ANATOMY AND
PHYSIOLOGY OF THE
CORNEA
PRESENTERS
CHANGWE MUSONDA
The cornea acts as a clear refractive surface and a protective barrier to
infection and trauma. Its anterior surface is elliptical (11.7 mm
horizontally, 10.6 mm vertically), whereas its posterior surface is
circular (11.7 mm). It is thinnest centrally (520 μm) and thicker
peripherally (660 μm).
COMPOSITION OF HUMAN CORNEA
• Water: 78%
• Collagen: 15%
Of which: Type 1: 50-55%
Type 3: 1%
Type 4: 8-10%
Type 6: 25-30%
• Other protein: 5%
• Keratan Sulphate: 0.7%
• Chondroitin/Dermatan Sulphate: 0.3%
• Hyaluronic acid and salts: 1%
ANATOMY
The cornea consists of five layers. From anterior to posterior, these are as
follows
• EPITHELIUM
This is a nonkeratinized stratified squamous epithelium (5–7 cell layers
thick), which accounts for around 10% of the thickness of the adult
cornea. It is of ectodermal origin. Only the columnar basal cells are
capable of the cell division required to replenish the continual
desquamation of superficial cells from the anterior surface.
Basal cells: It is the germinative layer of the epithelium and the only
layer with mitotic activity
Superficial Cells: They have microvilli and help in glycocalyx
formation and stability of the tearfilm.
• BASEMENT MEMBRANE ZONE
The basement membrane (BM) zone consists of the epithelial BM and
Bowman’s layer, which is a thin, avascular, superficial stromal layer of
collagen fibrils. The compact arrangement of collagen give it great
strength and relative resistance to trauma both mechanical and infective.
It is also of ectodermal origin. It is unable to regenerate and thus heals
by scarring.
• STROMA
The stroma accounts for around 80% of corneal thickness. Despite active
deturgence, its main component is water (75%). Of its dry weight, 70% is
collagen (types I, IV, V, VI), and the remainder is proteogylcan ground substance
(chondroitin sulfate and keratan sulfate). Keratocytes are a resident population of
modified fibroblasts involved in remodeling after injury. The stroma is of
mesodermal origin.
• DESCEMETS MEMBRANE
Descemet’s membrane consists of a fetal anterior banded zone (present at birth)
and a posterior nonbanded zone (produced later by the endothelium). It first
appears at 2nd month gestation, it is of mesodermal origin and the major protein
is type 4 collagen. It is not capable of regeneration. Thickness:
At birth: 3-4um
Childhood: About 5um
Adult: 10-12um
• ENDOTHELIUM
This is a monolayer of hexagonal cells forming a continuous mosaic
that is best seen with spectral microscopy. It is of mesodermal origin. It
is unable to regenerate. Cell loss with age is compensated by
enlargement (polymegathism) and migration of neighbouring cells.
PHYSIOLOGY
CORNEAL TRANSPARENCY
Corneal transparency is dependent on the following:
• Active deturgence. The endothelium is relatively permeable. A passive
flow of water and nutrients from the aqueous is drawn across into the
stroma (“stromal swelling pressure”). To prevent overload(edema) and
maintain its transparency, the endothelium pumps Na back out into the
+
aqueous by active Na K ATPase, together with a passive movement of
+ +
water. Water may also pass through hormonally mediated aquaporins.
The epithelium is relatively impermeable because of the presence of
apical tight junctions.
• Regular orientation and spacing of stromal collagen fibers. This
reduces diffractive scatter of light. After injury, loss of architecture may
result in opacity and scarring.
REFRACTION
• The cornea acts as a biconcave lens accounting for 70% of the eye’s
total dioptric power. The radii of curvature of the anterior surface is
7.68 mm, the posterior surface is 6.8 mm. The cornea is a robust
elastic surface. Its shape is maintained by structural rigidity and
intraocular pressure.
NUTRITION AND NERVE SUPPLY
• The cornea is avascular and relies on diffusion from the limbus and
aqueous for nutrition. Langerhans cells (antigen-presenting cells) are
present in the epithelium but are usually restricted to the outer third.
The ophthalmic division of the trigeminal nerve has three parts: the
frontal, lacrimal nerve and nasociliary nerve. The Nasociliary nerve
provides sensory innervation to the cornea.
