Corneal ulcer

Medical quality assurance by Dr. Albrecht Nonnenmacher, MD at April 23, 2016
StartDiseasesCorneal ulcer

A corneal ulcer is a relatively common condition that affects the eye. This kind of ulcer is painful and will cause the eye to appear red. Ulcers can cause the discharge of pus as well as a reduction of visual acuity.

Contents

Definition & Facts

A corneal ulcer is a type of sore affecting the cornea. There are many causes for these ulcers, though they are often preventable. Ulcers can be present in both eyes, though this is rare. If left untreated, corneal ulcers can lead to a reduction in vision or even total blindness. Early treatment goes a long way in ensuring that complications are avoided.

Symptoms & Complaints

In general, people with this condition will experience pain and a feeling that something is nestled in their eye. Redness, tearing, and discharge of pus are also common, especially as the ulcer becomes larger and more noticeable.

Another key symptom is experiencing additional pain and visual blurriness when looking at bright lights. The redness that is found with this condition is due to inflammation within the cornea. This inflammation can extend to the eyelids, which may become slightly swollen.

One of the clearest signs that a person is suffering from a corneal ulcer is the presence of a gray or whitish spot on the cornea. These spots will typically be situated towards the edge of the cornea, and can usually only be seen if the ulcer has become sizable. The cornea may be slightly swollen around the ulcer, which can make it more noticeable.

Causes

There are numerous factors that can contribute to the onset of a corneal ulcer. Corneal ulcers are typically brought about by infections, but these infections can themselves result from a number of causes. If bacteria invades the cornea, a bacterial infection may occur, which commonly occurs with people that wear contact lenses. Most bacteria won't cause an infection, but some can develop toxins that attack this portion of the eye.

Certain viruses can also lead to the contraction of a corneal ulcer. These viruses range from the varicella virus to the herpes virus. Fungal infections might lead to ulcers, especially if eye drops or contact lenses aren't handled properly.

There are instances where corneas can become scratched, often due to wood or metal. This is known as a corneal abrasion, and these scratches heighten the chances of an ulcer developing, as a scratch leaves the cornea more vulnerable to bacteria.

Any disorder that causes dry eyes or affects the eyelid may also increase the chances of an ulcer. Chemical burns on the cornea and irritation caused by contact lenses can also lead to the condition.

Diagnosis & Tests

An ophthalmologist will need to be visited in order to have the ulcer properly diagnosed, which will pave the way for treatment options. The diagnosis of a corneal ulcer is fairly straightforward. A special microscope is oftentimes used during this procedure, known as a slit lamp. When an ulcer first develops, it can be very difficult to see with the naked eye, which is why these microscopes are used.

In most instances, a dye called fluorescein is dropped into the eye. This dye will highlight the ulcer, better pinpointing its exact location. Once this has been completed, and the presence of a corneal ulcer has been determined, small scrapings of the ulcer may be collected and sent to a lab to identify what the cause was and if it's still present.

The reason for this is that one of the bacteria types that can lead to a corneal ulcer may cause a type of ulcer that progresses very rapidly. In this case, treatment must be administered immediately. One type of bacteria that causes rapid degradation of the cornea is pseudomonas.

Treatment & Therapy

The treatment for a corneal ulcer depends almost entirely on the cause for the ulcer. An antibiotic solution that's specifically targeted at the microbial agent that resulted in the formation of the ulcer will be administered, typically as an ointment or eye-drop. If a viral infection is the cause, topical antiviral drugs may be administered such as trifluridine drops. Oral antivirals including valacyclovir and famciclovir are also used to treat corneal ulcers caused by viral infections.

If dryness is the primary cause, tear alternatives will be placed into the eye. In certain causes where a piece of wood or metal led to a corneal abrasion, the particle will be removed, and specific medications will be used as a means of stopping any infection.

No matter the reason for the ulcer, anyone that wears contact lenses will be told to stop wearing them, at least for the time being. There could be situations where each of these treatment methods have proved ineffective. If so, a corneal transplantation might be suggested. A doctor needs to be consulted before having this surgery done.

Prevention & Prophylaxis

While corneal ulcers have many causes, there are some prevention tips that may prove useful. For one, eye protection is an absolute must when using any type of power tools or working at a construction site. Anyone with dry eyes will also need to use artificial teardrops.

If wearing contact lenses, hands must be washed thoroughly before putting the contacts in and taking them out. Finally, it is important to always clean one's contacts with solution, and if regular irritation ever occurs, to take the lenses out until the problems go away.