Cornea, External Eye Disease & Ocular Surface Disorders

Ocular surface disorders affect the cornea, conjunctiva, eyelids, tear film and glands that keep the front of the eye healthy. Common examples include dry eye disease, meibomian gland dysfunction, blepharitis, ocular allergy, recurrent corneal erosion and contact-lens-related inflammation. Diagnosis requires examination of the whole surface system rather than the cornea alone.

External eye disease is a broad term for conditions affecting the visible front of the eye and its supporting structures, including the cornea, conjunctiva, eyelid margins and tear film. Symptoms can include redness, pain, watering, discharge, light sensitivity, fluctuating vision and difficulty wearing contact lenses.

Keratoconus is a progressive thinning of the cornea, causing it to bulge into a cone shape - resulting in distorted, blurred vision not correctable with standard glasses. Early keratoconus is managed with rigid contact lenses or scleral lenses. Corneal collagen cross-linking (CXL) halts progression. Advanced cases may require DALK or penetrating keratoplasty (corneal transplant).

CXL is a minimally invasive procedure using riboflavin (Vitamin B2) drops and UV-A light to strengthen corneal collagen bonds - halting keratoconus progression. It is performed under topical anaesthesia and takes about 60 minutes. CXL does not reverse existing distortion but prevents further deterioration.

Treatment is tailored to dry eye severity. Mild cases: artificial tears and lid hygiene. Moderate: prescription drops (cyclosporine), omega-3 supplements, and meibomian gland therapy (warm compress, LipiFlow). Severe: punctal plugs, serum tears, and scleral lenses. Our specialist identifies evaporative vs aqueous-deficient dry eye using Schirmer's test and OSDI scoring.

We manage bacterial, fungal and Acanthamoeba keratitis. Corneal ulcers are treated with intensive topical antibiotics or antifungals. Severe or central ulcers threatening vision may require corneal glue or emergency transplant. Early presentation is critical - contact lens wearers with eye pain and redness should seek immediate evaluation.

Depending on which corneal layer is affected: DALK (Deep Anterior Lamellar Keratoplasty) for keratoconus - replaces only the diseased layers, preserving the endothelium for faster recovery. DSAEK/DMEK for endothelial failure (Fuchs' dystrophy) - replaces only the innermost cell layer. Full-thickness PK (penetrating keratoplasty) for combined disease.

Severe dry eye can disqualify a patient from LASIK due to the risk of worsening symptoms after flap creation. Our team performs a thorough dry eye assessment before any refractive surgery recommendation. In many cases, treating dry eye first allows LASIK to proceed safely - or we recommend SMILE or ICL as alternatives.