17714 Cornea Transplant

Overview

A cornea transplant is surgery to replace part or all of your cornea with healthy tissue from a donor. The cornea is the clear, dome-shaped window at the front of your eye. It bends (refracts) light so you can see clearly, and it also protects the inside of your eye. When the cornea becomes cloudy, scarred, swollen, or misshapen, light cannot get through properly and your sight can become blurred, hazy, or very poor. Replacing the damaged layer with a donor cornea can restore clear vision, relieve pain, or save the eye itself. It is also called corneal grafting or a keratoplasty (say: ker-ah-toe-plas-tee).

Yes. Cornea transplant is one of the most common and most successful types of transplant surgery worldwide. Thousands are carried out every year, and it has been done routinely for many decades.

It can be needed at any age, from young children to older adults. It is more common in older adults, because some causes — such as a condition called Fuchs' dystrophy (a gradual clouding of the inner cornea) and swelling after cataract surgery — become more likely with age. In younger people, injuries, infections, and inherited eye conditions are more often the reason.

Symptoms

Common symptoms

• Blurred, cloudy, or hazy vision that does not improve with new glasses
• Glare or halos around lights, especially at night
• Sensitivity to bright light
• Eye pain or a gritty, irritated feeling
• Redness or watering of the eye
• Seeing double, or a ghosting effect
• A white or grey patch visible on the front of the eye
• Vision that gets worse slowly over months or years

Symptoms in children

• Not following faces or toys with the eyes, or not making eye contact
• One eye turning in or out (a squint)
• White or cloudy look in the pupil or the front of the eye, sometimes seen in photos
• Frequent rubbing of the eyes
• Delayed visual development or trouble at school with seeing the board
• Children may not complain of poor vision because they have never known anything different, so newborn and child eye checks matter

Symptoms in older adults

• Gradual blurring that is put down to 'just getting older' or to cataracts
• Vision that is worse in the morning and clears slightly during the day (a pattern seen in Fuchs' dystrophy)
• Glare from headlights when driving at night
• Difficulty reading small print or seeing in low light
• Symptoms that appear after previous eye surgery, such as cataract surgery

Causes

Main causes

• Fuchs' dystrophy — an inherited condition where the inner layer of the cornea slowly stops pumping fluid out, so the cornea becomes cloudy and swollen
• Swelling (oedema) of the cornea after eye surgery, such as cataract surgery
• Eye infections, including infections caused by viruses or contact lens-related infections that scar the cornea
• Keratoconus — a condition where the cornea becomes thin and cone-shaped, usually in teenagers and young adults
• Injury or scarring from a chemical burn, a blow, or a foreign object
• Inherited corneal dystrophies other than Fuchs'
• Problems with the eye's stem cells (limbal stem cell deficiency), sometimes from injury or certain treatments
• Rarely, conditions such as autoimmune disease affecting the eye, or complications from other eye disease

Risk factors

• A family history of inherited corneal conditions such as Fuchs' dystrophy or keratoconus
• Previous eye surgery, especially cataract surgery
• Wearing contact lenses, particularly with poor lens hygiene, which raises the risk of serious eye infection
• Eye injuries, including chemical splashes at home or at work
• Rubbing your eyes a lot over many years
• Certain viral eye infections
• Some autoimmune conditions that can inflame the eye
• Being older, for age-related corneal changes

When to see a doctor

See a doctor urgently if:

• A sudden drop in vision, or a sudden increase in pain, redness, or light sensitivity — especially after eye surgery or a transplant
• A chemical splash or object in the eye (rinse first, then get help)
• A red, painful eye with feeling sick or blurred vision
• New flashes, floaters, or a shadow across your vision

Book a routine appointment if:

• Vision that is slowly getting blurrier and is not helped by new glasses
• Glare or halos around lights that make driving at night difficult
• A persistent gritty or irritated feeling in the eye
• A cloudy or white patch on the front of the eye
• A family history of corneal dystrophy, or a child with a squint or a cloudy eye
• Being told by an optician that your cornea looks unusual

Diagnosis

An eye doctor (ophthalmologist) will ask about your vision, your health, your family history, and any past eye surgery or injuries. They will look at your eye with a special microscope called a slit lamp (a lamp and microscope that lets them see each layer of the eye in detail), check how well you see, and measure the shape and thickness of your cornea. These tests are quick and painless and help the doctor decide whether a transplant is needed and which type would suit you best.

Tests that may be done

• Vision (visual acuity) test — reading letters on a chart at a set distance
• Slit lamp examination — a close look at the cornea, iris and lens
• Corneal topography or tomography — a painless scan that maps the shape and thickness of the cornea
• Pachymetry — a measurement of how thick the cornea is
• Eye pressure check
• A test of the cells on the inner surface of the cornea (specular microscopy)
• Blood tests or swabs if an infection is suspected
• Sometimes an ultrasound scan of the eye if the cornea is too cloudy to see through

What to expect at your appointment

The tests are done in an eye clinic and usually take less than an hour. You will not need to prepare in any special way, though you may be given eye drops to widen your pupils, which can blur your vision and make bright light uncomfortable for a few hours — so it is best not to drive yourself home. The doctor will explain the results and talk through your options, including the risks and benefits of surgery and what you can realistically expect from your vision afterwards.

Treatment

Treatment depends on what is wrong with your cornea. Sometimes glasses, contact lenses, eye drops, or other non-surgical treatment can help for a long time. When the cornea is too damaged or too cloudy for these to work, a transplant may be offered. The aim is to restore clear sight, ease pain, or save the eye. Your eye doctor will discuss which type of transplant fits your case and what the likely outcome is for you.

Self-care at home

• Follow your eye care team's instructions exactly, including how to use any prescribed eye drops
• Wash your hands before touching your eye or your drops
• Do not rub your eye — this is especially important after surgery
• Wear the eye shield or glasses you are given, as advised, to protect the eye
• Keep follow-up appointments, even if your vision feels fine
• Tell your doctor about any new redness, pain, or change in vision straight away
• Avoid swimming, dusty places, and eye make-up until you are told it is safe
• Ask your pharmacist before using any over-the-counter eye drops

Medical treatments

Before surgery, doctors may use treatments such as medicated eye drops to reduce swelling or control inflammation, special contact lenses to smooth an irregular cornea, or other supportive care. After a transplant, you will usually need medicated eye drops for months, and sometimes longer, to help the eye heal and to calm the immune system so it accepts the donor tissue. Your eye care team will set a schedule that is right for you and will adjust it over time. Never change or stop these drops on your own, as that can lead to rejection of the transplant.

When is surgery considered?

Surgery may be suggested when your vision is poor enough to affect daily life and other treatments have stopped helping, when the cornea is scarred or swollen, when there is ongoing pain, or when the eye is at risk. There are several types of operation: some replace only the inner layer, some only the outer layer, and some replace the full thickness. The surgeon will pick the type that best matches your condition. Many people have the operation under local anaesthetic as a day case, and you can usually go home the same day.

Living with this condition

At first, your vision may be blurry and your eye may feel uncomfortable, gritty, or watery. This usually settles over days to weeks. Vision often improves slowly — it can take months, and sometimes up to a year, to reach its best level. Plan for a period of reduced driving and bring someone with you to early appointments. You will need to protect your eye, keep using your drops on schedule, and attend follow-ups. Many people find that within a few months they can return to work, reading, and most everyday activities.

Lifestyle tips

• Wear sunglasses in bright light if glare bothers you, and consider wraparound glasses for wind and dust
• Use good hygiene with contact lenses if you are fitted with them — never sleep in them or use tap water on them
• Avoid rubbing your eyes, and treat dry, itchy eyes early
• Wear protective eyewear for DIY, gardening, sport, and any work with chemicals or flying particles
• Keep a simple note of your drop schedule and set reminders on your phone
• Tell any doctor, dentist, or nurse that you have had a cornea transplant
• Keep up routine eye tests, even when things feel stable

Diet and exercise

There is no special diet for cornea problems, but eating a balanced diet with plenty of fruit and vegetables supports general healing. Drink enough water and limit alcohol. Gentle exercise such as walking is fine soon after surgery, but avoid heavy lifting, strenuous sport, swimming, and anything that could cause a knock to the eye until your surgeon says it is safe. Always check with your eye care team before restarting contact sports.

Mental health and emotional wellbeing

Waiting for surgery, coping with poor vision, and adjusting afterwards can be worrying. It is very common to feel anxious about whether the transplant will work or whether your body will reject it. Some people feel low or frustrated when recovery is slower than they hoped. Talking about these feelings helps. Share them with your eye care team, your family, or your family doctor, and ask about counselling if worry is affecting your sleep or mood. If you ever feel you cannot cope, contact your local mental health service or emergency services for support.

Prevention

Not all cornea problems can be prevented, especially inherited ones. But you can lower your risk of some causes. Protect your eyes with safety glasses at work and during DIY or sport, handle chemicals carefully, and never put tap water or homemade solutions in your eyes. If you wear contact lenses, follow the cleaning and wearing advice carefully and take them out at the first sign of redness or pain. Get eye problems checked early, and go for routine eye tests — early treatment can sometimes stop damage from getting worse.

Vaccines

There is no vaccine for cornea disease. Keeping up with routine vaccinations recommended for your age and health is still worthwhile, because general health and infection control support safe surgery and healing.

Screening programmes

There is no national screening programme for cornea disease. Routine eye tests at an optician can pick up early changes. If you have a family history of an inherited corneal condition such as Fuchs' dystrophy or keratoconus, tell your optician or doctor, as they may suggest earlier or more frequent eye checks. Children should have the standard newborn and child eye checks offered by your health service.

Complications

If left untreated

• Vision that slowly gets worse, sometimes to the point of significant sight loss
• Ongoing pain, glare, and sensitivity to light
• Scarring that cannot be reversed with glasses or drops
• In some cases, serious infection or damage that threatens the eye itself
• Difficulty with reading, driving, work, and everyday tasks

Long-term outlook

Most cornea transplants do well, and many people see a clear improvement in their sight. Some need a further operation years later, and a small number of transplants do not succeed. Rejection can often be treated if it is caught early, which is why keep-up appointments and using your drops as instructed matter so much. Even when sight cannot be fully restored, treatment can usually ease pain and protect the eye. Your eye care team can give you a realistic picture of what to expect in your own case.

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