Cornea and External Disease

The sub-specialty of Cornea and External Disease refers to the medical and surgical management of the full range of routine, complex and high-risk corneal and external eye diseases.  The cornea is the clear, dome-like structure on the front of the eye through which we see.  Corneas can be damaged through inflammation, degeneration, allergies, infections, injuries and inherited dystrophies. External disease refers to conditions of the conjunctiva and eyelids that affect the function of the eyes themselves.

Dr. Daniel P. Greene is a specialist in Cornea and External Disease, as well as specialists in cataract / lens implant surgery and complex surgical procedures involving the anterior segment of the eye.

What are common corneal and external disease conditions?

The corneal can be affected by a wide range of conditions including:

• Dry eye
• Infections such as cornea ulcers caused by bacteria, viruses, fungi, and protozoa
• Allergic and atopic conditions
• Auto-immune conditions
• Hereditary conditions and dystrophies such as Fuchs' dystrophy, epithelial basement membrane dystrophies, map-dot-fingerprint dystrophy, Reis-Bucklers corneal dystrophy, stromal cornea dystrophies, lattice corneal dystrophy, granular corneal dystrophy, congenital stromal corneal dystrophy, posterior corneal dystrophies, posterior polymorphous corneal dystrophy, and congenital hereditary endothelial dystrophy, for example
• Herpes zoster (shingles) and herpes simplex infections
• Iridocorneal endothelial syndromes (ICE syndromes)
• Keratoconus
• Growths and tumors including ptyergia and nodules.
• Scarring following trauma and complications from prior eye surgery

External disease conditions encountered include:

• Blepharitis, including difficult to treat conditions such as Demodex folliculorum
• Ocular pemphigoid
• Limbal stem cell deficiency
• Trichiasis
• Atopic conjuctivitis

These conditions can cause significant symptoms of ocular irritation and pain, and can lead to significant vision loss.  While all of the ophthalmologists of Richmond Eye Associates can diagnose and treat these conditions, consultation and referral to the Cornea and External Disease specialist may be necessary to help manage difficult or complex cases.

Medical treatment of corneal and external disease conditions

There are a wide variety of medical treatments for corneal and external disease conditions, ranging from over the counter artificial tears of different types to prescription medications to specially formulated eye drops made only by compounding pharmacies.  Other non-surgical treatments include bandage contact lenses to protect the cornea and punctal plugs for dry eye.

Microscopic and immunologic diagnostic tests are also available through the Cornea and External Disease specialists.

Surgical options for corneal and external disease conditions

The Corneal and External Disease specialist of Richmond Eye Associates is fellowship trained in advanced surgical management of corneal conditions such as penetrating and lamellar keratoplasty (corneal transplant), DSEK procedures, amniotic membrane procedures, and anterior segment reconstruction procedures.  In some cases corneal, scleral, or conjunctival biopsy might be necessary for diagnostic purposes.  Therapeutic laser procedures (PTK) are available as well.