Ocular Surface

Ocular Surface Treatment In Ambala

Cornea Services

The ocular surface is the interface between the functioning eye and our environment. This surface provides anatomic, physiologic, and immunologic protection and comprises the palpebral and bulbar conjunctival epithelium, the corneoscleral limbus, the corneal epithelium, and the tear film. While these structures represent the anatomical ocular surface, adnexal structures including the anterior lamellae of the eyelids, eyelashes, meibomian glands, and the lacrimal system are essential for appropriate protection and function of the ocular surface.

The ocular surface functions to maintain optical clarity of the cornea, serves as a refractive surface for accurate projection of light through the ocular media, and provides protection of the structures of the eye against microbes, trauma, and toxins. Creation of an unstable ocular surface from trauma or disease can compromise the integrity of any one of these protective functions and can lead to various forms of corneal and conjunctival dysfunction, broadly ranging from a mild corneal abrasion to severe stem cell loss, decreased vision, and ultimate blindness in the most severe disease. While the health and function of all these structures is imperative for a stable ocular surface, the most important key to anatomic and functional ocular surface stability remains the corneal epithelial stem cells. Our understanding of ocular surface disorders and stem cell physiology has undergone substantial evolution over the last three decades, with remarkable advancements in both corneal epithelial stem cell research as well as medical and surgical techniques for support and restoration of the ocular surface.

Ocular Surface Disease

Ocular surface dysfunction is the final common pathway that occurs as a result of an imbalance of ocular surface protective mechanisms. Each protective mechanism has its specific role, be it mechanical and/or physiological. Externally, the eyelids act as a physical barrier for protection of the ocular surface, and with each blink it distributes the tear film. Meanwhile, the corneal and conjunctival epithelia provide the biodefense system against microorganisms and proteolytic enzymes. The tear film is crucial, since it lubricates, protects and nourishes, as well as provides a smooth optical refractive surface. As in an orchestra, each component must function in concert to create a harmonious (and healthy) whole. For example, poor epithelial adherence to the basement membrane can lead to recurrent corneal erosion; lagophthalmos can lead to exposure keratopathy; these can all be exacerbated by the loss of corneal sensation and dry eyes.

When conventional medical therapy fails and/or secondary complications (such as persistent epithelial defect, scarring) occur, surgical intervention needs to be considered. The primary goals are to increase lubrication, to assist healing and epithelial adherence, to remove visually significant opacities and to restore sight with minimal side effects. This chapter reviews the current knowledge on various surgical procedures that assist in the protection and stabilization of the ocular surface in a variety of diseases.