What is a corneal detachment?

Corneal detachment is a change in one or more layers of the cornea that causes the cornea to detach from the eye.
As a rule, this only happens in part, so there is then a partial detachment of the cornea.

The causes are varied, but mostly they are mechanical triggers, such as a chemical burn, bruise or the penetration of a foreign body into the eye.
Since the cornea is a very well innervated section of the eye, such an injury is always associated with severe pain. Depending on the cause, corneal detachment can usually be treated very well.

Read more on the subject under: Corneal opacity

causes

The causes of a corneal detachment are very diverse. Depending on this, there is a different degree of detachment of the cornea.

A trauma, i.e. an accident, to the eye can cause tears in the cornea, which in turn can peel off part of the cornea. Usually these are bruises that cause cracks in the so-called Descemet's membrane, a lower layer of the cornea.

A foreign body such as a metal splinter can penetrate the eye. Damage to the cornea results in tears. It is important that the foreign body is removed early to prevent it from growing in. Even if the cornea is burned with acid, individual layers of the cornea can peel off and must be treated with a rinse as soon as possible to prevent further damage.
In the case of a burn, depending on the severity, the upper layer of the cornea is destroyed and detached. This is scabbed.

Read more on the subject under: Corneal edema in the eye

Corneal detachment by contact lenses

Occasionally, the use of contact lenses can damage the cornea with tears and, in some cases, corneal detachment. In most cases, however, this is not due to the contact lenses themselves, but rather to incorrect use.

Inserting and removing contact lenses with fingernails that are too long or sharp can lead to cracks in the cornea. Furthermore, wearing contact lenses for too long can damage the cornea and cause corneal detachment. Therefore, great attention should always be paid to the length of time that the contact lenses are allowed to stay in the eye.

diagnosis

If a corneal detachment is suspected, an anamnesis should first be carried out, i.e. a doctor-patient discussion, in order to identify possible causes for the damage to the cornea.
Usually the characteristic very strong pain is an indication, since the cornea is very well supplied by nerves.

The most important examination tool of an ophthalmologist if changes in the cornea are suspected is the slit lamp. The corneal surface can be viewed and assessed more precisely. Depending on the cause or suspicion, it may be helpful to stain some structures with the dye fluorescein.

What symptoms indicate corneal detachment?

The symptoms of corneal detachment depend on the cause and the severity of the damage. Since the cornea has many nerve endings and is therefore well supplied by nerves, an injury usually leads to severe pain.

When parts of the cornea are torn or detached, there is often a very unpleasant foreign body sensation. This is caused by the fact that the cornea is no longer intact and part of the cornea may lie loosely on it. Since the cornea is significantly involved in the ability to see, damage and detachment of the cornea lead to a significant impairment of vision. This can be different depending on the cause.

Usually there is an acute deterioration in vision, in some cases there may also be increasing impairment. Another common symptom of corneal detachment is reddening of the eye, which is caused by overly filled vessels in the conjunctiva. This is also known as a conjunctival injection. In addition, there is often increased tearing of the eye, which is a kind of protective mechanism. It is used to rinse any foreign bodies that may be present from the eye.

Treatment and therapy

Corneal detachment can be treated differently depending on the cause. In some cases, an ointment bandage may be sufficient. It has a stabilizing effect and at the same time protects against possible infections through antibiotic ointments.

If there are only small tears in the cornea, these can usually heal by themselves, as the tissue of the cornea can regenerate itself to a certain extent. However, surgical treatment is required for larger wounds. In the event of detachment, parts of the cornea or usually the entire cornea can be replaced.

In a so-called keratoplasty, i.e. a corneal transplant, a donor cornea is used as a replacement for the damaged cornea. The cornea is not supplied by blood vessels, but by diffusion, i.e. passive metabolism, via surrounding structures. This is the reason why corneal rejection occurs much less frequently after such a transplant.

If the cornea is detached or damaged by a chemical burn, rinsing the eye as quickly as possible is initially more important.
If the eye is not freed from all corrosive agents in a timely manner, permanent damage with permanent impairment of vision can occur.

Course of the disease

The course of the corneal detachment depends on the reason for the damage to the cornea, its severity and the treatment.

If, for example, the cornea is burned and the cornea becomes detached as a result, a good course can only be expected with this form if the eye is rinsed as quickly as possible.

In the event of major mechanical damage to the cornea, action must be taken promptly. In rare cases, a change over a few weeks can lead to a peeling of the cornea.

forecast

The prognosis of the corneal detachment can be given depending on the size of the corneal detachment and the possible therapy options.
In many cases, a corneal graft called a keratoplasty is the best way to relieve symptoms.

This surgical procedure usually has very good results because the cornea, as a layer that is not directly supplied by blood vessels, shows fewer rejection reactions after a transplant.
However, if appropriate treatment cannot be given promptly in the event of a corneal detachment, the prognosis can also be significantly less favorable.

An ophthalmologist should therefore always be consulted if symptoms and pain in the eye area are unclear.