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Corneal topography and the morphology of the palpebral fissure

Read, Scott A. (2006) Corneal topography and the morphology of the palpebral fissure. PhD thesis, Queensland University of Technology.

Abstract

The notion that forces from the eyelids can alter the shape of the cornea has been proposed for many years. In recent times, there has been a marked improvement in our ability to measure and define the corneal shape, allowing subtle changes in the cornea to be measured. These improvements have led to the findings that pressure from the eyelids can cause alterations in corneal shape following everyday visual tasks such as reading. There are also theories to suggest that pressure from the eyelids may be involved in the aetiology of corneal astigmatism. In this program of research, a series of experiments were undertaken to investigate the influence of the eyelids on the shape of the cornea.

In the first experiment, an investigation into the diurnal variation of corneal shape was carried out by measuring corneal topography at three different times (approximately 9 am, 1 pm and 5 pm) during the day over three days of the week (Monday, Tuesday and Friday). Highly significant diurnal changes were found to occur in the corneal topography of 15 of the 17 subjects. This change typically consisted of horizontal bands of distortion in the superior, and to a lesser extent, inferior cornea, increasing throughout the day (and returning to baseline the next morning). These changes appeared to be related to forces from the eyelids on the anterior cornea. Some changes were also found in corneal astigmatism. Corneal astigmatism power vector J0 (astigmatism 90/180°) was found to increase slightly over the course of the week. Whilst the changes in astigmatism were small in magnitude, this result leaves open the possibility that pressure from the eyelid may cause changes in corneal astigmatism. If pressure from the eyelids is involved in the aetiology of corneal astigmatism, then one may expect associations to exist between certain characteristics of the eyelids and corneal shape. An experiment was then undertaken to explore these possible associations.

We defined the average morphology of the palpebral fissure in different angles of vertical gaze for 100 young normal subjects. This was achieved through analysis of digital images that were captured in primary gaze, 20° downgaze and 40° downgaze. Parameters defining the size, position, angle and contour of the eyelids were determined. Highly significant changes were found to occur in the palpebral fissure with downward gaze. The palpebral aperture narrows in downward gaze, and the angle of the eyelids changes from being slightly upward slanted in primary gaze, to being slightly downward slanted in downward gaze. The eyelid margin contour also flattens significantly in downward gaze.

The average topography of the central and peripheral cornea was also defined for this same population. A technique was used that allowed the capture and subsequent combination of topography data from both the central and the peripheral cornea. The use of this technique provided a large corneal topography map, with data extending close to the limbus for each subject. Marked flattening was found to occur in the peripheral cornea and a conic section was found to be a poor descriptor of corneal contour in the periphery (i.e. greater than 6 mm diameter). Corneal astigmatism was also found on average to reduce in the periphery. However a number of distinct patterns of peripheral corneal astigmatism were noted in the population. Corneal astigmatism in the peripheral cornea was either found to remain stable (59% of subjects), increase (10% of subjects) or reduce (31% of subjects) in magnitude in comparison to the amount of central corneal astigmatism.

We also investigated associations between the parameters defining the palpebral fissure and parameters describing corneal shape in this population of subjects. A number of highly significant associations were found between the morphology of the palpebral fissure in primary gaze and the shape of the cornea. A general tendency was found for subjects with wider horizontal palpebral fissure widths to exhibit larger corneas and also flatter central corneal powers. There were also highly significant associations found between the angle of the eyelids and the axis of corneal astigmatism, but not the magnitude of corneal astigmatism. The associations found between corneal astigmatism and palpebral fissure morphology is further evidence supporting the hypothesis that pressure from the eyelids is involved in the aetiology of corneal astigmatism.

The results of these investigations have shown that corneal changes as a result of eyelid forces occur in the majority of young subjects tested over the course of a normal working day. The average morphology of the palpebral fissure and topography of the central and peripheral cornea has also been defined in detail for a large population of young subjects. Significant associations were found between corneal astigmatism and the morphology of the palpebral fissure. Whilst these results support a model of corneal astigmatism development based on eyelid morphology, they do not prove causation. Further research including measurement of eyelid pressure and corneal rigidity may aid in understanding the exact aetiology of the magnitude and axis of corneal astigmatism.

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ID Code: 16203
Item Type: QUT Thesis (PhD)
Supervisor: Collins, Michael& Carney, Leo
Keywords: cornea, astigmatism, aberrations, eyelids, corneal topography, videokeratoscopy, digital imaging, eyelid morphology
Divisions: Current > QUT Faculties and Divisions > Faculty of Health
Current > Schools > School of Optometry & Vision Science
Department: Faculty of Health
Institution: Queensland University of Technology
Copyright Owner: Copyright Scott A. Read
Deposited On: 03 Dec 2008 13:58
Last Modified: 29 Oct 2011 05:44

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