What is the Cornea?

The cornea is the eye's outermost layer. This clear, dome-shaped surface plays an important role in visual acuity. 

Although the cornea is clear and seems to lack substance, it is actually a highly organized group of cells and proteins. Unlike most tissues in the body, the cornea contains, under normal circumstances, no blood vessels to nourish or protect it against infections. Instead, the cornea receives 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.

The corneal tissue has five basic layers, which each have important functions.

Epithelium

The epithelium is the cornea's outermost region, comprising about 10 percent of the tissue's thickness. It is is filled with thousands of tiny nerve endings that make the cornea extremely sensitive to pain when rubbed or scratched. Its functions include:

  • Preventing foreign material, such as dust, water, and bacteria, from entering the eye and other layers of the cornea.

  • Providing a smooth surface that absorbs oxygen and cell nutrients from tears.

Bowman's Layer

Directly below the epithelium is a clear sheet of tissue known as the Bowman's layer. It is made of strong, layered protein fibers called collagen. Once injured, the Bowman's layer can form a scar as it heals. If these scars are large and centrally located, vision loss can occur.

Stroma

Beneath the Bowman's layer is the stroma, which makes up about 90 percent of the cornea's thickness. It consists mainly 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 transparency.

Descemet's Membrane

Under the stroma is the Descemet's membrane, a thin, but strong, tissue that serves as a protective barrier against infection and injuries. The Descemet's membrane is made of collagen fibers (different from those of the stroma). The membrane regenerates after injury.

Endothelium

The endothelium is 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 stroma. The endothelium  pumps 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.