Corneal Ulcer

  • Medical Author:
    Andrew A. Dahl, MD, FACS

    Andrew A. Dahl, MD, is a board-certified ophthalmologist. Dr. Dahl's educational background includes a BA with Honors and Distinction from Wesleyan University, Middletown, CT, and an MD from Cornell University, where he was selected for Alpha Omega Alpha, the national medical honor society. He had an internal medical internship at the New York Hospital/Cornell Medical Center.

  • Medical Editor: Charles Patrick Davis, MD, PhD
    Charles Patrick Davis, MD, PhD

    Charles Patrick Davis, MD, PhD

    Dr. Charles "Pat" Davis, MD, PhD, is a board certified Emergency Medicine doctor who currently practices as a consultant and staff member for hospitals. He has a PhD in Microbiology (UT at Austin), and the MD (Univ. Texas Medical Branch, Galveston). He is a Clinical Professor (retired) in the Division of Emergency Medicine, UT Health Science Center at San Antonio, and has been the Chief of Emergency Medicine at UT Medical Branch and at UTHSCSA with over 250 publications.

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What are risk factors for corneal ulcers?

Risk factors for the development of corneal ulcer include having had a prior corneal ulcer, failing to wear eye protection when using power tools or during welding, having extremely dry eyes, misusing contact lenses, failing to treat a red eye, exposure to UV light (snow blindness), and abnormalities of the eyelids or lashes.

What are corneal ulcer symptoms?

A corneal ulcer may cause redness of the eyelid and/or conjunctiva, pain, a feeling that something is in the eye; tearing and pus or thick discharge draining from the eye may occur. If the ulcer is more centrally located in the cornea, vision might be blurry. There may be an increase in pain when the person looks at bright lights.

What are corneal ulcer signs?

An ophthalmologist (a medical doctor who specializes in medical and surgical treatment of eye diseases) may notice signs of inflammation (redness) in the conjunctiva of the eye and in the anterior chamber of the eye. The eyelids may be swollen, and a white or gray round spot on the cornea could be visible with the naked eye if the ulcer is large. Not all gray spots are ulcers. The ulcer may be central in the cornea or marginal, at the outer edge of the cornea. There may be swelling (edema) of the cornea around the ulcer. There may be scarring from prior corneal ulcers. There may be a single (or multiple ulcers) in the eye, and ulcers may be present in one or both eyes.

What types of doctors treat corneal ulcers?

If you develop a corneal ulcer, you should be examined promptly by an ophthalmologist. An ophthalmologist is a medical doctor who is specialized in diagnosis and medical/surgical treatment of eye diseases. If the corneal ulcer is very serious or vision-threatening, your ophthalmologist may refer you to an ophthalmologist who subspecializes in diseases of the cornea.

How does a health-care professional diagnose a corneal ulcer?

The presence of a corneal ulcer can be diagnosed by an ophthalmologist (and other medical caregivers) through an eye examination. The ophthalmologist will be able to detect an ulcer by using a special eye microscope known as a slit lamp. A drop containing the dye fluorescein, when placed in the eye, can make the ulcer easier to see. Scrapings of the ulcer may be sent to the laboratory for identification of bacteria, fungi, or viruses. Certain bacteria, such as a species of Pseudomonas, may cause a corneal ulcer which is rapidly progressive.

What is the treatment for a corneal ulcer?

Treatment is aimed at eradicating the cause of the ulcer. Anti-infective agents directed at the inciting microbial agent will be used in cases of corneal ulcer due to infection. Generally, these will be in the form of drops or ointments to be placed in the eye; but occasionally, especially in certain viral infections, oral medications will also be employed. Occasionally, steroids will be added, but should only be used after examination by an eye doctor or other physician using a slit lamp, because in some situations, steroids may hinder healing or aggravate the infection.

In cases aggravated by dryness or corneal exposure, tear substitutes will be used, possibly accompanied by patching or a bandage contact lens.

In corneal ulcers involving injury, the inciting agent must be removed from the eye (using copious irrigation for chemicals or by using a slit lamp microscope to remove particles such as wood or metal) and then adding medications to prevent infection and minimize scarring of the cornea.

If the corneal ulcer is due to an eyelash growing inward, the offending lash should be removed, together with its root. If it grows back in an abnormal manner, the root may have to be destroyed using a low-voltage electrical current. If the corneal ulcer is secondary to the eyelid turning inward, surgery directed at correctly repositioning the eyelid may be necessary.

Contact lenses should be discontinued in the affected eye of any case of corneal ulcer, regardless of whether the ulcer was initially caused by the contact lens.

If the ulcer cannot be controlled with medications, it may be necessary to surgically debride the ulcer. If the ulcer causes significant corneal thinning and threatens to perforate the cornea, a surgical procedure known as a corneal transplant may be necessary.

Individuals with corneal ulcers due to immunological diseases may require patient-specific treatment with immunosuppressive drugs. Such patients may require care coordinated with an ophthalmologist in conjunction with other doctors.

Anyone with an irritated eye that does not improve quickly after removing a contact lens or after mild irrigation should contact an ophthalmologist immediately. Do not borrow someone's eyedrops.

Medically Reviewed by a Doctor on 5/6/2016

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