Cornea & Keratoconus Specialists
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Fellowship-trained cornea specialists — from emergency foreign body removal and corneal ulcer treatment to keratoconus care, pterygium surgery and sight-restoring corneal transplant surgery.
What is the cornea?
The cornea is the clear, dome-shaped surface at the front of the eye. It is responsible for approximately two-thirds of the eye’s focusing power and serves as the eye’s first barrier against infection, dust, and UV exposure.
Because the cornea is transparent and has no blood vessels, it relies on a delicate balance of hydration and cellular health to maintain clarity. When disease, injury, or degeneration disrupts that balance, vision can become blurred, distorted, or painful — and everyday activities like reading, driving, and recognizing faces become difficult.
The anterior segment includes the cornea, iris, lens, and the fluid-filled chambers at the front of the eye. Conditions affecting the anterior segment — including uveitis (inflammation inside the eye) — also fall within this subspecialty.
Whether you have something stuck in your eye that needs urgent removal, a corneal infection from contact lens wear, progressive keratoconus, Fuchs’ dystrophy causing blurry morning vision, a pterygium affecting your comfort or sight, or uveitis linked to an autoimmune condition — our cornea service provides specialist-level care across multiple locations.
Our cornea service is led by two fellowship-trained cornea specialists — with international training from Cambridge, Melbourne, Columbia, and UCSF — both faculty at the University of Toronto Department of Ophthalmology, with over 60 combined publications and expertise spanning corneal transplantation, keratoconus and specialty contact-lens management, and ocular inflammatory disease. Our surgeons, including Dr. Maini, have published their own results with an astigmatism-correction technique used during laser-assisted cataract surgery — including where it worked less well than planned.
Corneal and anterior segment conditions
Our cornea service manages the full range of conditions affecting the cornea and front of the eye — from progressive degenerations to acute infections and inflammatory disease.
Keratoconus
A progressive condition where the cornea thins and bulges into a cone shape, causing increasingly blurred and distorted vision — often noticed as frequent prescription changes in glasses or contact lenses. Keratoconus typically affects both eyes, is most commonly diagnosed in the teens or twenties, and can run in families. Eye rubbing is a known risk factor. Early detection with corneal topography (Pentacam) allows timely treatment to be planned before significant vision loss occurs.
Fuchs’ endothelial dystrophy
A degenerative condition where the cornea’s inner cell layer (endothelium) gradually loses function, causing the cornea to swell and vision to become cloudy. The hallmark symptom is blurry vision in the morning that gradually clears during the day as the cornea dries. Fuchs’ dystrophy affects adults typically over 50, tends to run in families, and progresses gradually over years. Advanced cases may require corneal transplant surgery (DMEK or DSAEK). Our team’s published work includes peer-reviewed reports on inherited corneal dystrophies, reflecting experience with less common corneal disease.
Infectious corneal ulcers
A corneal ulcer (microbial keratitis) is an open sore on the cornea caused by bacterial, viral, or fungal infection. Contact lens wearers are at significantly higher risk — especially with overnight wear, poor hygiene, or swimming in lenses. Symptoms include eye pain, redness, tearing, light sensitivity, and rapid vision loss. This is an eye emergency: prompt diagnosis with corneal culture and targeted antimicrobial therapy are critical to prevent permanent scarring or perforation.
Pterygium
A wedge-shaped growth of fibrovascular tissue from the conjunctiva onto the cornea, commonly caused by long-term UV exposure and outdoor work. Pterygia cause chronic redness, irritation, foreign body sensation, and — as they grow onto the cornea — increasing astigmatism and blurred vision. Pterygium surgery is a core part of our cornea service and is performed at U Surgical Centre. We use the conjunctival autograft technique, which covers the treated area with healthy tissue taken from the same eye. Compared with older techniques that left the area bare, this greatly lowers the chance of the pterygium growing back.
Corneal scarring & opacities
Scars from previous infections, injuries, or surgeries can permanently cloud the cornea and impair vision. Depending on the depth and location of the scar, treatment ranges from specialty contact lenses to partial or full-thickness corneal transplantation.
Corneal foreign body
Metal, wood, glass, or other particles can become embedded in the corneal surface — commonly from grinding, drilling, hammering, or high-speed tools without proper eye protection. A corneal foreign body causes immediate pain, tearing, redness, and the sensation that something is stuck in the eye. If you have metal in your eye, do not attempt to remove it yourself. Prompt in-office removal under slit-lamp magnification, followed by rust ring removal with a rotating burr if needed, prevents infection and minimizes scarring. Most patients can return to work within one to three days.
UVG integrated care: Corneal foreign body removal is done in the office, and pterygium surgery is performed at U Surgical Centre. Patients with keratoconus requiring specialty contact lenses are coordinated with U Optical for scleral lens fitting. Patients with dry eye as a contributing factor are co-managed with the U Dry Eye Institute (UDEI). Urgent corneal ulcer assessment is available for same-day or next-day evaluation.
How we evaluate corneal health
Accurate diagnosis is the foundation of effective corneal care. Our cornea specialists use advanced imaging to assess corneal shape, thickness, and cellular health — detecting problems that are invisible to the naked eye.
| Test | What it measures |
|---|---|
| Corneal topography | Maps the curvature of the corneal surface. Essential for diagnosing and monitoring keratoconus, corneal warpage, and irregular astigmatism. |
| Pentacam (corneal tomography) | Provides 3D imaging of the entire cornea — front surface, back surface, and thickness mapping. Detects early keratoconus, corneal ectasia, and Fuchs’ dystrophy progression. |
| Pachymetry | Measures corneal thickness at multiple points. Critical for monitoring Fuchs’ dystrophy progression and planning corneal transplant surgery. |
| Specular microscopy | Photographs and counts the endothelial cells lining the inner corneal surface. Low cell counts indicate Fuchs’ dystrophy or endothelial compromise — guiding surgical timing. |
| Anterior segment OCT | High-resolution cross-sectional imaging of the cornea, anterior chamber, and iris. Used to assess corneal scars, graft integrity, and anterior segment inflammation. |
| Slit-lamp biomicroscopy | Direct magnified examination of the cornea, conjunctiva, and anterior segment. The cornerstone of every corneal assessment — identifies infections, ulcers, dystrophies, and surface irregularities. |
OHIP coverage: Your specialist consultation, slit-lamp examination, and medically necessary diagnostic tests are covered by OHIP. Some advanced imaging (Pentacam, specular microscopy) may have a fee — your specialist will explain any costs before ordering.
Corneal treatment options
Treatment depends on the specific condition and its severity. Your cornea specialist will recommend the most appropriate approach — from medical therapy to advanced surgical techniques — tailored to your individual needs.
| Treatment | How it works | Best for |
|---|---|---|
| Keratoconus monitoring and referral | Regular corneal topography (Pentacam) scans show whether keratoconus is progressing. If corneal cross-linking is recommended, your cornea specialist will refer you to a centre that provides it and continue your keratoconus care here. Cross-linking uses riboflavin (vitamin B2) drops and ultraviolet light to strengthen the cornea. | Keratoconus at any stage, and corneal thinning after laser vision correction |
| DMEK | Descemet Membrane Endothelial Keratoplasty — replaces only the diseased inner cell layer. Usually the fastest visual recovery of the transplant techniques. | Fuchs’ dystrophy and endothelial failure |
| DSAEK | Descemet Stripping Automated Endothelial Keratoplasty — replaces the endothelial layer with a thin donor tissue disc. | Endothelial disease, especially complex or revision cases |
| PKP (full-thickness transplant) | Penetrating keratoplasty — replaces the entire corneal thickness with donor tissue. | Deep scarring, advanced keratoconus, failed partial transplants |
| Pterygium excision with autograft | Surgical removal of the pterygium followed by conjunctival autograft — healthy tissue from the same eye is transplanted to cover the excision site. Compared with older techniques that left the area bare, this greatly lowers the chance of regrowth. Day surgery at U Surgical Centre, usually about 30–45 minutes. | Pterygium causing redness, irritation, astigmatism, or cosmetic concern |
| Corneal foreign body removal | In-office removal under slit-lamp magnification using a sterile needle or burr. Rust ring removal is performed when metallic fragments have oxidized into the surrounding tissue. | Embedded foreign bodies — metal, wood, glass, or other particles |
| Antimicrobial therapy | Targeted antibiotic, antiviral, or antifungal medications — topical, oral, or both — based on culture and clinical assessment. | Infectious corneal ulcers and microbial keratitis |
| Specialty contact lenses | Rigid gas-permeable or scleral lenses create a smooth optical surface over an irregular cornea. Coordinated with U Optical. | Keratoconus, corneal scarring, post-transplant astigmatism |
Modern transplant techniques: DMEK and DSAEK are partial-thickness transplants that replace only the diseased layer of the cornea — preserving the healthy tissue above. Compared to traditional full-thickness transplants, these techniques offer faster recovery, less astigmatism, and lower rejection rates. Corneal transplants are performed by our cornea specialists, Dr. Vincent Lam and Dr. Raj Maini, at the hospitals where they hold surgical privileges. Your assessment before surgery takes place with your cornea specialist at Uptown Eye. Dr. Maini’s fellowship training was in Melbourne, and he has experience across more than 10,000 procedures. Donor corneal tissue is coordinated through the Eye Bank of Canada (Ontario Division).
Uveitis and ocular inflammation
Uveitis is inflammation inside the eye that can cause eye pain, redness, light sensitivity, floaters, and blurred vision. It can occur in isolation or be associated with systemic autoimmune conditions such as ankylosing spondylitis, sarcoidosis, Crohn’s disease, ulcerative colitis, rheumatoid arthritis, and lupus. Uveitis can affect anyone but is most commonly diagnosed in adults between 20 and 60.
Left untreated, uveitis can lead to serious complications including glaucoma, cataracts, and permanent vision loss. Early diagnosis and appropriate treatment are essential.
Types of uveitis
| Type | Location | Common presentation |
|---|---|---|
| Anterior uveitis (iritis) | Iris and ciliary body | Eye pain, redness, light sensitivity, blurred vision. The most common form. May be recurrent. |
| Intermediate uveitis | Vitreous cavity | Floaters and blurred vision without significant pain. Often associated with systemic inflammatory conditions. |
| Posterior uveitis | Retina and choroid | Visual disturbance, floaters. Can cause retinal damage if not treated promptly. Coordinated with our retina service. |
| Panuveitis | All layers | Inflammation throughout the eye. Requires comprehensive workup and often systemic immunosuppressive treatment. |
Dr. Vincent Lam completed a dedicated uveitis fellowship at UCSF Proctor Foundation — one of the world’s leading centres for ocular inflammatory disease — bringing specialized expertise in the diagnosis and management of complex uveitis cases.
Multidisciplinary approach: Uveitis is often linked to systemic conditions. When needed, we coordinate with rheumatologists, internists, and other specialists to ensure your treatment addresses both the eye and the underlying cause.
What to expect at your appointment
| 1 | Getting referredMost patients are referred by their optometrist or family doctor. Ask for a referral to Uptown Eye Specialists, specifying cornea or anterior segment. We also accept self-referrals. |
| 2 | Your first appointmentIncludes a comprehensive slit-lamp examination, corneal topography or Pentacam imaging, pachymetry, specular microscopy (if indicated), and a detailed discussion of your diagnosis and treatment plan. Bring your current glasses, contact lens prescription, and any recent eye test results from your optometrist. |
| 3 | Treatment and follow-upFor urgent conditions — corneal foreign bodies, corneal ulcers, and acute uveitis — treatment begins the same day. Pterygium surgery is scheduled at U Surgical Centre. Corneal transplants are performed at the hospital where your cornea specialist holds surgical privileges. If cross-linking is recommended for keratoconus, we refer you to a centre that provides it and continue your keratoconus care with us. Follow-up frequency varies: active infections and uveitis require close monitoring, while stable conditions are reviewed at longer intervals. |
| 4 | Ongoing coordinationWe coordinate care with your referring optometrist, and when needed, with other UVG specialists (retina, glaucoma) and external physicians (rheumatology, internal medicine). You benefit from UVG’s integrated ecosystem at every step. |
OHIP coverage: Your specialist consultation, slit-lamp examination, corneal foreign body removal, pterygium excision, and medically necessary corneal procedures (including corneal transplant surgery) are all covered by OHIP. Pterygium removal for appearance alone is not covered. Some patients choose to have the graft held in place with fibrin glue instead of stitches; this is an optional upgrade that OHIP does not cover, and your surgeon will explain the choice. Some advanced diagnostics (Pentacam, specular microscopy) may have a fee.
Common questions about corneal care
Our cornea & anterior segment specialists
Dr. Vincent Lam
OD, MD, FRCSC
Etobicoke · Vaughan · Scarborough
Dr. Raj Maini
MD, FRCSC
Brampton · Vaughan · Scarborough
Research-led care
Our cornea, uveitis & ocular surface research
Our cornea service — led by Dr. Vincent Lam and Dr. Raj Maini — manages corneal and anterior-segment disease, ocular-surface disease, and uveitis (inflammation inside the eye). Dr. Lam completed a dedicated uveitis fellowship at the UCSF Proctor Foundation, one of the world’s leading centres for ocular inflammatory disease. Our team’s published research advances how these conditions are diagnosed and treated.
Cytomegalovirus Anterior Uveitis in Consecutive Eyes with Hypertensive Uveitis: A Tertiary Care Centre Experience
A tertiary-centre case series identifying cytomegalovirus (CMV) as a cause of anterior uveitis in eyes presenting with raised eye pressure — helping clinicians recognize and correctly treat an often-missed cause of ocular inflammation.
Safety and Efficacy of BroadBand Intense Pulsed Light Therapy for Dry Eye Disease with Meibomian Gland Dysfunction
A prospective study showing that broadband intense pulsed light (IPL) therapy safely improves dry eye symptoms and meibomian gland function — advancing our treatment of ocular surface disease.
- Trauma-Induced Exacerbation of Epithelial-Stromal TGFBI Lattice Corneal Dystrophy
Part of more than 300 peer-reviewed publications from across the Uptown Eye Specialists team.
Concerned about your corneal health?
Do you have a pterygium, need an assessment for a corneal transplant, or want a specialist opinion on another corneal condition or uveitis? Our fellowship-trained cornea specialists are here to help. Most patients are referred by their optometrist or family doctor — ask for a referral to Uptown Eye Specialists.
We see patients across multiple locations throughout the Greater Toronto Area.
From our journal.
No pressure to decide today — these explain the condition, the options, the limits, and what to actually expect.