The Possibility of Corneal Rejection

The chances are that your cornea surgery will be successful. If it fails, it will most likely fail because your body recognizes the new corneal tissue as foreign and tries to reject it. This can result in a cloudy cornea which may require a repeat procedure. With Penetrating Keratoplasty (full thickness Corneal Transplant), the body may attempt to reject the new tissue in about 20% of the cases. If the rejection is treated early in its course, 90% of the time it can be reversed with medications and the corneal tissue will regain its clarity. With Endothelial Keratoplasty (DSAEK and DMEK), as well as with Deep Anterior Lamellar Keratoplasty (DALK), rejection rates are significantly lower which is why these procedures, when they can be done are usually preferable.

In cases where the rejection is not treated early in the course, the chance of eventual failure is much higher. Therefore, it is extremely important that patients recognize the signs of impending rejection and to report them as early as possible. It is important to note that rejection of the cornea can happen at any time, even years after the surgery.

Rejection Warning Signs

Patients must call the office if any of these symptoms persist for 24 hours:

Decreased Vision – the most common way early corneal transplant rejection is detected.

Increased Pain – after surgery, there may be some discomfort around the eye, but this should go away in a few days. If the eye becomes more uncomfortable, it could be a sign of a corneal transplant rejection.

Increased Redness – after surgery, there may be some redness or swelling. It should slowly start improving within a few days. If instead the eye is getting redder or more swollen, please call.

Increased Light Sensitivity – After surgery, your eye(s) may be light sensitive. You will be given dark glasses to wear. The light sensitivity should slowly diminish over a few days or sometimes weeks. If it should worsen or recur once it has been resolved, please call.

Flu Shots – At times, this vaccination may increase the risk of rejection. Patients who plan on getting a flu shot before surgery or any time after surgery, should notify their doctor. Sometimes drops may be prescribed before you receive the flu shot.


1. Keeping the eye dropper or tube clean is essential. Avoid touching the top of the dropper or tube to anything, especially the fingers or any part of the eye.

2. Medication should be stored at room temperature; refrigerate only if you have been instructed to do so.

3. Use the medication only in the eye for which it is ordered.

4. Do not share your medication with anyone.

5. Use only the ophthalmic medication your physician has prescribed.

6. Never use eyedrops that have changed color.

7. Do NOT transfer medication from one bottle to another.

8. Keep eye medication out of reach of children.

9. Wait five minutes between consecutive drops.

10. When using both eyedrops and eye ointment, administer drops first.

Click here to learn the proper technique for administering eyedrops.