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Corneal Ulcers

A corneal ulcer as a possible cause of ocular symptoms is looked for by using corneal fluorescein staining and blue light.
The general practitioner can treat a superficial erosion caused by mechanical trauma. The aetiological diagnosis and treatment of other corneal ulcers should be left to an ophthalmologist.
Keratitis always requires emergency treatment Keratitis.
Dry eye syndrome predisposes to spontaneous corneal ulcers Dry Eye Syndrome.
For eye problems in contact lens users, see Contact Lenses.

Corneal ulcers may be sterile or infected. An intact cornea and normal tears protect the eye well from infections. If they are not normal, susceptibility to infections increases.
An infected corneal ulcer is rather rare nowadays, and it usually develops only on previously affected cornea (trauma, contact lens injury, keratoconjunctivitis sicca, loss of corneal sensation, etc.)

Pain, redness, discharge, impaired vision and sensitivity to light
A greyish area may be visible on the cornea.
Infectious keratitis is caused by bacteria, viruses, fungi and parasites.
In severe cases a collection of leukocytes (hypopyon) is visible in the anterior chamber. The irritation may spread to the internal parts of the eye and cause secondary iritis.
The patient should be referred as an emergency case to an ophthalmologist for treatment. A specific infectious agent should be identified, and treatment is targeted accordingly.

A corneal erosion usually develops after trauma.
Spontaneous erosion is also rather common in a patient with dry eyes or diabetes.
The patient has a strong sensation of a foreign body or pain, tear-flow and light sensitivity.
The cornea is clear and the erosion is visible with fluorescein staining and blue light.
The eye is painful as long as epithelialization is not complete, usually for 1-3 days.
The treatment consists primarily of antimicrobial ointment 4 times daily and secondarily of oil-based antimicrobial drops 5 times daily for approximately a week to prevent infection and to promote healing of the corneal erosion.
In the case of trauma-related erosion, it is worth checking after a couple of days if the ulcer has started to heal. If the ulcer has not healed, an ophthalmologist should be consulted.
If the patient has recurrent spontaneous corneal ulcers (recurrent corneal erosion), the patient should be referred to an ophthalmologist for treatment evaluation.
If the erosion is situated centrally in the cornea, vision is temporarily impaired. Restoration of normal vision takes longer than the epithelialization, which should be explained to the patient to prevent unnecessary consultations.
Advise the patient not to rub the eye. Patching the eye with a dressing (”monoculus” treatment) does not accelerate healing Patching Corneal Abrasions but it may be used to reduce pain caused by eye lid movement.
For the treatment of an erosion see also article A Foreign Body on the Cornea.

Symptoms include conjunctival erythema, pain and feeling of a foreign body.
The condition is most probably caused by bacterial toxins.
The patient is usually of advanced age.
A marginal ulcer becomes visible with fluorescein staining in the lateral part of the cornea. The cornea is opaque in this area, and the ulcer resembles a strand.
Treatment consists of topical antimicrobial-glucocorticoid drops after assessment by an opththalmologist.

Ahmed F, House RJ, Feldman BH. Corneal Abrasions and Corneal Foreign Bodies. Prim Care 2015;42(3):363-75. [PubMed]
Wipperman JL, Dorsch JN. Evaluation and management of corneal abrasions. Am Fam Physician 2013;87(2):114-20. [PubMed]