Corneal Ulcers

The cornea can develop an infection. Such infections can be mild to severe. Risk factors for infection include contact lens wear, eye trauma and certain corneal conditions. Mild infections are often treated with frequent antibiotic drops. More severe infections may be cultured in the office or emergency room and then treated with frequent specially-made fortified antibiotics around the clock.

Patients with severe corneal ulcers are seen regularly, often every day, until the infection appears to be improving. Most corneal ulcers resolve with antibiotic drop treatment. Depending on the amount of residual scarring the vision may or may not return to normal. Rarely, an infection is so severe that an emergent corneal transplant is required.

DISEASE NAME

Corneal ulcer. Also called infectious keratitis.

DEFINITION

An infection in the cornea.

SYMPTOMS

Redness, foreign body sensation, pain, light sensitivity, discharge, mild to severe decreased vision.

CAUSES

Typical causes are bacteria, fungi or a parasite such as acanthamoeba.

RISK FACTORS

Contact lens wear, eye trauma and certain corneal conditions including ocular surface disease and prior corneal surgery.

COMPLICATIONS

Corneal ulceration; glaucoma; corneal thinning, scarring and irregularity; corneal neovascularization; cataract formation; corneal perforation; moderate to severe decreased vision, loss of they eye.

TESTS AND DIAGNOSIS

Slit lamp examination is essential. Corneal scrapings for smears and cultures may be indicated. A corneal biopsy may be helpful if cultures are negative and the condition is worsening. Anterior segment optical coherence tomography (AS-OCT) imaging may be helpful to determine the extent of the infection.

TREATMENT

Corneal infections are treated with appropriate antibiotic, anti-fungal or anti-acanthamoeba medications. Dilating drops are often used. Glaucoma medications may be needed. In severe cases not responding to medical treatment, amniotic membrane tissue may be placed on the eye, or a corneal transplant may be required.

PREVENTION

Eye protection when engaged in risky activities. Remove contact lenses whenever the eye is red or irritated. Seek urgent ophthalmic care if ocular symptoms persist.