Corneal Scarring

Typically, the cornea is clear and transparent, allowing light to pass through it without obstruction and reach the retina. This is important because the cornea plays a crucial role in bending light to focus images accurately on the retina at the back of the eye.

A corneal scar, which manifests as either an opacity or an irregularity in the cornea, can hinder its ability to focus light correctly. Often patients with scarring experience dimmed vision, blurred vision, or as if they are viewing through a cloudy filter.

However, not every corneal scar impacts vision. Scars located on the peripheral areas of the cornea might not affect vision at all. In contrast, scars situated in the central part of the cornea, particularly over the pupil, can lead to significant vision loss.

Corneal scarring can occur due to trauma, improper contact lens use, eye disease or degenerations, or even systemic diseases. Common causes include:

• Improper contact lens wear: Misuse of contact lenses, including improper cleaning, delayed replacement, inadequate hand hygiene, and sleeping in lenses.
• Corneal abrasion or eye injury: Most minor surface scratches heal without scarring, but severe mechanical injuries or deeper trauma can cause permanent scarring.
• Keratitis: Severe inflammation of the cornea secondary to viral, bacterial, or fungal infections.
• Keratoconus: Progressive abnormal thinning of the cornea causing the tissue to bulge forward and form apical scars.
• Corneal Dystrophies: Hereditary eye disorders that cause progressive structural changes and clouding within corneal layers.
• Ocular Herpes / Zoster: Viral infections that cause corneal dendritic sores, which can leave permanent deep stromal scarring.
• Stevens-Johnson Syndrome (SJS): Severe systemic reactions that cause painful blisters and lesions across ocular membranes, resulting in surface damage and scarring.
• Severe Dry Eye Disease: Chronic lack of lubrication and tear film instability that increases surface friction, micro-erosion, and eventual scarring.

A variety of treatment options exist for corneal scars, tailored to their severity and location. For mild peripheral scars, glasses or soft contact lenses might suffice. In cases of mild to severe scarring, specialty contact lenses are often most effective.

Among the treatment options, RGP (rigid gas permeable) lenses and scleral lenses are two types of specialty contact lenses that can be particularly effective for scarred corneas. Scleral lenses vault completely over the scarred cornea, creating a tear-filled optical chamber that neutralizes irregular surface distortions and provides sharp, comfortable vision.

For specific severe scarring cases, a corneal transplant could be advised. Additionally, laser treatments like phototherapeutic keratectomy (PTK) are available to eliminate shallow scars, while deeper scars might necessitate corneal transplant surgery.

The treatment plan for a corneal scar is influenced by its size, depth, and location on the eye, but it is also shaped by the patient's lifestyle and vision goals. At Charlotte Contact Lens Institute, we conduct thorough examinations for corneal scarring, ensuring ample time for one-on-one discussions with the doctor to address any questions.