Disease: Corneal Ulcer

    Corneal ulcer facts

    • A corneal ulcer is an open sore on the cornea.
    • There are a wide variety of causes of corneal ulcers, including infection, physical and chemical trauma, corneal drying and exposure, and contact lens overwear and misuse.
    • Corneal ulcers are a serious problem and may result in loss of vision or blindness.
    • Most corneal ulcers are preventable.
    • With appropriate and timely treatment, the majority of corneal ulcers will improve with minimal adverse effect on vision.

    What is a corneal ulcer?

    A corneal ulcer is an open sore on the cornea, the clear structure in the front of the eye. The cornea overlies the iris, which is the colored part of the eye.

    What does a corneal ulcer look like?

    A corneal ulcer will often appear as a gray to white area on the normally transparent cornea. Some corneal ulcers may be too small to see without adequate magnification and illumination. See the first reference for pictures of a corneal ulcer.

    What are the causes of a corneal ulcer?

    Most corneal ulcers are caused by infections. Bacterial infections cause corneal ulcers and are common in people who wear contact lenses. Bacteria can directly invade the cornea if the corneal surface has been disrupted. Some bacteria produce toxins that can cause ulceration of the cornea. Viruses that may cause corneal ulcers include the herpes simplex virus (the virus that causes cold sores) and the Varicella virus (the virus that causes chickenpox and shingles). Fungal infections can cause corneal ulcers and may occur with improper care of contact lenses or overuse of eyedrops that contain steroids.

    Tiny cuts or scratches in the corneal surface may become infected and lead to corneal ulcers. For example, metal, wood, glass, or almost any type of particle that strikes the cornea can cause minor trauma. Such injuries damage the corneal surface and make it easier for bacteria to invade and cause a corneal ulcer. A corneal abrasion is a larger loss of the corneal surface and may ulcerate if left untreated.

    Disorders that cause dry eyes can leave the eye without the germ-fighting protection of the tear film and cause or aggravate corneal ulcers.

    Disorders that affect the eyelid and prevent the eye from closing completely, such as Bell's palsy, can dry the cornea and make it more vulnerable to ulcers.

    Any condition which causes loss of sensation of the corneal surface may increase the risk of corneal ulceration.

    Chemical burns or other caustic (damaging) solution splashes can injure the cornea and lead to corneal ulceration.

    People who wear contact lenses are at an increased risk of corneal ulcers. The risk of corneal ulcers and other complications are lowest with daily wear disposable lenses. The risk of corneal ulceration increases at least tenfold when using extended-wear lenses. Extended-wear contact lenses are those contact lenses that are worn for several days without removing them at night.

    Scratches on the edge of the contact lens can scrape the cornea's surface and make it more open to bacterial infections. Similarly, tiny particles of dirt trapped underneath the contact lens can scratch the cornea. Bacteria may be on the improperly cleaned lens and get trapped on the undersurface of the lens. If lenses are left in eyes for long periods of time, bacteria can multiply and cause damage to the cornea. Wearing lenses for extended periods of time can also block oxygen to the cornea, making it more susceptible to infections.

    In addition, some patients with immunological disorders(immunosuppressed, rheumatoid arthritis, lupus, and others) may develop corneal ulcers as a complication of their disease.

    What are corneal ulcer symptoms?

    A corneal ulcer may cause redness, pain, a feeling that something is in the eye, tearing, and pus or thick discharge draining from the eye. Vision might be blurry, and there may be an increase in pain when the person looks at bright lights.

    What are corneal ulcer signs?

    An ophthalmologist (a medical doctor who specializes in medical and surgical treatment of eye diseases) may notice signs of inflammation (redness) in the conjunctiva of the eye and in the anterior chamber of the eye. The eyelids may be swollen, and a white or gray round spot on the cornea could be visible with the naked eye if the ulcer is large. Not all gray spots are ulcers. The ulcer may be central in the cornea or marginal, at the outer edge of the cornea. There may be swelling (edema) of the cornea around the ulcer. There may be scarring from prior corneal ulcers. There may be a single (or multiple ulcers) in the eye, and ulcers may be present in one or both eyes.

    How is a corneal ulcer diagnosed?

    The presence of a corneal ulcer can be diagnosed by an ophthalmologist (and other medical caregivers) through an eye examination. The ophthalmologist will be able to detect an ulcer by using a special eye microscope known as a slit lamp. A drop containing the dye fluorescein, when placed in the eye, can make the ulcer easier to see. Scrapings of the ulcer may be sent to the laboratory for identification of bacteria, fungi, or viruses. Certain bacteria, such as a speciaes of pseudomonas, may cause a corneal ulcer which is rapidly progressive.

    What is the treatment for a corneal ulcer?

    Treatment is aimed at eradicating the cause of the ulcer. Anti-infective agents directed at the inciting microbial agent will be used in cases of corneal ulcer due to infection. Generally, these will be in the form of drops or ointments to be placed in the eye; but occasionally, especially in certain viral infections, oral medications will also be employed. Occasionally, steroids will be added, but should only be used after examination by an eye doctor or other physician using a slit lamp, because in some situations, steroids may hinder healing or aggravate the infection.

    In cases aggravated by dryness or corneal exposure, tear substitutes will be used, possibly accompanied by patching or a bandage contact lens.

    In corneal ulcers involving injury, the inciting agent must be removed from the eye (using copious irrigation for chemicals or by using a slit lamp microscope to remove particles such as wood or metal) and then adding medications to prevent infection and minimize scarring of the cornea.

    Contact lenses should be discontinued in any case of corneal ulcer, regardless of whether the ulcer was initially caused by the contact lens.

    If the ulcer cannot be controlled with medications, it may be necessary to surgically debride the ulcer. If the ulcer causes significant corneal thinning and threatens to perforate the cornea, a surgical procedure known as corneal transplant may be necessary.

    Individuals with corneal ulcers due to immunological diseases may require patient-specific treatment with immunosuppressive drugs. Such patients may require care coordinated with an ophthalmologist in conjunction with other doctors.

    Anyone with an irritated eye that does not improve quickly after removing a contact lens or after mild irrigation should contact an ophthalmologist immediately. Never borrow someone's eyedrops.

    What are corneal ulcer symptoms?

    A corneal ulcer may cause redness, pain, a feeling that something is in the eye, tearing, and pus or thick discharge draining from the eye. Vision might be blurry, and there may be an increase in pain when the person looks at bright lights.

    What are corneal ulcer signs?

    An ophthalmologist (a medical doctor who specializes in medical and surgical treatment of eye diseases) may notice signs of inflammation (redness) in the conjunctiva of the eye and in the anterior chamber of the eye. The eyelids may be swollen, and a white or gray round spot on the cornea could be visible with the naked eye if the ulcer is large. Not all gray spots are ulcers. The ulcer may be central in the cornea or marginal, at the outer edge of the cornea. There may be swelling (edema) of the cornea around the ulcer. There may be scarring from prior corneal ulcers. There may be a single (or multiple ulcers) in the eye, and ulcers may be present in one or both eyes.

    How is a corneal ulcer diagnosed?

    The presence of a corneal ulcer can be diagnosed by an ophthalmologist (and other medical caregivers) through an eye examination. The ophthalmologist will be able to detect an ulcer by using a special eye microscope known as a slit lamp. A drop containing the dye fluorescein, when placed in the eye, can make the ulcer easier to see. Scrapings of the ulcer may be sent to the laboratory for identification of bacteria, fungi, or viruses. Certain bacteria, such as a speciaes of pseudomonas, may cause a corneal ulcer which is rapidly progressive.

    What is the treatment for a corneal ulcer?

    Treatment is aimed at eradicating the cause of the ulcer. Anti-infective agents directed at the inciting microbial agent will be used in cases of corneal ulcer due to infection. Generally, these will be in the form of drops or ointments to be placed in the eye; but occasionally, especially in certain viral infections, oral medications will also be employed. Occasionally, steroids will be added, but should only be used after examination by an eye doctor or other physician using a slit lamp, because in some situations, steroids may hinder healing or aggravate the infection.

    In cases aggravated by dryness or corneal exposure, tear substitutes will be used, possibly accompanied by patching or a bandage contact lens.

    In corneal ulcers involving injury, the inciting agent must be removed from the eye (using copious irrigation for chemicals or by using a slit lamp microscope to remove particles such as wood or metal) and then adding medications to prevent infection and minimize scarring of the cornea.

    Contact lenses should be discontinued in any case of corneal ulcer, regardless of whether the ulcer was initially caused by the contact lens.

    If the ulcer cannot be controlled with medications, it may be necessary to surgically debride the ulcer. If the ulcer causes significant corneal thinning and threatens to perforate the cornea, a surgical procedure known as corneal transplant may be necessary.

    Individuals with corneal ulcers due to immunological diseases may require patient-specific treatment with immunosuppressive drugs. Such patients may require care coordinated with an ophthalmologist in conjunction with other doctors.

    Anyone with an irritated eye that does not improve quickly after removing a contact lens or after mild irrigation should contact an ophthalmologist immediately. Never borrow someone's eyedrops.

    Source: http://www.rxlist.com

    A corneal ulcer may cause redness, pain, a feeling that something is in the eye, tearing, and pus or thick discharge draining from the eye. Vision might be blurry, and there may be an increase in pain when the person looks at bright lights.

    Source: http://www.rxlist.com

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