Corneal Ulcer

An in-depth look at the causes, treatment, and risks of corneal ulcers and how they can affect you for the rest of your life.

A corneal ulcer is an open sore or break on the cornea. The cornea is the clear, protective covering at the front of the eye and is the first part of the eye to refract light. A corneal ulcer is often the result of an untreated corneal abrasion (a scratch on the cornea). Once an injury or scratch occurs, bacteria immediately begin invading the wound, which leads to infection and corneal ulcers.

Corneal ulcers occur in people of all ages. Typically the ulcer is infectious, but some corneal ulcers are not. Pain, redness, and vision problems are usually associated with ulcers that contain bacteria. Still, all corneal ulcers should be looked at by an eye care professional to ensure that there is no infection and to help craft an appropriate treatment plan.

Corneal Ulcer Symptoms

Symptoms of corneal ulcers vary from person to person, depending on such factors as the location and size of the ulcer. If the ulcer is caused by bacteria, it may be visible to the naked eye in the form of a white patch on the cornea. Not all corneal ulcers are visible, however, especially if they are caused by the herpes simplex virus (discussed more in the causes section). Typically, corneal ulcers cause symptoms such as:

• Pain ranging from mild to severe, but typically severe
• Redness of the sclera (white part of eye)
• Photophobia (sensitivity to light)
• Impaired and/or blurred vision
• Watering of the eye
• Clouding of the eye
• Discharge from the eye
• Feeling of foreign body in eye

What Causes Corneal Ulcers?

In most cases, corneal ulcers are caused by germs that enter the area through a previous injury or scratch to the cornea. The germs may be viral, bacterial, or fungal, or there may be a parasitic infection. If the ulcer is caused by the herpes simplex virus (dendritic ulcer) it may not be visible to the naked eye. The herpes simplex virus is a common viral infection that many people contract during childhood. Symptoms of this virus typically include mouth sores, sore throat, and swollen glands. Rarely does this virus spread to other parts of the body, but this can occur if you touch an infected area and then touch your eye.

Contact lens wearers are known to be prone to corneal ulcers due to the rubbing of the contact lens against the surface of the eye. If enough rubbing occurs, the surface can become weak and break, which enables bacteria to enter the eye and begin reproducing and spreading. Contact lens wearers who do not practice proper hygiene also increase their risk of developing corneal ulcers. For example, leaving soft contact lenses in while sleeping, or practicing poor hygiene while removing or adjusting the lenses increases the exposure to bacteria that can lead to infection.

Acanthamoeba are common parasites that enter into the eye (acanthamoeba keratitis). Contact lens wearers who fail to remove their lenses before swimming can contract this parasitic infection. Fungal keratitis can occur after an injury to the cornea involving plant material or if your immune system is suppressed.

Additional causes of corneal ulcers may include:

• Eye allergies
• Corneal abrasions
• Eyelids that do not close all the way, such as with Bell’s palsy
• Dry eyes
• Immune system disorder
• Inflammatory diseases such as multiple sclerosis and psoriasis

Diagnosing Corneal Ulcers

If you experience symptoms of corneal ulcers, you should contact an eye care professional immediately for a complete eye exam. Untreated corneal ulcers can lead to permanent eye damage and vision loss. During the eye exam your eye doctor will look for signs of infection. In cases where an ulcer is not visible, eye drops that stain the eye may be used to identify an ulcer. Typically your eye doctor will use a slit lamp (eye microscope) to look into your eye. Regardless of the visibility of the ulcer, a yellow dye may be used to see the affected area more easily. Visual acuity tests and corneal scrapings may be used to determine the cause of the ulcer. Blood tests may be needed to rule out specific disorders and diseases.

Corneal Ulcer Treatment

In order to treat corneal ulcers, doctors must first determine the cause of the ulcer. Treatment should not be delayed when corneal ulcers develop. If the cause is unknown, antibiotics are given to fight the infection and bacteria. The antibiotics are usually given in the form of eye drops, sometimes as often as one drop per hour. If the cause is known, special eye drops are used to treat that problem. In some cases, corticosteroid eye drops are prescribed to reduce swelling and inflammation.

If the corneal ulcer is severe, a cornea transplant (keratoplasty) may be needed. During this procedure the diseased or damaged cornea is removed. A new cornea is then grafted into the area with tiny sutures. The sutures (stitches) are removed after the healing process has taken place, or three to four weeks after surgery. Most people can see an improvement in their vision within days after the surgery. In some cases, hospital stays as long as two days are required.

Your eye doctor may also recommend you:

• Wear protective glasses
• Take pain medications as instructed
• Avoid eye makeup
• Avoid sharing makeup, towels, or eye-drops with others
• Avoid wearing contact lenses during treatment
• Discontinue wearing contact lenses while sleeping
• Wear an eye patch to avoid symptoms such as sensitivity to light
• If a corneal transplant is performed, do not allow water to enter your eye

In some cases, minor but permanent vision changes occur, but most people completely heal from corneal ulcers. Follow-up visits with your eye doctor are typically recommended, regardless of the severity of the ulcer.

Corneal Ulcer Risk Factors

If you had a corneal ulcer in the past, you are considered to be prone to long-term damage to the cornea and may experience noticeable changes in your vision in the future. Other factors that increase your risk of developing ulcers include:

• Wearing contact lenses, especially soft lenses, while you sleep
• Severe dry eye
• Recent infection or injury to eye
• Severe allergies
• Eyelids that do not close completely
• Athletes who do not use eye protection during athletic activities
• Small children playing with pointed objects
• Weakened immune system, such can be caused by HIV
• Work or hobbies that use pointed tools or produce dust, such as farming or construction work

Complications of Corneal Ulcers

Most complications from corneal ulcers occur because the ulcer has been left untreated. Typically, treatment can prevent complications such as:

• Loss of vision
• Scarring on the cornea
• Loss of affected eye
• Cataracts or glaucoma
• Spread of infection to other parts of eye and body

When to See Your Eye Doctor

Corneal ulcers should not be ignored. If you are experiencing symptoms of one, you should seek medical attention immediately. Signs of a corneal ulcer include:

• Severe pain
• Any change in vision
• Feeling of foreign body in eye
• History of scratches to the eye
• History of exposure to chemicals or flying particles
• Excessive discharge draining from eye
• Symptoms worsening after diagnosis and treatment of this condition

Preventing a Corneal Ulcer

If you have an eye infection or injure your eye, you should seek medical attention immediately from an ophthalmologist or eye doctor. Early treatment can prevent the ulcer from developing. Symptoms of corneal ulcers should not be ignored. Contact lens wearers should wash their hands before handling contact lenses to prevent the transmission of bacteria and foreign objects. Discontinue wearing contact lenses while you sleep. Talk with your eye-care professional about prevention measures you should take during your normal daily activities.

Questions to Ask Your Doctor

• How will this affect my vision in the future?
• How long will it take to treat?
• How can I prevent this from happening again?
• Will I need to miss work/school?
• If symptoms recur, how longs should I wait to see you again?