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An Introduction to Corneal Physiology
Sara M. Thomasy DVM, PhD, DACVO
With appreciation for slides provided by Ellison Bentley and Christopher J. Murphy
Corneal physiology
• Multiple layers
• Major functions:
– Protection
• Biodefense
• Healing
– Refractive system
• Transparent
Corneal Anatomy
• Epithelium: stratified squamous non-keratinized
• Anterior basement membrane: Basement membrane of epithelium
• Bowman’s layer: collagenous acellular zone
– Most variable element across vertebrates (present in birds, most primates, lizards, elephant)
– Not present in domestic mammals
• Stroma: Lamellae composed of fine, uniform diameter, evenly spaced, collagen fibrils
• Descemet’s membrane: Robust basement membrane of endothelium
• Endothelium: simple cuboidal epithelium
anatomy.iupui.edu/courses/histo_D502/ Lab.19.eye.f01.html
Human/Primate/Bird : 6 layers
AE E
AE = Anterior epithelium
ABM = Anterior basement membrane
BL = Bowman’s layer or Anterior Limiting Lamina (acellular)
S = Stroma (with intersperced keratocytes)
DM = Descemet’s membrane
E = Endothelium
ABM BL S DM
www.vetmed.ucdavis.edu/.../ epath_overview_index.html
Domestic Mammals: 5 layers
No Bowman’s Layer
Dog/Cat/Horse/Cow: 5 layers
ABM
• Stratified, squamous non-keratinized epithelium
• Physical, molecular barrier to injury
• Smooth optical surface
• Self renewing over 7-14 day period
Adler’s 11th ed, 4.21
Anterior Epithelium
Dog: H&E
Anterior Epithelium
• ~10% of corneal thickness.
• 2-4 layers of superficial
squamous cells
• 2-8 layers of polygonal wing cells
• Single layer of basal cells
• Transparent due to few organelles
Horse:
Masson’s
trichrome
Squamous
Wing
Basal
Types of cell-cell connections
• Gap junctions (macula communicans)
– Arrays of small channels
– Permit small molecules to pass through
• Tight junction (zonula occludens)
– Fusion of membranes
– Near impermeable barrier
• Desmosome/hemidesmosome
– Convergence of tonofilaments at CM
– Dense fibrous material between
– Tissues that undergo mechanical stress
From Krachmer, Cornea fig 1-4
Junctional Complex
• Tight junction (zonula occludens)
• Zonula adherens
• Desmosome
If you got real small and looked at your
feet while standing here………
The most superficial cells of the anterior corneal
epithelium possess microplicae and microvilli.
Name one function these could play?
Adherence and stability of the PTF
Exchange of oxygen & nutrients between PTF and cells
Continual Loss of Superficial Squamous Cells
Left: SEM of multiple superficial squamous cells of the anterior corneal epithelium
Right: TEM of a single squamous cell of the anterior corneal epithelium sloughing
off the surface into the precorneal tear film. Where will it go?
http://80.36.73.149/almacen/medicina/oftalmologia/enciclopedias/duane/graphics/figures/v7/0080/004f.jpg
Superficial squamous cells
• Flat, polygonal
– 2-6 mm thick, 40-60 mm diameter
• Terminally differentiated
• Microvilli - increase surface area
• Less mitosis and metabolism
Note lack of nuclei in superficial cells (Adler’s 10th ed, fig 4-3, TEM)
Superficial squamous cells
• Smaller light cells – younger
• Larger dark cells - older, soon to slough
• Membrane associated mucins -
glycocalyx (from epi and goblet cells)
Transmission electron microscopy
Krachmer, Cornea vol I, fig 1-2, 1997
Dark cell
Superfical squamous cells
• Barrier function:
– Desmosomes & tight junctional complexes between cells
– Cell membranes joined together to form semi-permeable barrier
Surface epithelial cells of human cornea
From: Adlers’ 10th edition (fig 4-2,
D=desmosome, M=microvilli)
How would this
affect topical ocular
drug delivery?
Drug penetration through epithelium
• Intermediate solubility ideal
• Lipophilic drugs (CSA)
– Poor stromal penetration
• Hydrophilic drugs (Gentamicin)
– Poor epithelial penetration
Much more from Dr.
Clode in pharmacology!
Wing cells
• 2-4 layers between superficial & basal cells
• Distinct keratin expression
• Interdigitated
– Desmosomes, gap junctions connect
Basal epithelial cells
• Single cuboidal layer
• Gap junctions, junctional complexes
– Communication between cells
• Lateral interdigitations
• Mitotic activity Normal canine cornea
Basal epithelial cell attachment
• Hemidesmosomes-composed of integrins
– Receptors for ECM molecules
– Role in wound healing?
• Linked to keratin filaments and anchoring fibrils
– Type VII collagen
TEM of canine cornea
Hemidesmosomes
Anchoring
fibrils
Basal epithelial cell attachment
• Adhesion complex:
– Hemidesmosome
– Basement membrane
– Anchoring fibrils
– Anchoring plaques
• Basal cells rupture rather than
break adhesion complex
Spontaneous chronic corneal epithelial
defects (SCCED)
• Anterior stroma
– Thin hyalinized layer (4-5mm)
– Barrier to reformation of
adhesion complexes
• Rest of cornea normal on
light & electron microscopy
– NOT a basement membrane
abnormality
Is this a basement membrane defect??
Alterations in SCCED
TEM spontaneous chronic
corneal epithelial defect (SCCED),
magnification 29K
TEM of normal dog after 8
weekly debridements,
magnification 29K
Basal epithelial cells
• Cells move from outside in
• Stem cells
– Transient amplifying cells
• Replicate rapidly
• Limited number of times
• Become basal epithelial cells
– Move in and up
– Differentiate in process
Sloughed Cells are Replaced by Regeneration
From Limbus
The stem cells of the anterior corneal epithelium are located at the limbus
Limbal stem cells
• Corneal stem cells
– Differentiate into transient amplifying cells & one stem cell
– Reside palisades of Vogt
– No keratin K3
– Unique markers (p63)
– Unlimited life span
Limbal stem cell deficiency
Limbal allograft
Limbal allograft – 3 weeks post-op
Limbal allograft – 6 months post-op
What does this look like?
Limbal autograft – 2 months post-op
Symblepharon: A limbal stem
cell deficiency?
Physiologic roles of epithelium
• Optically smooth surface
• Hyperplasia of epithelium
after ablation of stoma
• Epithelial thickness may
be controlled by stroma
Immed post 4 months post
Physiologic roles of epithelium
• Barrier formation
– Tight junctional complexes of superficial cells most critical
– Drug implications:
• Must penetrate hydrophobic epithelium & hydrophilic stroma
Wild Type Klf4CN
Physiologic roles of epithelium
• Barrier formation
– Tight junctional complexes of superficial cells most critical
– Drug implications:
• Must penetrate hydrophobic epithelium & hydrophilic stroma
Wild Type Klf4CN
Physiologic roles of epithelium
• Barrier formation
– Tight junctional complexes of superficial cells most critical
– Drug implications:
• Must penetrate hydrophobic epithelium & hydrophilic stroma
Physiologic roles of epithelium
• Immunologic:
– Langerhans cells
• Specialized dendritic cells derived from bone marrow
• Reside among basal cells of peripheral epithelium
• Professional antigen presenting cells
• ↑ with ocular inflammation & migrate towards site of injury IVCM of equine cornea with
fungal keratitis
Langerhans cell in mouse
cornea
Primate
What structure is this?
Anterior basement membrane
What histologic stain is being used?
Periodic Acid-Schiff (PAS)
Anterior basement membrane
• Specialization of extracellular matrix
• 40-60 nm thick
• Type IV collagen (lamina densa)
• Laminin, fibronectin
• Epithelial and stromal sources
• Ligands for integrins
• Growth factors, proteoglycans
• Topography influences cell behavior
• Maintenance of epithelium
• Matrix for cell migration
SEM of canine BM
Anterior basement membrane
Abrams et al, Cells, Tissue, Organs 2002
An Intact Basement Membrane
Promotes Corneal Wound Healing
• Normal basement membrane:
– Usually difficult to remove
– Matrix for cell migration
– New adhesion complexes (days to
weeks)
• Removal of basement membrane:
– Longer to reform adhesion complexes
– May not be normal for >1 year
TEM Canine ABM
Normal canine basement membrane
Exposed stroma in SCCED patient
Primate
What structure is this?
Bowman’s Layer
Name 3 animals that have this layer.
Primates, birds, giraffes, & whales
What is the purpose of Bowman’s layer?Invest Ophthalmol Vis Sci. 2011 Nov 11;52(12):8818-27.
Invest Ophthalmol Vis Sci. 2011 Nov 11;52(12):8818-27.
• Transparent, refractive surface
• 80-90% of cornea
• Arranged in lamellae
• Major cell type: Keratocyte
• Mainly composed of ECM:
– Collagens I, III, V, VI
– Proteoglycans
– Elastin
Corneal Stroma – Substantia Propria
Canine corneal lamellae
(polarizing photomicrograph)
Stroma composed of
numerous lamellae
Endothelium on
Descemet’s membrane
• Collagen fibers are 25 nm
• Type I collagen primarily
• Lamellae – type I collagen bundles
• 300 in center
• 500 in periphery
• 2 mm thick & 960 mm wide
• Type IV collagen holds them together
• Parallel within lamellae but
orientation varies
• Circumferential annulus
Human corneal lamellae
Basement membrane 7.5Bowman‘s layer 110 Anterior Stroma 33
Descemet‘s membrane 50
Epithelium Not assessed
Endothelium Not assessed
Human
(kPa)
Posterior Stroma Not assessed
Rabbit
(kPa)
0.574.5Absent1.1
0.3811.74.1
Human vs Rabbit Cornea
Highly
Intertwined
Mostly
Parallel
Human Rabbit
Corneal collagen fiber organization in rabbits and dogs is similar
Elastic modulusAnterior stroma 1.1 kPa
Posterior stroma 0.48 kPa
Dog
Lamellar Structure of the Normal Dog CorneaJamie Jester; UC, Irvine: 2nd harmonic imaging
Stroma – proteoglycan structure
• GAGs bound to core proteins
• Named for protein cores
– Four types of proteins
• Lumican
• Keratocan
• Mimecan
• Decorin
– Two types of GAGs
• Keratin sulfate
• Dermatan sulfate
• Highly sulfated, negatively charged
Stroma – proteoglycan function
• Decorin-dermatan sulfate
– Binds to type VI collagen
– Anterior > posterior cornea
• Retains more water
• Lumican-keratan sulfate
– Important for transparency
• Keratocan-keratan sulfate
– Rarely found elsewhere than the cornea
• Mimecan-keratan sulfate
– Similar to a proteoglycan found in bone
• Responsible for spacing, packing of collagen fibrils
• Lumican plays role in collagen fibril diameter
• Binds Na+ & K+, decreases effective osmolarity
• Keratocan – important for corneal thickness
• Increase viscosity
Stroma – proteoglycan function
WT Kera KO
Keratocytes
• Similar to fibroblasts
• Stellate shape
• Structural & biochemical homeostasis
• Extensive cytoskeletal components
– Contraction
– Maintenance of corneal shape
• Dendritic processes-up to 50 mm long
Nishida T, Yasumoto K, Otori T, Desaki J. The network structure of corneal fibroblasts in the rat as revealed by
scanning electron microscopy. Invest Ophthalmol Vis Sci. 1988 Dec;29(12):1887-90.
Keratocytes Form an Interconnected Network that extends Throughout the
Entire Thickness of the Cornea
• Gap junctions between
• Function as a single cellular system
• Regulated by extracellular environment
– Interact with ECM through intergrins
• Turnover every 2-3 years
• Injury - become independent from each other
Keratocytes
• Synthesize:
– Collagens
– Glycosaminoglycans
– Matrix metalloproteinases
– Phagocytose foreign
material when activated
• Critical for stromal
wound healing
Keratocyte function
From Krachmer, 1997,Cornea fig 1-8
Other stromal cells
• MHC + antigen presenting cells
– Anterior stroma
• MHC - antigen presenting cells
– Peripheral and central stroma
• Macrophages
– Posterior stroma
• Adult stromal stem cells
– Periphery
Adler’s 11th ed Fig 4.13
Is the most posterior stroma unique?
• Thin strip of stroma after BB technique
• 5-8 lamellae
• Acellular, ‘strong’
• Proposed new layer
Ophthalmology 2013;120:1778-1785.
• But this area is not acellular
• Interlamellar adhesive strength known
• Why only visible on dissected samples?
Descemet’s
membrane
Ophthalmology 2013;120:1715-1717.
“There is nothing new
under the sun”
Corneal Transparency
• The hallmark of corneal disease is an opacity
• It’s transparent because of
– What it has
• Nonkeratinized epithelium
• Relative stromal dehydration
• Small uniform diameter collagen fibrils
– Evenly spaced
– Arranged in lamellae
– And what it doesn’t have
• Blood vessels
• Myelinated nerve fibers
• Pigmentwww.snopes.com/horrors/ techno/cornea.htm
That’s what we tell the students…
• But:
– Sizes of fibers do vary
– Spaces between fibers vary
– Bowman’s layer
• Transparent
• Fibers randomly arranged
Porcine cornea
Stromal transparency
• Control distance between fibrils:
– Proteoglycans
– FACIT collagens
– Type VI collagen
– Fibronectin
• Fibers connected to next nearest neighbor
– Resistant to AP & lateral stretching
– Lattice maintained
Müller L, 2004, EER
Stromal transparency
• Importance of fiber diameter:
– Artificial corneas
• Synthetic polymers and collagen
• Transparency dependent on diameter below wavelength of light
– Sclera
• Larger diameter
• Opaque
Biosynthetic corneal implant
Cornea
Sclera
What about stromal cells?
• Dendritic processes of cells – minimal light scatter
• Keratocyte nuclei – light scatter
• High concentrations of corneal crystallins in keratocytes
– Minimize fluctuations in refractive index
Normal canine cornea
Corneal crystallins
• Crystallins: water-soluble proteins
• Corneal epithelium & keratocytes
• Protective function
– Absorb UV radiation
– Decrease lipid peroxidation & free radical formation
• Major types:
– Aldehyde dehydrogenase (ALDH)
• 10-40% of the water-soluble protein in the cornea
– Transketolase (TKT)
What happens with corneal wounding?
• Dramatic increase in light scatter by myofibroblasts
• Marked decrease in ALDH and TKT
• Cellular basis for transparency?
Jester JV, Moller-Pedersen T, Huang J et al. The cellular basis for
transparency: evidence for ‘corneal crystallins.’ J Cell Sci, 1999: 112,
613-622.
AKA Posterior limiting lamina or posterior limiting membrane (PLM)
Endothelium or posterior epithelium
Descemet’s membrane or PLM
Posterior stroma
Descemet’s membrane
• True basement membrane of endothelium
• 7-15 mm thick
• Grows throughout life of individual
• Ends in anterior trabeculae of outflow angle
• Comprised of:
• Collagen types III, IV, V, VI & VIII
• Laminin
• Distinctively layered
• Resistant to proteolytic enzymes
• Tears with shearing forces
• Adherent to posterior cornea
Descemet’s membrane
What happens if Descemet’s membrane ruptures?
Corneal hydrops!
Feline acute bullous keratopathy - any risk factors?
Systemic cyclosporine administration Pierce et al Vet Ophthalmol 2016
Corneal endothelium: a simple cuboidal epithelium.
The innermost layer of the cornea. In contact with the
aqueous humor of the anterior chamber.
Bonus round: What other structures in nature are
packed in hexagonal arrays and why?
Corneal endothelium: a simple cuboidal epithelium.
The innermost layer of the cornea. In contact with the
aqueous humor of the anterior chamber.
Bonus round: What other structures in nature are
packed in hexagonal arrays and why?
Hexagonal geometry is the most efficient packing geometry in nature
Corneal Endothelium serves both barrier and active pump functions to
minimize water content of the stroma.
SEM of corneal endothelium that lines the
innermost surface of the cornea
• High metabolic activity
– Large nuclei
– Rich in mitochondria & Golgi apparatus
– Prominent endoplasmic reticulum
• Tight and gap junctions present
Does epithelium or endothelium contribute more to stromal dehydration?
From Birth to Death: It’s a constant loss of cells
Very poor regenerative capacity in most species (rabbit an exception)
That’s what we tell the students…
• How does endothelial cell density (ECD) decline with age?
• Cats
- Rapid, non-linear ↓ in ECD for first 10 months postnatal
- Slower decline from 10-12 months
- No change in ECD from 1-14 years
Cat
Barody RA, Bito LZ, DeRousseau, Kaufman PL. Ocular development and aging. 1.
Corneal endothelial changes in cats and in free-ranging and caged rhesus monkeys. Exp
Eye Res 1987 45:607-622.
That’s what we tell the students…
• How does endothelial cell density (ECD) decline with age?
• Cats
- Rapid, non-linear ↓ in ECD for first 10 months postnatal
- Slower decline from 10-12 months
- No change in ECD from 1-14 years
• Rhesus macaque
– 20% ↓ between 1-6 years
– 0.1-0.7% ↓ per year for life
– No difference caged versus free range
• Divide in rabbits
• Evidence for peripheral stem cells
Rhesus macaque
Barody RA, Bito LZ, DeRousseau, Kaufman PL. Ocular development and aging. 1.
Corneal endothelial changes in cats and in free-ranging and caged rhesus monkeys. Exp
Eye Res 1987 45:607-622.
How does increased IOP from glaucoma affect
the cornea?
• ↑ pressure gradient will force more fluid across an intact barrier
• ↓ corneal endothelial pump efficiency
• Will not directly disrupt the epithelial or endothelial barrier functions
Horse
What happens to the endothelium with injury?
• Polymegathism - variability in cell area
– Increased cellular stress, instability, abnormal cytoskeleton
• Pleomorphism - deviation from normal shape
• Both increase with age, corneal thickness does not
– Changes indicate stress, may be more likely to be damaged
Normal 47 yr old 47 yr old after 27 years of contact lens wear
Endothelial control of corneal thickness
• Ion transport systems
– Water moves osmotically down gradients from active ion transport
• Results in corneal dehydration
• Na+-K+ ATPase
• Na+-H+ exchanger
– Located in basolateral aspect of cells
– H+ acidifies aqueous & intracellular CO2
• Net result of 2 pumps
– Na+ out, K+ in, H+ out
• Carbonic anhydrase
– Coverts to H2 & bicarbonate→ moved out of cell→ water follows
• Mimic aqueous components
• Energy source = glucose
• BAB/junctional stabilizer = calcium & glutathione
• Buffer = bicarbonate (ion transport)
• pH = 7.38
• Osmolarity = 304
Intraocular irrigating solutions
Corneal Innervation It does more than just transmit nociception
• The most densely innervated structure in the body
• Nerves present anterior but not posterior
• Ophthalmic branch of CN V
– Sensory, autonomic nerve fibers
• Neuropeptides
– SP, CGRP, VIP
• Neurotransmitters
– Norepi & Ach
These compounds, secreted by the nerve endings, are trophic
(neurotrophic). They are essential for maintaining normal corneal health.
If you denervate the cornea, degenerative changes will occur!
Normal dog
360 mm 120 mm
Marfurt, IOVS 2001
Canine corneal innervation
• 14-18 superficial stromal nerve bundles enter radially at limbus
• Bundles branch
– dense anterior stromal plexus
• Epithelial leashes extend through basal layer, then through basal, wing, squamous cell layers
Marfurt, IOVS, 2001
Corneal wound healing
• Epithelial, stromal, & endothelial processes differ
• Trauma, infection, surgery
• Regulated by growth factors, cytokines, proteases, neuropeptides
– Autocrine, paracrine
– Epithelial cells, keratocytes, nerves, lacrimal gland, immune system
Corneal epithelial wound healing
• Cell migration
– Ameboid movement toward center of wound
– Cells thin
– Migrate toward center of lesion
• Centripetal movement
• 20-50 mm/hr
Adler’s Physiology, 10th edition, fig 4-26
• Initial lag phase
– Retract, thicken, lose hemidesmosomal attachments
– Cytoskeletal proteins, vinculin, actin, talin, integrins synthesized
– Integrins disassociate & migrate over surface
• Adherens molecule to ECM
• Fibronectin = provisional matrix for attachment
• Cell proliferation to re-establish thickness, differentiation,
adhesion complexes to BM
• Restore barrier & optical function
Krachmer, Cornea, Fig 8-7
Corneal epithelial wound healing
What’s wrong with SCCEDs?
• Have fibronectin
– Provisional matrix for cell attachment
– Epithelial cells can migrate
• No laminin, collagen IV, collagen VII
– Epithelial cells cannot reform rest of BM & adhesion complexes
Stromal wound healing
• Trauma, infection, inflammation
• Epithelial or stromal injury
– Adjacent keratocytes die
• Defect fills with fibrin clot
• Remaining keratocytes transform
Krachmer, Cornea, Fig 8-15
• Keratocyte-fibroblast-myofibroblast transformation
– Lose connections to other keratocytes
– Stimulated by TGFb
– Critical for wound contraction & matrix organization
– Myofibroblast phenotype
• Prominent actin filaments
• Expression of smooth muscle form of actin
Stromal wound healing
Stromal wound healing
• Polymorphonuclear leukocytes arrive in 2-6 hours
– Debride wound
– From tear film immediately & vasculature
• Myofibroblasts - migrate to wound margin
– Secrete extracellular matrix constituents
• PMNs & myofibroblasts ∆ fibrin plug to scar
Stromal wound healing
• Wound strength increases for 4-6 months
– Some studies-up to 4 years
• Scar composition
– Type III collagen
– Poorly sulfated proteoglycans
– Fibronectin
– Laminin
Krachmer, Cornea fig 8-20
• Corneal scarring:
– Different amounts & types of collagen, proteoglycans
– Differing diameters collagen fibers
– Increased reflectivity of keratocytes
Stromal wound healing
Keratomalacia
• Enyzmatic degradation
– Infection
– Inflammation
• Source:
– Bacterial or fungal collagenases
– MMPs from keratocytes or
inflammatory cells (PMNs)
• Matrix metalloproteinases (MMPs)
– Zinc binding proteases
– Collagenases (MMP-1, -8, -13)
– Gelatinases (MMP-2,-9)
– Stromelysins (MMP-3, -10, -11)
– Matrilysin (MMP-7)
• Degrade or modify ECM
• Tissue inhibitors of MMP-TIMPs-play a role in wound healing
• Need balance for normal wound healing to occur
Keratomalacia
Endothelial wound healing
• Defects primarily covered by cell spread
– Leads to cell enlargement
– Do not break contact
– Some myoblastic differentiation
– Maybe some endothelial proliferation at wound edge (cats)
– Corneal thickness not normal until monolayer re-established
Epithelial-stromal interactions
• Complex environment
– Soluble factors
– Extracellular matrix
– Biomechanical factors
• Studying factors in isolation
– Likely inaccurate
Epithelial-stromal interactions
• Epithelial debridement/injury
– Apoptosis of underlying keratocytes
– Found in multiple species
– Inducible factor from tears?
Canine cornea 3 days post epithelial debridement
Growth factors in epithelial wound healing
• Growth factors - stimulate cell mitosis in tissues
– Named by tissue of origin or behavior
• Platelet-derived growth factor or transforming growth factor
• Cytokines - mitosis & differentiation of inflammatory cells
• Distinction is artificial
Questions?