Corneal Scars: Causes, Effects & Treatment Options

What causes corneal scars?

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• Previous infection — healed bacterial, viral (especially herpes simplex) or fungal keratitis
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• Trauma — cuts, foreign bodies or chemical injuries involving deeper layers
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• Keratoconus — scarring at the cone apex, or after acute hydrops
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• Surgery or inflammation — previous eye surgery or severe inflammatory disease
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How a scar affects vision

The cornea must be optically clear. A scar scatters light; the visual impact depends on:

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• Location — central scars over the pupil blur vision; peripheral scars may be unnoticed
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• Density — faint haze causes glare; dense leucomas block vision
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• Surface regularity — raised or uneven scars also distort the tear film and corneal optics
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Diagnosis

Slit-lamp examination determines scar depth and density; topography and tomography show its optical effect; pachymetry and endothelial assessment complete surgical planning. Photographs may document change over time.

Treatment options

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• Observation — for stable, visually insignificant scars.
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• Contact lenses — rigid or scleral lenses can neutralise surface irregularity and improve vision without surgery.
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• Phototherapeutic keratectomy (PTK) — excimer laser polishing can remove or smooth selected superficial scars and dystrophic deposits.
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• Corneal transplantation — for deep or dense central scars: DALK when the endothelium is healthy, PK when all layers are involved.
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When is transplant considered for a scar?

Only when the scar limits daily life and optical or laser options cannot provide adequate vision — the same honest threshold applied to any transplant decision. Recurrent herpes-related scars need the underlying viral tendency controlled before grafting.

Information on this page is for general education and does not replace an examination, diagnosis or personalised medical advice from a qualified eye-care professional.

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