Corneal opacity and scarring

Disease Description (Causes and Symptoms)

• Definition: A condition in which the transparency of the cornea is impaired, obstructing the transmission of light; it includes opacities or scars occurring at various depths, from the superficial layer (epithelium) to the stroma.
• Main causes: Trauma (corneal abrasion, foreign body), infection (bacterial, fungal, or viral corneal ulcer), inflammation (such as keratitis), corneal degeneration or dystrophy, underlying diseases such as keratoconus, and postsurgical scarring.
• Brief pathophysiology: The arrangement of collagen fibers in the cornea may be disrupted, or proliferation of fibroblasts (or myofibroblasts) may produce irregular fibrous layers and scar tissue. When accompanied by neovascularization or corneal stromal damage, the opacity may worsen.
• Main symptoms: Decreased vision (depending on the location and depth of the opacity), glare or photophobia, blurred vision or image distortion (due to irregular astigmatism), pain or discharge (during active infection), and eye fatigue or a foreign-body sensation.

Treatment Methods

• Principle: The treatment strategy is determined according to the cause, location, and depth of the opacity — the underlying disease is treated first, while the scar or opacity itself is managed conservatively or surgically.
• Conservative treatment
  • Infection treatment: Bacterial (broad-spectrum antibiotic eye drops → switch according to culture results), fungal (antifungal agents), viral (antiviral agents).
  • Inflammation control: Topical steroids (used only when an active infection is controlled), with nonsteroidal anti-inflammatory drugs as an adjunct when necessary.
  • Symptom relief: Artificial tears, protective contact lenses (therapeutic soft lenses), and pain control.
• Treatments to reduce scarring or opacity
  • Superficial opacity: May be improved with superficial debridement, aseptic cleansing, or phototherapeutic laser (Phototherapeutic Keratectomy, PTK).
  • Deep or central opacity: Layer-specific (partial) corneal transplantation (full-thickness (penetrating) transplantation, DALK, etc.) may be considered.
  • Other: Amniotic membrane transplantation (to promote healing), corneal tattooing (limited use for cosmetic purposes), and contact lenses (vision correction with special rigid or toric lenses).
• Key points in current and important guidelines
  • Steroid eye drops are contraindicated (or should be used cautiously) in active infections.
  • When a structural disease such as keratoconus is the underlying cause, corneal strengthening (cross-linking) can help suppress progression but has limited effects on the scar itself.
• Precautions, complications, and self-care
  • Complications: Corneal perforation, reinfection, graft failure (rejection or recurrence of opacity), worsening keratoconus, secondary glaucoma, and others.
  • Self-care: Follow contact lens hygiene practices, visit an ophthalmologist immediately after eye trauma, use prescribed medications regularly, and do not use steroids on your own without medical advice.
  • After surgery: Postoperative antibiotic and steroid eye-drop treatment to prevent infection, along with regular follow-up, is necessary.

Outpatient Visit Checklist (Including Items to Prepare and Example Questions)

• Items/information to prepare
  • A list of all medications currently being taken (including eye drops) and the times they are taken
  • History of previous ophthalmic surgery, trauma, or treatment (year and procedure name)
  • When the vision changes began and how quickly they progressed (e.g., suddenly or gradually)
  • Details of the symptoms (presence of pain, discharge and its color, glare, night vision, etc.)
  • Whether contact lenses are used, their type, and how they are maintained
  • Medical history of systemic diseases such as diabetes or autoimmune disease
  • If possible, photographs of the symptoms (on a mobile phone) or copies of previous examinations (fundus or slit-lamp photographs, corneal topography)
• Items to submit to the doctor during the outpatient visit
  • A recent visual acuity chart or record, if available; previous prescriptions or test results
• Example questions to record for yourself during the outpatient visit
  • The date the symptoms began and when they worsened (e.g., when and in what situations they become more severe)
  • Whether you have recently worn contact lenses or experienced eye trauma

Examples of General Questions to Ask the Doctor

• To what extent is this opacity (scar) expected to affect my vision?
• What are the main side effects of the medications (eye drops or oral medications), and what drug interactions should I be aware of?
• What are the criteria for recommending surgery (such as corneal transplantation or PTK), and how long is the recovery period after surgery?
• How are the likelihood of recurrence and the long-term prognosis (possibility of vision recovery) assessed?

Examples of Disease-Specific Questions

• Which layer of the cornea contains my opacity (epithelium, stroma, or endothelium)? What treatments are recommended for each layer?
• Depending on whether the current scar is central (along the visual axis) or peripheral, would nonsurgical correction (glasses or contact lenses) be sufficient, or would surgical correction be necessary?