Dr. Orwa Nasser MD MPH - Corneal Ulcer

Corneal Ulcer

A corneal ulcer is an open sore on the cornea, the clear dome-shaped surface at the front of the eye that helps focus vision and protect inner eye structures. It is also known as ulcerative keratitis and is considered a medical emergency because it can lead to permanent vision damage if not treated promptly. Most corneal ulcers are caused by infections that enter through a break in the corneal surface. Risk factors include contact lens trauma, dry eye, injury, immune disorders, and eyelid abnormalities.

Symptoms:

    ·    Red or bloodshot eye.

    ·    Eye pain or aching.

    ·    Excessive tearing.

    ·    Pus or thick discharge.

    ·    Sensitivity to light.

    ·    Blurred or decreased vision.

    ·    Foreign-body sensation.

    ·    Swollen eyelids.

    ·    Visible white or gray spot on the cornea.

    ·    Symptoms often worsen quickly without treatment.

Causes:

·    Microbial infections:

o   Bacterial infections are the most common cause, especially in contact lens wearers.

o   Viral infections such as herpes simplex virus may also lead to corneal ulceration.

o   Fungal infections may occur after trauma involving plant material.

o   Parasitic infections such as Acanthamoeba are associated with improper contact lens hygiene.

·    Corneal injury or trauma: Scratches, foreign bodies, burns, and chemical exposures increase susceptibility to ulcer formation.

·    Eyelid and tear film abnormalities: Conditions such as dry eye disease or incomplete eyelid closure reduce corneal protection and increase risk.

·    Immune-mediated disorders: Autoimmune diseases and severe ocular surface disorders may predispose individuals to corneal ulcers.

Diagnosis and Tests:

·    Diagnosis requires urgent evaluation by an eye specialist.

·    Slit-lamp examination allows detailed inspection of the cornea.

·    Fluorescein dye highlights epithelial defects and ulcer areas.

·    Corneal cultures or scrapings may be performed to identify infectious organisms.

·    Assessment of tear function and eyelid health may also be necessary.

Management and Treatment: Corneal ulcers require prompt and targeted treatment.

·    Antimicrobial therapy:

o   Antibiotic eye drops are used for bacterial ulcers.

o   Antiviral medications treat viral causes.

o   Antifungal medications are required for fungal infections.

o   Anti-amoebic therapy is used for parasitic infections.

o   Frequent dosing may be necessary during the initial phase of treatment.

·    Supportive therapies:

o   Cycloplegic drops may reduce pain.

o   Artificial tears help protect the corneal surface.

o   Contact lenses must be discontinued during treatment.

o   Steroid drops should only be used under specialist supervision.

·    Surgical options:

o   Corneal crosslinking may be considered in some cases.

o   Debridement may be performed to remove infected tissue.

o   Severe or non-healing ulcers may require corneal transplantation.

o   Emergency surgery may be necessary if corneal perforation occurs.

Prognosis:

·    With early treatment, many corneal ulcers heal within several weeks.

·    Deep or central ulcers may leave corneal scarring.

·    Delayed treatment increases the risk of vision loss or perforation.

·    Close follow-up is essential to ensure proper healing.

Prevention:

·    Practice proper contact lens hygiene and avoid overnight wear unless prescribed.

·    Wear protective eyewear during activities that risk eye injury.

·    Treat dry eye and eyelid conditions promptly.

·    Manage underlying systemic or autoimmune diseases carefully.

When Should I See My Healthcare Provider? Seek immediate evaluation if you develop redness, pain, blurred vision, discharge, or a visible white spot on the cornea.

When Should I Go to the Emergency Room? Go immediately if you experience sudden severe eye pain, rapid vision loss, or worsening symptoms after trauma.

What Questions Should I Ask My Healthcare Provider?

    ·    What is the cause of my corneal ulcer?

    ·    Do I need antimicrobial treatment?

    ·    How often should I return for follow-up?

    ·    Am I at risk of vision loss?

    ·    How can I prevent recurrence?

Key Takeaways:

    ·    A corneal ulcer is an open sore on the cornea and is a medical emergency.

    ·    Infections are the most common cause.

    ·    Symptoms include pain, redness, tearing, and blurred vision.

    ·    Prompt antimicrobial treatment is essential.

    ·    Delayed care increases the risk of permanent vision damage.