea & limbus marked
clinicaly by summits of marginal arcades of limbal
capillaries
Gets seperated from corneal epithelium after
death
Resistant to injury & infection
Once destroyed ,will not regenerate,gets replaced
by scar tissue

STROMA- SUBSTANTIA PROPRIA

Contributes to bulk of cornea - 500 micrometer thick

Around 200-250 regularly arranged lamellae of collagen
bundles
Lie in proteoglycan ground substance with small population
of keratocytes
Lamellae are in layers which are parallel to each other &
with corneal surface & run from limbus to limbus

ULTRA STRUCTURE - STROMA

Each stromal lamella comprise of a band of collagen fibrils

arranged parallel to each other
Unique uniformity of fibril diameter & regular seperation
,both within & b/n lamellae
Orderly arrangement of collagen fibrils is responsible for
transparency of corneal stroma
Keratocytes which are few in number occupy 2.5 -5% of
stromal volume are responsible for synthesis of stromal
collagen & proteoglycan. Long thin flattened cells appear as
stellate cells when viewed from corneal surface. Seen
within lamellae as well as b/n lamellae

DESCEMETS MEMBRANE
Posterior

limiting layer
Basal lamina of corneal endothelium
Strong resistant sheet , sharply defined
Plane of seperation from stroma is used in
lamellar keratoplasty
Thickens with age
Major protein is type 4 collagen
Descemets membrane can be reformed
after degeneration

ULTRASTRUCTURE-DESCEMETS

Anterior fibrillar layer & posterior granular layer

Increase in size with age is due to growth of
granular layer
Fibrils also contribute to trabecular meshwork at
the iridocorneal angle

Corneal Endothelium
Single

layer of flat polygonal mostly

hexagonal cells in a mosaic pattern
In adults,it has hardly any ability to
divide.
Total 5,00000 cells,cell density
decreases with age
2500 to 3000 endothelial cells/sq
mm
does not regenerate

It

shows
polymegathism[hetyerogeneity in cell
size]&polymorphism[heterogeneity in
cell shape with age& .as a result of
trauma,infection
Cells are closely interdigitated with
jn.complexes[zonulae
occludens&macula adherens]
Cell

are attached to descemets memb.

by hemidesmosomes.

Endothelial Barrier
basis

of barrier function is the

existence of tight junctions and
gap junctions between
endothelial cells
prevents influx of aqueous to the
stroma
leaky barrier allows glucose,
amino acids, etc. to enter the
stroma but not bulky fluid .

Endothelial pump
most

important function of endothelium is

regulate water content of corneal stroma.
Endothelial cells have ion transports which
counteract the imbibition of water into
stroma
Active Enzyme systems:
Na+ - K + ATPase
Carbonic Anhydrase
Na+ - H+ pump
Bicarbonate dependent ATPase

Mechanism:
Na+

- K + ATPase and Na+ - H+ pump

actively secretes Na+ into aqueous
CO2 and H2O generate HCO3 - by means
of CAse and is secreted into aqueous
This creates an osmotic gradient (2 3
mOsm), coupled with the ions water
moves from corneal endothelial cells to
aqueous humor.
This balances swelling pressure of
corneal stroma

Blood supply
Avascular
Small

loops from ant.ciliary

arteries enterits periphery for
about 1mm

Invaded

by new vessels in
infections& inflammations

Corneal Nutrition
oxygen

requirement for metabolic activities

comes from atmospheric oxygen dissolved
in the tear film

Closed

eyelids: oxygen enters the tear film

from the superficial conjunctival capillaries

carbon

dioxide and other metabolic end

products are similarly removed across the
tear film, the corneal endothelium, or
through the limbal capillaries

Glucose

(aqueous) - main source of energy

Corneal Sources of
Oxygen
atmospheric

oxygen dissolved in

the tear film

aqueous humor and limbal
circulation
minimal oxygen requirement to
maintain clarity: 7-15 mmHg
oxygen when eyes are open: 155
mmHg
oxygen when eyes are closed: 55
mmHg

Corneal Innervation
most

densely innervated surface

epithelium in the body
richly supplied with sensory nerve
endings that generally subserve touch
and pain
major nerve supply: long ciliary nerve
from the ophthalmic division of the
trigeminal ganglion
presence of autonomic sympathetic
nerves originating from the superior
cervical ganglion

Corneal Reaction to Injury

Epithelium:

immediate repair
Bowmans layer: none
Stroma: keratocyte activated to
produce ECM and collagen
Descemets Membrane:
resecreted by endothelial cells
Endothelium: cell migration over
defect

Foetal

embryology

cornea is hydrated &transluscent

Epithelium-surface

ectoderm

Stroma&bowmans

layer-mesenchymal
cells between surface
ectoderm&developing lens.

Endothelium&descemets

membneuroectodermal in origin &derived from

neural crest at margin of optic cup.

Transparency of cornea
Transparency

is the quality or
state of transmitting light
without appreciable scattering so
that bodies lying beyond are
entirely visible.

factors
1)PHYSICAL

epithelium & endothelium

smooth tear film

arrangement of stromal fibres.

avascularity of cornea

cellular factors

absence of myelin sheath for corneal

nerves
2)PHYSIOLOGICAL

Relative dehydration

Epithelium and Endothelium

They

act as barrier preventing movement of water and ions into

stroma

Epithelium

provides greatest resistant to electrolyte diffusion, by

means of cells ,outermembrane&tight jn

Endothelium

is 200 times more permeable than epithelium to

electrolytes but is 10 times more resistant than stroma

The

resistance is created by means of interdigitation of cell

borders and increasing the distance substance must travel

Endothelium

also shows pump mechanism which help in

maintaining corneal hydration

Tear film
It

forms a homogenous layer over

cornea

It

acts as a lubricant

Fills

up small surface irregularities of

surface

Abnormalities

transparency

can affect corneal

Arrangement of stromal Lamellae

Over

the years many theory has been

proposed to explain transparency
Based on,

The arragement of collagen fibrills

The refractive index of the collagen

fibrills

The ref.index of extrafibrillar material

The ratio of these two refractive

indices
All play a major role in determining the
extent of light scattered by the stroma

Maurice theory[1957]
Collagen

fibrils are arranged in a

regular lattice in which
interfibrillary distance <wave
length of light
Scattered light is destroyed by
destructive interference.

Goldmann &benedek
theory[1967]
Lattice

arrangement not
required.
Fibrils wont affect transmission
of light unless they are >1/3rd of
wavelength
Refractive elements <2000A do
not scatter light.

Corneal avascularity
Chemical

theory
[meyer
&chafre]:sulfate ester of
hyaluronic acid acts as VIF

Campell&michaelson:release

of a
VSF,thought to be a vasoactive
amine at site of inflammation

MECHANICAL

[Cogan]-blood vessels
cant jnvade cornea due to its
compactness

COMBINED
[maurice

et al]Both
VSF&compactness of corneal
stroma

Hydration of cornea

Relative

state of dehydration;H 2O content

is 3.5gm/dry wt which is about 78%.
Its kept constant by
1)factors drawing water into cornea

IMBIBITION PRESSURE
2)factors preventing inflow of water

BARRIER ACTION
3)factors drawing water into cornea
ACTIVE PUMP
4)Evaporation of water from surface

COMPOSITION OF HUMAN CORNEA

WATER

COLLAGEN
TYPE 1
TYPE 3
TYPE 4
TYPE 6

-78 %
-15%
- 50-55%
- 1%
- 8-10 %
-25-30%

OTHER PROTEIN
- 5%
KERATAN SULPHATE - O.7
%
CHONDROITIN/DERMATANO.3%
HYALURONIC ACID
+
SALTS

1%

Thank you