Corneal Ulcers | Microbial Keratits

Corneal Ulcers are Serious and Sight Threatening Eye Infections

A corneal ulcer is an open sore on the cornea, the clear structure overlying the iris (which is the colored part of your eye).  A corneal ulcer is an urgent medical condition and should be treated by an eye doctor.

Causes of Corneal Ulcers

Infections of the cornea

Most corneal ulcers are caused by infections.

• Bacterial infections are the most common cause of corneal ulcers and are common in people who improperly wear their contact lenses.
• Viral infections are also possible causes of corneal ulcers.  Such viruses include the herpes simplex virus (the virus that causes cold sores) or the varicella virus (the virus that causes chickenpox and shingles). 
• Fungal infections can cause corneal ulcers and may develop with improper care of contact lenses or the overuse of eyedrops that contain steroids.

Corneal Injuries

Tiny tears or abrasions in the corneal surface may become infected and lead to corneal ulcers.  These tears can come from direct trauma by scratches from metallic or glass particles striking the cornea;  or scratches from eyelashes that turn inward and rub on the cornea.  Such injuries damage the corneal surface and make it easier for bacteria to invade and cause a corneal ulcer. Other injuries could be from chemical burns or damaging fluids that splash in the eye.

Severe Dry Eyes

Disorders that cause dry eye syndrome can leave your eye without the germ-fighting protection of tears and may make the eye vulnerable to possible infection.  The dry eyes may also come from Bell’s Palsy, a disorder that prevents the eye from closing completely.

Extended Wear Contact Lens Use

People who wear contact lenses are at an increased risk of corneal ulcers. The risk of corneal ulcers increases tenfold when using extended-wear (sleeping overnight in your lenses) soft contact lenses.  Contact lenses may reduce the corneal defense mechanisms by:

• Rarely, scratches on the edge of a contact lens can scrape the cornea's surface and make it more vulnerable to bacterial infections.
• Similarly, tiny particles of dirt or makeup 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 your lenses are left in your eyes for long periods of time, these bacteria can multiply and cause damage to the cornea.
• Most frequently, wearing contacts for extended periods of time can also reduce oxygen to the cornea, making it more susceptible to infections.

Corneal Ulcer Symptoms

• Red eye
• Pain in the eye that can become severe
• Light sensitivity  (photophobia)
• A white or gray round spot on the cornea that is visible with the naked eye if the ulcer is large
• Feeling that something is in your eye
• Excess tearing and watery eyes
• Mucus type discharge draining from your eye
• Blurred vision

Seek Care from your Eye Doctor if you experience any of those symptoms, especially pain in the eye with blurred vision.

Corneal Ulcer Treatment

Medical Treatment

Depending on the cause of the corneal ulcer,  appropriate eye drop medicine will be prescribed that will be used as frequently as every 15-30 minutes for the first day or part of the first day of treatment.  Medicine will then be continued, but tapered  in frequency based on the healing process. 

Follow-up care will be continued daily until the doctor notes improvement.

Oral pain medications may be prescribed to control the pain.  Pain can also be controlled with special eyedrops.

Surgery

In very, very rare cases, if the ulcer cannot be controlled with medications or if it threatens to perforate the cornea, an emergency surgical procedure may be necessary.

Prevention of Corneal Ulcers

Seek immediate attention from our doctors for any eye pain that doesn’t go away within 30 minutes to one hour.  Wear eye protection when exposed to small particles that can enter your eye.

If you have dry eyes or if your eyelids do not close completely seek care from our dry eye experts. 

Frequent Misdiagnosis of Corneal Ulcers

Often an eye doctor will diagnose a corneal ulcer when, in fact, the condition is a peripheral corneal infiltrate caused by inflammation.  This condition is treated with corticosteroids, not antibiotics.  The experts at Master Eye Associates are skilled and experienced in making this diagnosis.

Contact Lens Wearers

If you wear contact lenses, be extremely careful about the way you clean and wear your lenses.

• Always wash your hands before handling the lenses.  Never use saliva to lubricate your lenses because your mouth contains bacteria that can harm your cornea.
• Remove your lenses from your eyes every evening and carefully clean them.  Never use tap water to clean the lenses. 
• Only sleep in contacts approved by your optometrist for overnight wear.  Have periodic exams (every 6 months) to assess the corneal health when wearing contacts for extended wear. 
• Store the lenses in fresh disinfecting solution overnight.  DO NOT store the lenses in saline. 
• Remove your lenses when your eyes are irritated and leave them out until your eyes feel better or seek medical care. 
• Regularly clean and replace your contact lens case.
• Replace disposable lenses timely as prescribed to minimize the deposits and potentially the bacteria load that adheres to the deposits.

Summary

A corneal ulcer is an ocular emergency and should be diagnosed and treated by an expert. Without treatment you can become partially or completely blind in a very short period of time. Your cornea may also perforate, or you could develop scarring, cataracts or glaucoma.

With proper treatment and careful monitoring, corneal ulcers should improve within two to three weeks.