The cornea is the clear window of the eye to the world. Anything that diminishes the clarity of this window will decrease the quality of vision. Dr. Gary Hirshfield in Queens is experienced in all aspects of medical and surgical corneal disease. The components of the cornea from the front to the back are the tear film, the epithelium, the stroma and the endothelium. For the cornea to be clear and give a clear image to the rest of the eye all of these components must function normally.
The most common abnormality of the cornea is a defect in the tear film or, so called, dry eye. Actually dry eye is a group of diseases that all lead to a defect in the tear film. Perhaps the most common problem is a condition called blepharitis. This condition takes many different forms but in almost all cases leads to symptoms of burning, crusting, redness, pain, discharge and abnormalities of the tear film and blurry vision. Our understanding of blepharitis has improved in recent years. The proper diagnosis can now lead to the appropriate combination of medication, nutritional and behavioral treatments that will alleviate or even eliminate these often very upsetting symptoms. Dry eye can also be caused by a lack of enough liquid tears. This is very common in postmenopausal women and people with inflammatory conditions, such as arthritis, although anyone can have a dry eye. Choosing the right therapy including the correct drops and supplements is an art as well as a science and is very well left to an experienced ophthalmologist.
Disorders of the corneal stroma don’t usually cause irritation or discharge but cause loss of vision. The most common problems are corneal scars from infections or inflammations, keratoconus and many other types of less common disorders. Typically the proceduraltreatment for this is corneal transplantation. Dr. Hirshfield is very experienced in corneal transplantation for these types of disorders. This can be done under local anesthesia on an outpatient basis. Occasionally if a scar in the cornea is very close to the surface it can be removed with a laser.
The endothelium is responsible for pumping water out of the cornea to keep it from swelling. When the endothelium stops working well the cornea can become swollen and cloudy. The most common causes of endothelial disease are after eye surgery or a disease called endothelial dystrophy. Until recent years the treatment for this was a corneal transplant. Recently, new procedures for transplanting only the endothelium have emerged. The advantage of these procedures is a much shorter healing time and quicker return of visual function. There are acronyms for these procedures such as DSEK and DSAEK. Dr. Hirshfield can tell you which, if any, of these procedures may be appropriate for your case. Of course, this is just a brief overview of some common elements of corneal disease and treatments. All types of medical and surgical treatments of corneal disease are offered at Hirshfield Eye Associates in Queens.