Cornea Transplant

Overview

The cornea is the clear, curved window at the very front of your eye. It helps focus light so you can see clearly. If the cornea becomes cloudy, scarred, swollen or misshapen, vision can become blurry or painful. A cornea transplant (also called keratoplasty, meaning 'cornea surgery') is an operation that replaces part or all of that damaged cornea with healthy cornea tissue from a donor. The donor tissue comes from someone who chose to donate their eyes after death. It is one of the most common and most successful types of transplant surgery.

Yes. Cornea transplants are one of the most common transplant operations in the world. Many thousands are done every year, and success rates are high, especially when the rest of the eye is healthy.

Anyone can need a cornea transplant, from babies to older adults. It is most often done in people whose cornea has been damaged by a condition called keratoconus (where the cornea bulges into a cone shape), by swelling of the inner layer of the cornea, by scars from infection or injury, or by problems after earlier eye surgery. In older adults, the most common reason is a condition called Fuchs' dystrophy (say 'fooks'), where the inner layer of the cornea stops pumping fluid out properly.

Symptoms

Common symptoms

• Blurry, cloudy or hazy vision that glasses do not fix
• Glare from lights, halos around lights, or trouble driving at night
• Sensitivity to bright light
• A white or grey patch on the front of the eye
• Eye pain or a gritty, scratchy feeling
• Redness or watering of the eye
• Vision that gets worse slowly over months or years

Symptoms in children

• Not complaining about vision, because a child may not realise their sight is different from anyone else's
• Squinting, holding toys or books very close, or sitting near the television
• Rubbing the eyes a lot
• A cloudy or white look to the eye noticed by a parent, carer or health visitor
• Some children are born with a cloudy cornea, which is usually spotted at newborn checks

Symptoms in older adults

• Vision that becomes hazy and foggy, often worse in the morning, which can be a sign of Fuchs' dystrophy
• Glare and halos that make night driving difficult
• Cornea problems appearing alongside cataracts, which may be treated together
• Slower healing and a need for more frequent check-ups after surgery
• Dry eye, which is common with age and can affect recovery

Causes

Main causes

• Keratoconus — the cornea thins and bulges into a cone shape, usually starting in the teenage years
• Fuchs' dystrophy — an inherited condition where the inner layer of the cornea stops working, so the cornea becomes swollen and cloudy
• Scars from eye infections, such as herpes infections of the eye or serious bacterial or fungal infections
• Injury to the eye, including chemical splashes and blows to the eye
• Problems after earlier eye surgery, such as cataract surgery, when the cornea does not recover well
• Inherited or congenital conditions that make the cornea cloudy from birth or childhood
• Rarely, other diseases that affect the shape or health of the cornea

Risk factors

• A family history of keratoconus
• Rubbing your eyes often and hard, which is linked to keratoconus
• Wearing contact lenses, especially if they are poorly fitted or worn too long
• Long-term use of some types of eye drops, such as steroid drops, which can weaken the cornea
• Having certain viral infections that affect the eye
• Having had eye surgery before
• Getting older, which makes Fuchs' dystrophy more likely to cause problems

When to see a doctor

See a doctor urgently if:

• You have a sudden change in your vision
• You have eye pain, a red eye, or a lot of discharge
• You have had a cornea transplant and notice new redness, pain or worsening vision
• You have had a cornea transplant and your eye is hit or injured
• You have a chemical splash or something sharp in your eye — rinse with clean water and seek care straight away

Book a routine appointment if:

• Your vision is slowly becoming blurrier or cloudier, even with new glasses
• You see halos or glare, especially at night
• You have a family history of keratoconus or Fuchs' dystrophy
• You are finding it harder to read, drive or do everyday tasks because of your sight
• You have already been told you may need a cornea transplant and want to talk it through

Diagnosis

An eye doctor (ophthalmologist) diagnoses cornea problems by looking closely at your eye and asking about your vision and health history. They use a special microscope with a bright light, called a slit lamp, to see each layer of the cornea in detail. They may also take a photograph-like map of your cornea to measure its shape and thickness. This is painless and takes only a few minutes.

Tests that may be done

• Vision test — reading letters from a chart to check how well you see
• Slit lamp examination — a bright light and microscope to look at the cornea layer by layer
• Corneal topography — a scan that maps the shape and curve of the cornea
• Pachymetry — a quick measurement of how thick the cornea is
• Specular microscopy — a photo test that counts the cells in the inner layer of the cornea
• Eye pressure check, which is quick and usually painless
• Sometimes blood tests or swabs if an infection is suspected

What to expect at your appointment

Most visits take less than an hour. Drops are used to widen your pupils for some tests, which can make your vision blurry and your eyes sensitive to light for a few hours, so it helps to have someone with you or to plan not to drive straight afterwards. Your doctor will explain what they found, what your options are, and what a transplant would involve for you.

Treatment

Treatment depends on what is wrong with your cornea and how much it affects your life. Early on, glasses, special contact lenses or medicated eye drops may be enough. If the cornea is badly scarred, swollen or badly shaped and other options no longer help, surgery to replace part or all of the cornea can restore sight. There are different types of transplant — some replace the full thickness of the cornea, and some replace only the damaged layers. Your surgeon will discuss which is likely to suit you best.

Self-care at home

• Wear safety glasses or goggles for DIY, gardening, sport and any activity where something could get in your eye
• Avoid rubbing your eyes — if they itch, ask your pharmacist or eye doctor about allergy or dry eye treatment instead
• Follow your eye drop schedule carefully after surgery, and never stop drops without asking your eye doctor
• Keep your follow-up appointments, even when your eye feels fine
• Wear the eye shield or glasses your team recommends, especially at night and in the early weeks
• Avoid swimming, hot tubs, and getting water or dirt in the eye until your team says it is safe
• Wash your hands before touching your eye or putting in drops
• Take a break from heavy lifting, strenuous exercise and dusty places until you are told it is fine

Medical treatments

Before surgery, doctors may try eye drops that reduce swelling or calm the immune system, special contact lenses that reshape the cornea, or treatments for the underlying cause, such as infection. After a transplant, most people need eye drops for months or sometimes years to help the eye heal and to stop the body rejecting the donor tissue. Your eye care team will set out a plan for you and adjust it at each visit. Always ask your doctor or pharmacist before using any new eye drop, including ones you can buy without a prescription.

When is surgery considered?

Surgery may be suggested when your vision is poor enough to affect daily life and other treatments no longer help, when the cornea is badly scarred or swollen, when there is ongoing pain from the cornea, or when an infection or injury has damaged the cornea and is not healing. The decision is yours, made together with your eye specialist, after you have had the chance to ask about risks, recovery time and what to expect.

Living with this condition

In the first weeks after surgery your vision may be blurry and your eye may feel sore, watery or light sensitive. This is normal and usually settles. Most people can go back to light daily activities quite soon, but driving, heavy lifting and dusty or dirty environments need to wait until your team says it is safe. Plan for several follow-up visits in the first year. Over time, most people find their sight is clearer and daily tasks become easier.

Lifestyle tips

• Keep a simple note of your drop times or set phone reminders, so you do not miss a dose
• Wear sunglasses in bright light if glare bothers you
• Protect your eye from knocks and from anything that could get into it — including pets' tails, children's toys and branches
• Avoid smoky, dusty or windy places in the early weeks
• Tell your dentist, pharmacist and any other health professional that you have had a cornea transplant
• Carry a card or note about your transplant and your medicines in case of an emergency

Diet and exercise

There is no special diet for a cornea transplant, but eating well and drinking enough water helps your body heal. A balanced mix of fruit, vegetables, whole grains, beans and protein is a good guide. Gentle activity such as walking is usually fine soon after surgery, but check with your team before going back to vigorous exercise, contact sports, swimming or heavy weights. Avoid rubbing your eyes when you are tired or sweaty.

Mental health and emotional wellbeing

Eye problems and eye surgery can feel worrying. It is common to feel anxious before the operation, frustrated by blurry vision, or low if recovery takes longer than you hoped. Feeling nervous about your sight is not a sign of weakness. Talking to your eye care team about your worries often helps, and so does telling family or friends how you feel. If low mood or anxiety is lasting more than a couple of weeks or affecting your sleep and daily life, please speak to your doctor. If you ever have thoughts of harming yourself, contact your local emergency number or a crisis line in your country straight away — you deserve immediate support.

Prevention

Not all cornea problems can be prevented, especially inherited ones like keratoconus or Fuchs' dystrophy. But some causes can be reduced. Protecting your eyes at work and at home, treating eye infections quickly, avoiding eye rubbing, and keeping up with contact lens hygiene all help protect your cornea. If you have a family history of cornea disease, regular eye checks can catch changes early.

Screening programmes

There is no national screening programme for cornea disease in most countries. However, regular eye tests — usually every two years, or more often if your optician advises — can pick up early changes in the cornea. If a close relative has keratoconus, tell your optician, as they may suggest more frequent checks.

Complications

If left untreated

• Vision may stay blurry or become worse over time
• Scarring or swelling of the cornea can become permanent
• Ongoing eye pain or a feeling of something in the eye
• In some cases, severe infection or injury can lead to serious sight loss
• Rarely, an untreated eye infection can spread and become a serious problem for the whole eye

Long-term outlook

The outlook for cornea transplant is generally very good. It has one of the best success rates of any transplant operation, and most people notice a real improvement in their sight. Some people need a second transplant many years later, and a small number of transplants do not work as well as hoped. Your eye team will keep a close watch on you and adjust your care as needed. Whatever your situation, there is support available to help you make the most of your vision.

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