Definition of Cornea

The Cornea

The first beam of light from the left is the cornea, the second beam is on the iris in the anterior chamber.
The first beam of light from the left is the cornea, the second beam is on the iris in the anterior chamber. | Source

About the Author

Daughter of Maat is an ophthalmic technician and has been examining patients on a daily basis for over 19 years.

She has had rigorous training under the supervision of an ophthalmologist and specialized in the cornea, cataracts, and retina as well as how systemic disease affects the eye. She has been certified by JCAHPO as a Certified Ophthalmic Assistant.

The cornea is essentially the window through which we see the world. It is a fascinating structure because, despite the fact that it is devoid of blood vessels, it has an amazing ability to regenerate.

The cornea can heal a superficial abrasion in about 24 hours without any scarring. In fact, it heals faster than any other part of the body.

The cornea is a group of cells that you can see through that provide 70 percent of the eye’s focusing power (cells that focus light – how cool is that?). This group of cells is comprised of five layers:

  • The Epithelium
  • Bowman’s Layer
  • The Stroma
  • Descemet’s Membrane
  • The Endothelium

The Five Layers of the Cornea


A Corneal Abrasion

A corneal abrasion stained with a yellow dye known as fluorescein.
A corneal abrasion stained with a yellow dye known as fluorescein. | Source

The Epithelium

The epithelium is the first layer of the cornea and contains all the nerve endings. The foreign body sensation, or feeling of something in your eye, is caused by these very sensitive nerve endings. These nerve endings also stimulate the tear ducts when the eye becomes dry.

The endothelium is the most likely layer to be injured by foreign bodies or abrasions and is only protected by the tear film which keeps the epithelium clean and nourished. It fills in irregularities as well, providing a shiny, smooth surface which provides clear vision.

The tear film also plays a part in the cornea’s amazing healing ability. It acts as a lubricant that prevents friction and keeps the eyelid from sloughing off any loose epithelial tissue. With an abrasion, this is very important.

Opacities found on the epithelium
Opacities found on the epithelium | Source

An abrasion is essentially a scratch on the corneal epithelium. More specifically, it is a piece of the epithelium that is missing due to injury. It is similar to chipped paint, the more you rub the paint, the more the paint comes off.

It’s the same with an abrasion. The more the eyelid is allowed to rub against the abrasion, the worse the abrasion gets. Some people have this condition chronically, and it is known as recurrent corneal erosion.

Abrasions and foreign bodies are quite painful, especially when the eye blinks. Injury to the cornea also causes sensitivity to light. Even if the cornea is merely dry, the person can become quite photophobic (light sensitive).

For those with chronic dry eyes, artificial tears provide relief and prevent corneal damage when used regularly. Keeping the cornea moist also helps abrasions to the epithelium heal faster.

Bowman’s Layer

The second layer of the cornea is known as Bowman’s layer. Unlike the other layers of the cornea, this layer is not composed of individual cells; it is made of randomly placed collagen fibrils.

Collagen is a protein most commonly found in connective tissue. In fact, it is the most abundant protein found in mammals. It typically takes the form of elongated filaments called fibrils.

Bowman’s membrane has no regenerative properties, which means it will scar if injured. Its actual function is currently unknown in ophthalmology. Interestingly, Bowman’s membrane is only found in the corneas of primates. It is absent in the cornea of dogs, cats, and other carnivores.

The Stroma

The third and thickest layer of the cornea is called the stroma. This layer gives the cornea its stability. Interestingly, the stroma is 78% water, and it does not regenerate. It typically scars if injured and depending on the severity of the injury may require a corneal transplant to restore visual clarity.

The stroma is the layer of the cornea that is targeted during refractive surgery procedures such as LASIK. This is because it also gives the cornea its shape. Refractive errors such as myopia, hyperopia and astigmatism can be permanently fixed by making the cornea either flatter or steeper (depending on the patient’s refractive error). This is achieved by using a laser to ablate (remove) a portion of the stroma, allowing light to focus properly on the retina.

Decemet’s Membrane

The fourth layer is Descemet’s membrane which is very elastic and snaps like a rubber band if it is cut. This layer is the basement membrane of the endothelial cells. If it is injured, the eye will usually require a transplant since the endothelial cells depend on Descemet’s membrane for support.

This layer is the target of many new transplant procedures such as:

  • Descemet’s Stripping Endothelial Keratoplasty (DSEK)
  • Descemet’s Stripping Automated Endothelial Keratoplasty (DSAEK)

Penetrating Keratoplasty

This is a one year old transplant, but you can still see the thin margin of the donor button (arrow).
This is a one year old transplant, but you can still see the thin margin of the donor button (arrow). | Source
  • Descemet’s Membrane Endothelial Keratoplasty (DMEK)
  • Descemet’s Membrane Automated Endothelial Keratoplasty (DMAEK)

These procedures involve removing Descemet’s membrane and the endothelium of the cornea and replacing them with donor tissue (using the same layers).

This is a huge improvement from the original procedure known as penetrating keratoplasty, or PKP, which removed a central “button” that was the full thickness of the cornea (see photo).

Although PKPs are still performed when needed, the Descemet’s membrane procedures have become the gold standard.

Descemet's Stripping Automated Endothelial Keratoplasty (DSAEK) Procedure

Corneal Endothelium Specular Microscopy

The individual hexagonal endothelial cells are easily seen here.
The individual hexagonal endothelial cells are easily seen here. | Source

The Endothelium

The final layer of the cornea is the endothelium. This layer maintains corneal deturgescence. In English, this means it maintains the relative dehydration that is necessary to keep the cornea transparent.

The cells of the endothelium act like little pumps to maintain the fluid in the cornea so that it looks like a clear window. They are hexagonal in shape and they are limited in number.

Because it cannot regenerate, the endothelium can be afflicted with endothelial dysfunction in which the cells cease to work properly, or die off altogether, causing a corneal dystrophy such as:

  • Fuchs Dystrophy
  • X-Linked Endothelial Corneal Dystrophy
  • Posterior Polymorphous Dystrophy
  • Congenital Hereditary Corneal Dystrophy

Fuchs dystrophy is by far the most common of the endothelial dystrophies. With Fuchs dystrophy, the endothelial cells deteriorate and eventually die off. This causes corneal edema and excess fluid to accumulate, causing the vision to become cloudy and blurred.


A patient being tested with a keratometer.
A patient being tested with a keratometer. | Source

Corneal Topography

A map of a patient's cornea. The area in red is the location of the astigmatism.
A map of a patient's cornea. The area in red is the location of the astigmatism. | Source

Corneal Astigmatism

One of the most common issues with the cornea is astigmatism. In fact, just about everyone has astigmatism, but some do not require correction for it.

Astigmatism is an irregularity in the cornea, and can be likened to a speed bump. It’s a raised portion of tissue in a specific area of the cornea that causes images to look as if they have a doubled edge. It is easily corrected with glasses, contacts or laser corrective surgery, such as LASIK.

Astigmatism can easily be detected with various tests including:

  • Refraction
  • Keratometry
  • Corneal Topography

A refraction is the test used to determine a patient's glasses prescription. The technician will normally find astigmatism during a refraction by performing retinoscopy, or using an astigmatic clock.

Keratometry manually looks for astigmatism by aligning a set of mires. This test is typically only performed by technicians with extensive experience in the field and when corneal topography can’t be performed, such as with severe scarring.

Corneal topography is a map that shows corneal elevation in different colors, allowing the doctor to see the thickest and thinnest part of the cornea along with any irregularities. The test is usually performed prior to any ocular surgery such as cataract surgery or LASIK.

© Copyright 2012 - 2015 by Melissa Flagg (aka: Daughter of Maat) ALL RIGHTS RESERVED

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Comments 6 comments

Apostle Jack profile image

Apostle Jack 3 years ago from Atlanta Ga

Thanks for the info.

billybuc profile image

billybuc 3 years ago from Olympia, WA

That was really interesting. I've had glasses since I was five but know very little about the eyes. Thank you and Happy New Year!

fpherj48 profile image

fpherj48 3 years ago from Beautiful Upstate New York

DOM...You are so incredibly knowledgeable in your particular field....just an enormous wealth of information for your readers. IMO, it's comforting to know that when we have questions or concerns about our EYES and our sight, etc....all we need to do is visit YOU!

Before today, I'm sure I'd have never realized how very amazing the "cornea" is!...........Thank you......Happy New Year!..UP++++

Daughter Of Maat profile image

Daughter Of Maat 3 years ago from Rural Central Florida Author

@Apostle Jack Your Welcome! Thanks for stopping by!

Daughter Of Maat profile image

Daughter Of Maat 3 years ago from Rural Central Florida Author

@billybuc Thank you! I've had glasses myself since I was five. I think that's what led me to my career. Every time I went to the eye doctor, I was fascinated by all the equipment and tests etc. I especially loved the photography of the inside of the eye. I think that's what sold me the most. It grossed my mom out horribly, but I would always ask for copies of the photos because I just loved looking at them! lol :D Happy New Year to you as well my friend! I've been reading your blog and hubs, but I just haven't had a chance to comment. I've recently found some actual freelance writing clients, and they are keeping me quite busy!

Daughter Of Maat profile image

Daughter Of Maat 3 years ago from Rural Central Florida Author

@Paula, awe thank you! you're too kind! I really enjoy sharing what I know with patients, and I guess that shows. My patients always told me I had a knack for explaining things simply, yet thoroughly. I guess my true calling is writing what I know! :D Thank you!

Happy New Year to you as well! Can you believe it's almost 2013 already? Time flies so quickly!

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