Corneal Ulcer
👁️🗨️ Corneal Ulcer
🔍 Definition
A corneal ulcer is an open sore on the cornea, usually resulting from an infection that penetrates the corneal epithelium into the stroma, leading to inflammation, necrosis, and potential scarring.
🧠 It is a vision-threatening emergency and often painful.
⚠️ Etiology (Causes)
🔹 Infectious (Most Common)
| Pathogen Type | Examples | Notes |
|---|---|---|
| Bacterial | Pseudomonas, Staph, Strep | Most common, esp. in contact lens wearers |
| Viral | Herpes simplex, Herpes zoster | Dendritic or geographic ulcers |
| Fungal | Fusarium, Aspergillus, Candida | After plant trauma, chronic steroid use |
| Parasitic | Acanthamoeba | Associated with contact lens & water exposure |
🔹 Non-Infectious
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Exposure keratitis (e.g., Bell's palsy, nocturnal lagophthalmos)
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Neurotrophic keratitis (e.g., post-HSV, diabetes)
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Chemical injuries
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Autoimmune (e.g., rheumatoid arthritis)
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Dry eye disease (severe cases)
🧪 Symptoms
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⚡ Severe eye pain
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😢 Tearing / discharge
-
🌞 Photophobia
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👁️ Blurred or decreased vision
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🔴 Redness
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🤕 Foreign body sensation
🔬 Signs on Slit-Lamp Exam
| Finding | Description |
|---|---|
| Corneal infiltrate | Whitish opacity in the stroma (infectious focus) |
| Epithelial defect | Seen with fluorescein staining |
| Surrounding edema | Corneal haze or stromal swelling |
| Hypopyon | Pus in the anterior chamber |
| Ciliary injection | Redness near the limbus |
| Decreased corneal sensation | Often seen in viral ulcers (HSV) |
🔬 Investigations
| Test | Purpose |
|---|---|
| Fluorescein staining | Detects epithelial defect, ulcer margin |
| Corneal scraping | For Gram stain, KOH, Giemsa, culture, PCR |
| Confocal microscopy | May help diagnose Acanthamoeba |
| PCR | For HSV or other viral DNA |
| Visual acuity testing | Baseline assessment |
💊 Treatment
✅ Empirical Therapy
Start immediately after taking corneal scrapings:
| Case | Treatment Example |
|---|---|
| Bacterial ulcer | Fortified vancomycin + ceftazidime drops OR fluoroquinolones |
| Contact lens user | Ciprofloxacin or tobramycin (anti-Pseudomonas) |
| Fungal ulcer | Natamycin 5%, amphotericin B, voriconazole |
| Viral ulcer (HSV) | Topical acyclovir 3% ointment OR ganciclovir |
| Acanthamoeba | PHMB, chlorhexidine, propamidine |
⚠️ Avoid Steroids Initially!
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Steroids can worsen infectious ulcers
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Only considered in immune-related stromal ulcers or HSV keratitis (under antiviral cover)
🔁 Follow-up & Monitoring
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Daily review initially
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Monitor size of ulcer, epithelial healing, anterior chamber reaction
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Adjust antibiotics based on culture sensitivity
🔄 Complications
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Corneal perforation
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Scarring & vision loss
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Secondary glaucoma
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Endophthalmitis
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Panophthalmitis (rare but severe)
🧠 Mnemonic: "PAINFUL EYES"
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Photophobia
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Acute pain
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Infiltrate
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Necrotic epithelium
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Fluorescein positive
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Ulcer
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Limbal redness
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Exudate (discharge)
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Yield cultures
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Emergency referral
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Scarring risk
👁️🗨️ Prevention
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Proper contact lens hygiene
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Prompt treatment of minor abrasions
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Avoiding steroid eye drops without medical advice
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Eye protection in high-risk environments
Would you like:
-
A comparison table of corneal ulcer vs. abrasion vs. keratitis?
-
A flowchart on how to manage a red eye?
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Clinical case vignettes for practice?
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