Corneal Ulcers

Perspective: A corneal ulcer forms when the surface of the cornea is damaged or compromised. Ulcers may be sterile (no infecting organism) or infectious. The term infiltrate is also commonly used along with ulcer. This refers to the immune response wherein inflammatory cells accumulate in the cornea where they do not normally belong.

Whether or not an ulcer is infectious is an important distinction for the physician to make and determines the course of treatment. Bacterial ulcers tend to be extremely painful and are typically associated with a break in the epithelium, the superficial layer of the cornea. In some cases, the inflammatory response involves the anterior chamber along with the cornea. Certain types of bacteria, such as Pseudomonas, are extremely aggressive and can cause severe damage and even blindness within 24-48 hours if left untreated.

Sterile infiltrates on the other hand, typically cause less pain. They are often found near the peripheral edge of the cornea and are not necessarily accompanied by a break in the epithelial layer of the cornea.

There are many causes of corneal ulcers. Contact lens wearers (especially soft) have an increased risk of ulcers, particularly if they do not adhere to strict regimens for the cleaning, handling, and disinfection of their lenses and cases. In addition, wearers who sleep in their lenses are at a higher risk. Other patients at risk include those who have severe dry eyes, difficulty blinking, or who are unable to care for themselves.

Other causes of corneal ulcers include viral infections, inflammatory diseases, corneal abrasions or injuries, and other systemic diseases.

Description, Signs and Symptoms

The symptoms associated with corneal ulcers depend on whether they are infectious or sterile, as well as the aggressiveness of the infecting organism.

• Red eye
• Pain (often severe)
• Tearing
• Discharge
• Blurry vision
• White spot on the cornea (which may not be visible to the naked eye)
• Light sensitivity

Management and Treatment of Corneal Ulcers

The course of treatment depends on whether the ulcer is sterile or infectious. Bacterial ulcers require aggressive treatment. In some cases, antibacterial eye drops are used every 15 minutes, and depending on the clinical presentation, steroid drops may be used to decrease scarring. Viral ulcers, such as from a Herpetic (cold sore) virus, are typically treated with antiviral drops or ointment. Sterile ulcers, however, are typically treated with steroid and antibiotic eye drops.

Symptoms

• blurry vision on awakening that may gradually clear as the day progresses
• pain from epithelial blisters on the corneal surface
• overall visual impairment, distorted vision and reduced contrast
• poor night vision
• light sensitivity
• glare
• halos

Please feel free to contact us regarding information for patients with corneal ulcers or any corneal disease or problem. Drs. Altman, Primack, and Shah are Fellowship trained Cornea Specialists at Eye Consultants of Pennsylvania, P.C. and may be reached at 610-378-1344.