Yes, it is entirely possible to get a scar on your eye. Ocular scarring is a permanent alteration of tissue structure that follows significant injury, inflammation, or disease. This process is the body’s natural attempt to repair damaged tissue, but the resulting scar tissue lacks the specialized clarity or function of the original cells. Eye scars can range from a minor, visually insignificant blemish to a dense, opaque lesion that severely impairs sight.
Where Eye Scars Occur
The most visually consequential location for scarring is the cornea, the clear, dome-shaped outermost layer at the front of the eye. The cornea is responsible for roughly 65% to 75% of the eye’s focusing power and must remain transparent to allow light to pass through unimpeded. Scar tissue forming in the corneal layers, particularly the thick central stroma, causes a loss of transparency.
Any opacity on the cornea scatters light and blocks the visual pathway, directly interfering with the eye’s ability to focus light onto the retina. While the cornea is the primary concern for vision loss, scarring can also affect other parts of the eye.
The conjunctiva, the thin membrane covering the white part of the eye and the inner surface of the eyelids, can also develop scars. Conjunctival scars are usually less visually disruptive but can cause chronic irritation, dryness, or adhesions that restrict eye movement. Deeper injuries can occasionally affect the sclera, the tough, white outer wall of the eyeball, manifesting as a localized, white or discolored patch.
Common Causes of Ocular Scarring
Scarring develops when the body’s healing response replaces specialized tissue with unorganized, fibrous connective tissue.
Physical Trauma
Physical trauma is a frequent cause, ranging from simple corneal abrasions, which usually heal without issue, to deep lacerations caused by foreign objects or blunt force injuries. Serious injuries that penetrate the inner layers of the cornea often result in permanent, vision-blocking scar tissue.
Ocular Infections
Infections are another leading cause, particularly bacterial, viral, or fungal keratitis, which is an inflammation of the cornea. These infections rapidly destroy corneal tissue, creating ulcers that heal by leaving dense, opaque scars. Misuse of contact lenses, such as sleeping in them or poor cleaning habits, significantly increases the risk of developing these sight-threatening infections.
Chemical Exposure
Exposure to harsh chemicals can cause severe and rapid scarring. Alkali substances, like lye or ammonia, are especially destructive because they penetrate the cornea deeply and quickly, causing continuous tissue breakdown. Acidic substances tend to cause a more superficial injury by coagulating protein on the surface, which limits deeper penetration but still results in significant scarring.
Inflammatory Conditions
Less commonly, severe inflammatory or autoimmune conditions can lead to corneal scarring. Diseases like severe rheumatoid arthritis, Stevens-Johnson syndrome, or chronic dry eye disrupt the surface of the eye, causing persistent inflammation and subsequent scar formation. This chronic damage compromises the ocular surface, making the tissue vulnerable to secondary infections and eventual scarring.
Impact on Vision and Symptoms
The consequence of an eye scar is directly tied to its location, depth, and density. A scar positioned directly over the visual axis—the path light takes through the center of the pupil—will cause the most significant impairment. Even a small, dense scar in this central area can severely reduce visual acuity, causing blurred or cloudy vision.
Scars located closer to the periphery of the cornea often cause minimal or no visual symptoms because they do not obstruct the direct path of light. However, peripheral scars can still cause glare sensitivity and light scattering, especially noticeable when driving at night. The unorganized structure of the scar tissue causes incoming light to scatter rather than focusing cleanly, which produces a hazy or distorted image.
Depending on the cause and depth of the injury, symptoms can also include chronic eye pain, a persistent feeling that something is in the eye, and excessive tearing. If the scarring results in an irregular corneal surface, it can induce significant astigmatism, making objects appear wavy or distorted. The severity of vision loss is proportional to the opacity; deep, full-thickness scars can lead to near-total blindness in the affected eye.
Medical and Surgical Management
Initial management focuses on controlling inflammation and preventing further tissue damage, often using topical medications like steroid or anti-inflammatory drops. For scars causing visual impairment, treatment begins with non-surgical methods.
Specialized contact lenses, such as rigid gas-permeable or scleral lenses, can mask the irregularity of a scarred cornea. These lenses create a smooth optical surface over the damaged tissue to improve vision.
Laser Treatment (PTK)
When a scar is superficial and limited to the outermost layers of the cornea, Phototherapeutic Keratectomy (PTK) may be an option. PTK uses an excimer laser to precisely remove or smooth the clouded tissue, effectively polishing the cornea to restore clarity. This technique is less invasive than a full transplant and is effective for scars that have not penetrated the deep stroma.
Corneal Transplantation (Keratoplasty)
For deep or dense scars that PTK cannot remove, corneal transplantation, or keratoplasty, is the definitive treatment.
The most comprehensive option is Penetrating Keratoplasty (PK), a full-thickness transplant where the entire central cornea is replaced with clear donor tissue. While highly effective, PK carries a higher risk of rejection and requires a lengthy recovery time.
Newer techniques allow for partial-thickness transplants, which preserve the patient’s healthy corneal layers. Deep Anterior Lamellar Keratoplasty (DALK) replaces only the front and middle layers, leaving the innermost layer (endothelium) intact. This selective approach significantly reduces the risk of rejection. Endothelial Keratoplasty procedures, such as Descemet Stripping Automated Endothelial Keratoplasty (DSAEK), replace only the innermost endothelial layer and are used when opacity is due to endothelial cell failure rather than deep scarring.