Corneal Ulcer

Causes

There are several potential causes of a corneal ulcer, but it is most often the result of an infection.

• Bacterial infections: Bacterial infections are common with improper contact lens use, especially if lenses are worn overnight or not cleaned regularly. Common bacterial types include Pseudomonas, Staphylococcus, and Streptococcus.
• Viral infections: Viral infections such as herpes simplex (which is associated with cold sores and genital herpes) and varicella-zoster (chicken pox and shingles) can lead to corneal ulcers.
• Fungal infections: Fungal infections can occur in immunosuppressed patients or after accidental exposure to organic material, like a stick or plant. Common fungal agents include Aspergillus and Candida.
• Parasites: Parasites like Acanthamoeba can be introduced into the eye by wearing contacts when swimming in a body of water or pool or using tap water to clean your contacts.
• Dry eyes: Severe dryness from environmental factors or other disease processes can increase the risk of corneal damage and ulcers.
• Eye injuries: Ulcers commonly occur due to traumatic injuries like scratches, burns, toxic substances, or foreign bodies in the eye.
• Allergic reactions: Severe allergic reactions affecting the cornea can also result in ulcers.
• Altered immunity: People with medical conditions that change or suppress their natural immune system are more susceptible to many of these conditions.

Symptoms

Common symptoms of corneal ulcers include:

• Severe eye pain
• Red, bloodshot eye
• Excessive tearing, pus, or discharge
• Blurred or reduced vision
• Sensitivity to light (photophobia)
• A feeling that there is something in your eye
• Irritated and swollen eyelids
• A white or gray spot on the cornea (may be hard to see)

Diagnosis

An eye specialist or other healthcare professional can identify a corneal ulcer using a slit lamp exam. Obtaining samples of any infection present will also be important to identify the underlying cause and correct treatment options. A tissue biopsy may also be needed in extreme cases where the corneal ulcer isn’t responding to treatment.

Treatment Options

Remember to see your healthcare provider at the first sign of a corneal ulcer. Delayed treatment can result in vision loss or blindness.

• Medication: Topical and oral antibiotics, antifungal and antiviral medications, corticosteroids, and nonsteroidal anti-inflammatory drugs (NSAIDs) can treat corneal ulcers.
• Protective Contact Lenses: Scleral lenses (bandage contacts) can protect your eye from additional damage as your cornea heals.
• Tarsorrhaphy: This treatment forces your eye to remain closed to protect it and provide the optimal healing environment.
• Surgery: Surgery and corneal transplant may be considered if other treatments fail.

In severe cases, or if the ulcer doesn't respond to medication, surgery (such as a corneal transplant) may be required. Immediate medical attention is crucial to prevent complications like scarring or permanent vision damage.