Corneal ulcer is a breach in the epithelium of the cornea along with inflammation. The cornea in the area of corneal ulcer becomes white. Corneal ulcer, usually affects visual acuity and sometimes cosmetic appearance. Timely intervention by a cornea specialist can save the eye affected by corneal ulcers.
Causes of Corneal Ulcers
Different organism like bacteria, virus, and fungus causes corneal ulcer.
Bacterial ulcers are more common in contact lens wearers and due to hospital acquired infection. Bacterial ulcer can be caused by gram positive bacteria as well as gram negative bacteria. Effect of corneal ulcer on cornea depends upon size of the ulcer, duration of the ulcer, location on the cornea and immune status of the patient. Larger corneal ulcer take longer time to heal with medications and sometimes need a corneal transplant. Long standing corneal ulcers usually become resistant to many eye drops and need intensive treatment.
Viral corneal ulcers commonly seen are herpes simplex keratitis, shingles, and chicken pox. Chances of recurrence with viral infection is high. Any decrease in immunity can cause recurrence of these infections.
Fungal corneal ulcers are common in diabetic patients. Patients with uncontrolled diabetes and patients with diabetes not using medication can get affected with fungal infection. Injury to the eyes with vegetative material like plants or injury to the farmers during farming usually results in fungal keratitis. Overuse of steroid eye drops can also cause fungal keratitis.
Most common cause for corneal ulcer is trauma to the eye. Any injury with wooden stick, metal rod etc. can cause defect in corneal epithelium and make the cornea more prone to develop any infection.
Contact lens wearers are susceptible to develop corneal ulcers if they don’t maintain the contact lens hygiene. Any contamination to the contact lens solution or if the patient is sleeping with contact lens on can cause corneal ulcers. Contact lens should be used only after your eye specialists’ consultation and understanding the proper method to use it. Daily wear contact lenses are safer to use than extended wear lenses.
Patients with severe dryness are also prone to develop corneal ulcer due to decrease in tear volume on the corneal surface. In neurological problems like facial paralysis in which lids are not properly closed can also develop corneal ulcers due to corneal exposure.
The symptoms of corneal ulcers are pain, redness, watering, photophobia, lid swelling.
The common signs present in corneal ulcer eyes are congestion, corneal edema, lid edema, and in some cases intraocular inflammation. Different corneal ulcers have few specific signs for a particular organism and course of progression is also different for different corneal ulcers. Severity of symptoms also depends upon the nature of infective organism, its virulence, the extent of corneal involvement and the duration of corneal ulcer. Acanthamoeba induced corneal ulcer is very painful and very difficult to treat. Fungal corneal ulcers are not very painful but take more time to respond to the treatment.
Diagnosis of corneal ulcer requires meticulous eye examination by a cornea expert. History taking and detailed eye examination is a must. Corneal scraping and culture of the infective agent is required to identify the etiology. Drug sensitivity should be done in non responding cases.
Treatment of Corneal Ulcer
The mainstay of treatment for corneal ulcers is anti-infective agents like antibiotics, antiviral and antifungal agents depending upon the etiology of corneal ulcer in a particular case.
Cycloplegic drops are also used to relieve ocular pain. Along with eye drops many- a -times oral antibiotics are also used.
Corneal ulcer usually takes time to completely resolve. Smaller ulcers heal quickly whereas a large ulcer may take few weeks to months in some cases. Regular monitoring and follow up is the key to managing cases of corneal ulcers.
After complete healing of corneal ulcers white scaring remains in the cornea in many cases which can hamper the vision permanently.
Corneal ulcers sometimes don’t respond to medical therapy despite trying multiple medications. In these situations, corneal transplantation may be required. Performing corneal transplant in these eyes is challenging. Chances of graft infection is high in postoperative period. Extensive care should be taken to while performing corneal transplant in these eyes.
Prevention of Corneal Infection
Avoid eye injury
Avoid contact lens induced trauma
Avoid sleeping with contact lens on
Avoid using over the counter eye drops for corneal infection
Most importantly- must consult an ophthalmologist or cornea specialist immediately
Regular eye check up for patients who have undergone any eye surgery in the past
Corneal infection or corneal ulcer is a vision threatening disease. If a patient encounters any of the symptoms discussed above, he or she should consult the corneal specialist without delay. Prompt treatment is the key to achieve better outcome in cases of a corneal ulcer.
Bharti eye has a dedicated team of corneal surgeons who are experts in managing all sorts of corneal diseases.