The aging cornea: From mechanisms to clinical applications

Aging is a multifactorial process characterized by a gradual decline in function, increased susceptibility to diseases, and diminished regenerative capacity. As the primary refractive structure and barrier of the eye, the cornea undergoes significant structural and functional changes during aging, making individuals more prone to various ocular surface diseases. Key age-related corneal changes include epithelial thinning, stromal remodeling with increased collagen cross-linking, endothelial cell loss, and a decline in corneal nerve density and function. These changes are driven by core aging mechanisms such as genomic instability, telomere shortening, mitochondrial dysfunction, cellular senescence, impaired autophagy, stem cell exhaustion, and chronic inflammation. This review systematically explores the clinical manifestations, molecular mechanisms, and potential therapeutic approaches for corneal aging, providing a scientific basis for delaying corneal aging, maintaining ocular health, and preserving visual function.