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Corneal Ulcers

Alternate Names

  • keratitis
  • Normal eye

Definition

A corneal ulcer is a defect of the front surface of the cornea that is usually caused by an infection. The cornea is the clear window on the front of the eye that covers the colored iris and black pupil.

What is going on in the body?

Corneal ulcers generally form when the cornea is damaged in some way. The break in the cornea allows organisms to enter and cause an infection. Infections of the cornea can be quite serious because the cornea lacks blood vessels to bring in the body's natural defenses. The organisms may be a type of bacteria, virus, or fungus.
Soft contact lenses are a major cause of corneal ulceration. Allergies or other eye conditions may also occasionally cause corneal ulcers.

Risks

What are the causes and risks of the infection?

Herpes simplex infection is the most common viral cause of corneal ulcers in the United States. The virus that causes chickenpox and shingles can also cause corneal ulcers. Many times, bacterial or fungal infections lead to corneal ulcers.
Other causes of corneal ulcers include:
  • allergies
  • conjunctivitis, an inflammation of the clear covering of the white of the eye
  • contact lenses. Extended wear soft contacts are the leading cause of severe bacterial ulceration in adults.
  • trauma to the cornea

Prevention

What can be done to prevent the infection?

People who wear contacts should clean them as directed and remove them when sleeping. Over the counter cosmetic tinted soft lenses have led to an increase in ulceration in adolescents. Individuals should wear safety glasses to prevent injury and contamination of the eyes in high-risk situations. Eye makeup and brushes should not be shared. Effective treatment of allergies may prevent some corneal ulcers.

Diagnosed

How is the infection diagnosed?

Diagnosis of a corneal ulcer begins with a medical history and physical exam. A slit lamp exam uses a microscope and a rectangular light source to examine the cornea. Often, the cornea is stained with a dye called fluorescein. Scrapings from the cornea may be sent to a lab to determine if a fungus or bacteria is present.

Long Term Effects

What are the long-term effects of the infection?

If corneal ulcers are not treated, the person may have corneal scarring, permanent visual impairment, or even a hole in the cornea, which could lead to blindness

Other Risks

What are the risks to others?

A corneal ulcer is not contagious.

Treatments

What are the treatments for the infection?

If the corneal ulcer is caused by bacteria, antibiotics must be given. Antibiotic drops are often given at hourly intervals at the start of a bacterial ulcer. Most ulcers are treated for several weeks. Contact lenses must be discontinued for up to six weeks even if the ulcer heals appropriately..
Antifungal drops or oral pills can be used for fungal infections. For infection with herpes simplex or other viruses, antiviral eye drops or oral pills may be given.

Side Effects

What are the side effects of the treatments?

Medicines used to treat corneal ulcers may cause stomach upset, rash, allergic reactions, and other side effects.

After Treatment

What happens after treatment for the infection?

Herpes ulcers often lead to scarring even with adequate treatment. Bacterial ulcers may rapidly cause blindness if not treated early and aggressively. Usually the treatment lasts several weeks. If the scarring is not in the center of the cornea, the scarring will not lead to loss of vision.

Monitor

How is the infection monitored?

Any new or worsening symptoms should be reported to the healthcare professional.

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