CORNEAL ULCERS

Who Is At Risk for Corneal Ulcers?

soft-contact-lens

People at risk for corneal ulcers include:

  • Contact lens wearers
  • People who have or have had cold sores, chicken pox or shingles
  • People who use steroid eyedrops
  • People with dry eye
  • People with eyelid disorders that prevent proper functioning of the eyelid
  • People who suffer injury or burns to the cornea

If you wear contact lenses, safe handling, storage and cleaning of your lenses are key steps to reduce your risk of a corneal ulcer. Learn how to safely take care of your contact lenses.

What Causes Corneal Ulcers?

protective-eyewear

Many causes of corneal ulcers can be prevented. Use the correct protective eyewear when doing any work or play that can lead to eye injury. And if you wear contact lenses, it is important to care for your contact lenses safely and correctly.
Corneal ulcers are usually caused by the following types of infections:

  • Bacterial infections
    These are common in contact lens wearers, especially in people using extended-wear lenses.
  • Viral infections
    The virus that causes cold sores (the herpes simplex virus) may cause recurring attacks that are triggered by stress, an impaired immune system, or exposure to sunlight. Also, the virus that causes chicken pox and shingles (the varicella virus) can cause corneal ulcers.
  • Fungal infections
    Improper use of contact lenses or steroid eyedrops can lead to fungal infections, which in turn can cause corneal ulcers. Also, a corneal injury that results in plant material getting into the eye can lead to fungal keratitis.
  • Parasitic (Acanthamoeba) infections
    Acanthamoeba are microscopic, single-celled amoeba that can cause human infection. They are the most common amoebae in fresh water and soil. When Acanthamoeba enters the eye it can cause severe infection, particularly for contact lens users.

Other causes of corneal ulcers include:

  • Abrasions or burns to the cornea caused by injury to the eye. Scratches, scrapes and cuts from fingernails, paper cuts, makeup brushes and tree branches can become infected by bacteria and lead to corneal ulcers. Burns caused by caustic chemicals found in the workplace and at home can cause corneal ulcers.
  • Dry eye syndrome.
  • Bell’s palsy and other eyelid disorders that prevent proper eyelid function. If the eyelid does not function properly, the cornea can dry out, and an ulcer can develop.
Corneal Ulcer Diagnosis

slit-lamp-examination

Your Eye M.D. will use a special dye called fluorescein (pronounced FLOR-uh-seen) to illuminate any damage to your cornea then examine your cornea using a special microscope called a slit lamp. The slit-lamp exam will allow your ophthalmologist to see the damage to your cornea and determine if you have a corneal ulcer.
If your Eye M.D suspects that an infection is responsible for your corneal ulcer, a tiny tissue sample may be taken so that the infection can be identified and properly treated.

Corneal Ulcer Treatment

Antibiotics, antifungal or antiviral eyedrops are the mainstay of treatment. Sometimes antifungal tablets will be prescribed, or an injection of medication is given near the eye for treatment.
Once any infection has diminished or is gone, then steroid or anti-inflammatory eyedrops may be used to reduce swelling and help prevent scarring. The use of steroid eyedrops is controversial and should only be used under close supervision by your ophthalmology. It is possible that steroid eyedrops may worsen an infection.
Oral pain medication may be prescribed to reduce pain.

corneal_transplant_03

Donor cornea is sutured in place.

corneal_transplant_02_1

Abnormal cornea is removed.

If symptoms of corneal ulcer continue after treatment – including pain and redness of the eye, tearing and discharge from the eye and blurry vision – let your ophthalmologist know right away so a different course of treatment can be started promptly.

Surgical treatment

If corneal ulcers cannot be treated with medication, surgery may be needed to keep your vision. A corneal transplant can replace your damaged cornea with a healthy donor cornea to restore vision.