A corneal ulcer is a serious eye infection that impacts the front of the eye. This type of infection can be caused by bacteria, fungus, or a virus. No matter the cause of the ulcer, treatment is needed to prevent scarring or spreading of the infection. If the ulcer is large or centrally located, it can be a serious threat to vision long-term. Treatments for corneal ulcers include topical eye drops, oral medications, and IV medications in the most severe cases.
Anatomy of the Cornea
The cornea is the clear front part of the eye which is responsible for focusing light into the eyes for vision.
In a healthy eye, the cornea is completely clear and free of blood vessels and opacities.
The outer layer of the cornea, the corneal epithelium is a protective layer that contacts the tear film and does not allow foreign substances to pass into the inner portion of the cornea.
In a corneal ulcer, an infection has penetrated the corneal epithelium and caused disruption to the clarity of the inner cornea.
Symptoms of a Corneal Ulcer
A corneal ulcer will cause intense pain due to the many free nerve endings in the cornea. The ulcer causes the protective epithelium to be removed and it then exposes the nerves of the inner portion of the cornea.
In addition to pain, a corneal ulcer is likely to cause a red eye from the associated inflammation. It may also have watering and discharge from the eye as the body responds to the infection of the eye.
Vision can become blurred from the ulcer if it is located within the line of sight. It can also be impacted from the watering and discharge from the eye.
Diagnosing a Corneal Ulcer
A corneal ulcer can be diagnosed by an eye doctor based on the findings from a problem focused exam of the eyes.
After gathering the history, including history of contact lens wear, the doctor will use a microscope to assess the health of the cornea.
A numbing eye drop is often instilled into the eye for comfort during the procedure. A yellow dye can be used to help identify the location of the corneal ulcer and whether there is any associated inflammation.
If the cause of the corneal ulcer is suspicious for an unusual infecting agent, such as a tree branch or rusted piece of metal, a culture may be performed to identify the causative agent.
Treating a Corneal Ulcer
A corneal ulcer is treated as an urgent eye condition given the risk of permanent scarring and vision loss from the ulcer.
If the corneal ulcer is due to a bacterial infection, an antibiotic eye drop or multiple antibiotic eye drops will be prescribed and the ulcer will be monitored until it is resolved within the next few days.
However, if the corneal ulcer is due to a viral infection, there are antiviral medications that can be prescribed as oral medications or as eye drops.
The most concerning type of ulcer is due to a fungal infection and requires compounded eye drops of anti-fungal medications and oral or IV anti-fungal medications.
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