The Facts About Corneal Ulcers
The first signs of a corneal ulcer are usually redness, pain, mild or severe discharge and reduced vision in the affected eye. Some corneal ulcers can progress very quickly, so if suspect you may have one, you should see your eye doctor immediately for diagnosis and treatment to minimize vision loss.
Signs and symptoms of corneal ulcers
- Red eye
- Severe pain, in some cases
- A white spot on the cornea, sometimes not even visible to the naked eye
- Sensitivity to light
Causes of corneal ulcers
Corneal ulcers can be sterile, with no infecting organisms, or they may be infectious. Most corneal ulcers are caused by a bacterial infection in the cornea. Bacterial ulcers commonly follow an eye injury, trauma or damage to the eye’s epithelium which covers the cornea. Certain types of bacteria can be very aggressive, leading to permanent damage of the cornea and even blindness within 24-48 hours if left untreated, so medical attention should be sought as soon as possible.
Wearers of contact lenses have a higher risk of corneal ulcers, as the lenses can rub against the surface of the eye, creating slight damage. This damaged epithelial tissue can allow bacteria to enter the eye, causing an eye infection that can lead to an ulcer. The best preventative measure you can take if you wear contacts is to wash your hands before putting in or removing your lenses. Having strict regimens for cleaning, handling and disinfecting contact lenses and lens cases will also reduce the risk of ulcers.
Corneal ulcers can also be caused by a fungal infection, referred to as fungal kerititis, particularly if an organic material, like a piece of wood, has caused trauma to the eye. This type of ulcer is most commonly seen in those who are already vulnerable due to another condition, such as an immune disorder.
Other causes of corneal ulcers include parasites (such as Acanthamoeba), ocular herpes, dry eye, eye allergies, general infections and diseases such as multiple sclerosis and psoriasis.
Treatment of corneal ulcers
If you suspect you have a corneal ulcer then you should make an appointment to see your eye doctor immediately. Untreated corneal ulcers can lead to a permanent loss of vision or even the loss of an eye. During the exam, your doctor will view the eye through a slit lamp microscope, and will likely apply fluorescein dye eyedrops to highlight the ulcer. Cells may be scraped from the corneal surface and a culture performed to determine the infecting organism.
If the cause is found to be bacterial, initial treatment is usually frequent applications of antibiotic eyedrops or ointment. Depending on the severity of the ulcer, you may need to return for follow-up exams every one to three days so that your doctor can monitor the eye and make sure it's healing properly. Patients with severe ulcers may require hospital treatment for IV antibiotics.
Fungal keratitis can only be diagnosed by examining a specimen or culture under a microscope. Treatment for this type of ulcer includes anti-fungal medication, which can be applied topically to the eye as eye drops or ointment. If the ulcer is severe, you may also be prescribed anti-fungal medication to be taken orally.
Sterile ulcers may be treated with steroid medications.
Prognosis and healing time depend greatly on the severity and location of the ulcer, as well as how early it was detected. Even with early diagnosis and treatment, permanent vision loss is possible, and a corneal transplant (penetrating keratoplasty) may become necessary.
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