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Although the cornea is clear and seems to lack substance,
it is a highly organized group of cells and proteins. Unlike
most tissues in the body, the cornea contains no blood vessels to
nourish or protect it against infection. Instead, the cornea
receives its nourishment from the tears and aqueous humor that
fills the chamber behind it. The cornea must remain transparent
to refract light properly, and the presence of even the tiniest
blood vessels can interfere with this process. To see well, all
layers of the cornea must be free of any cloudy or opaque areas.
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The corneal tissue is arranged in five basic layers, each having
an important function. These five layers are:
| 1. |
Epithelium: The cornea's outermost region, comprising about 10
percent of the tissue's thickness. The epithelium functions primarily to:
(1) Block the passage of foreign material, such as dust, water,
and bacteria, into the eye and other layers of the cornea; and (2)
Provide a smooth surface that absorbs oxygen and cell nutrients from
tears, then distributes these nutrients to the rest of the cornea. The
epithelium is filled with thousands of tiny nerve endings that make the
cornea extremely sensitive to pain when rubbed or scratched. The part of
the epithelium that serves as the foundation on which the epithelial cells
anchor and organize themselves is called the basement membrane.
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| 2. |
Bowman's Layer: A transparent sheet of tissue composed of
strong layered protein fibers called collagen. Once injured,
Bowman's layer can form a scar as it heals. If these scars are
large and centrally located, some vision loss can occur.
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| 3. |
Stroma: A layer accounting for 90% of the cornea's thickness,
consisting primarily of water (78 percent) and collagen (16 percent),
and does not contain any blood vessels. Collagen gives the cornea its
strength, elasticity, and form. The collagen's unique shape, arrangement,
and spacing are essential in producing the cornea's light-conducting
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| 4. |
Descemet's Membrane: A thin but strong sheet of tissue that
serves as a protective barrier against infection and injuries.
Descemet's membrane is composed of collagen fibers (different
from those of the stroma) and is made by the endothelial cells
that lie below it. Descemet's membrane is regenerated readily
after injury.
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| 5. |
Endothelium: The extremely thin, innermost layer of the cornea.
Endothelial cells are essential in keeping the cornea clear.
Normally, fluid leaks slowly from inside the eye into the middle
corneal layer (stroma). The endothelium's primary task is to pump
this excess fluid out of the stroma. Without this pumping action,
the stroma would swell with water, become hazy, and ultimately opaque.
In a healthy eye, a perfect balance is maintained between the fluid
moving into the cornea and fluid being pumped out of the cornea. Once
endothelium cells are destroyed by disease or trauma, they are lost
forever. If too many endothelial cells are destroyed, corneal edema
and blindness ensue, with corneal transplantation the only available
therapy.
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