How Is a Corneal Ulcer Treated?

A corneal ulcer (also known as keratitis) is an open sore on the cornea. The cornea completely covers the iris, just like a crystal covers the face of a watch. Corneal ulcers are usually caused by an eye infection, but they can also result from severe dry eye or other eye conditions.

At the very front of the eye, there is a clear layer of tissue called the cornea. The cornea acts like a window that allows light to enter the eye and, together with the tear film, helps protect the eye from bacteria, viruses, and fungi.

A corneal ulcer is an open lesion that forms on the cornea and is most often due to infection. Even minor eye injuries or irritation from wearing contact lenses for long periods can lead to infection and ulcer formation.

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Why Do Corneal Ulcers Develop?

The main cause of a corneal ulcer is infection:

Acanthamoeba Keratitis

This infection occurs most often in people who wear contact lenses. It is caused by an amoeba (Acanthamoeba). Although rare, it can be severe and may lead to blindness.

Herpes Simplex Keratitis

Herpes simplex keratitis is a viral infection that causes recurrent flare‑ups of lesions or sores on the eye. Several triggers can provoke an episode, including stress, prolonged exposure to sunlight, or anything that weakens the immune system.

Also read: Ocular Herpes – Everything You Need to Know

Fungal Keratitis

This fungal infection typically develops after the cornea is injured by a plant or plant‑based material. Fungal keratitis can also occur in people with a weakened immune system.

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Symptoms of a Corneal Ulcer

A corneal ulcer can cause pain and a sensation that something is stuck in the eye. There may be tearing, pus, or thick discharge from the eye. If the ulcer is located in the central part of the cornea, vision may become blurry. Pain can worsen when looking at bright lights (photophobia).

An ophthalmologist may observe signs of inflammation (redness) in the conjunctiva and in the anterior chamber of the eye. The redness is due to dilation of conjunctival blood vessels. The eyelids may become swollen. If the ulcer is large, a round white or gray spot on the cornea may be visible to the naked eye.

Not every grayish spot on the cornea is an ulcer. The ulcer may be central, affecting the middle of the cornea, or peripheral, near the outer edge of the cornea. Other symptoms and associated findings can include:

– Eye pain and tenderness  

– Redness and irritation  

– Tearing and discharge  

– Blurred or decreased vision  

– Sensitivity to light (photophobia)  

– The feeling of a foreign body in the eye  

Some more severe corneal ulcers are associated with iritis (anterior uveitis), which is inflammation inside the anterior chamber of the eye. In cases of significant iritis, layers of inflammatory cells may settle at the bottom of the anterior chamber (hypopyon). In rare cases, the cornea can become thinned, with bulging of the inner corneal layers.

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How Does an Ophthalmologist Diagnose a Corneal Ulcer?

An ophthalmologist (and some other healthcare providers) can diagnose a corneal ulcer with a comprehensive eye examination. The doctor uses a special type of microscope called a slit lamp to visualize the cornea and detect the ulcer.

Eye drops containing fluorescein dye may be placed on the eye to make the ulcer easier to see. Scrapings from the ulcer can be sent to the laboratory to identify bacteria, fungi, or viruses. Certain bacteria, such as Pseudomonas species, can cause rapidly progressive corneal ulcers.

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Treatment of a Corneal Ulcer

A corneal ulcer is considered an eye emergency because of the risk of permanent scarring and vision loss. If the ulcer is caused by a bacterial infection, the ophthalmologist will prescribe antibiotic eye drops—sometimes more than one type—and carefully monitor the ulcer over the next few days to ensure it is healing.

If the ulcer is due to a viral infection, antiviral medications can be prescribed either as oral medications or as antiviral eye drops. Fungal corneal ulcers are among the most serious and require specially compounded antifungal eye drops, along with oral or even intravenous antifungal medications in some cases.

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Regardless of the underlying eye condition, this delicate medical problem requires a thorough examination and timely, appropriate treatment by a skilled ophthalmologist using effective medical tools to achieve the best possible outcome. Whatever eye disease or complaint you are experiencing, you can book an appointment at Batal Specialized Medical Complex for a full eye examination and to begin addressing your eye problems, no matter how complex they may be.

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