Summary about Disease
A corneal ulcer is an open sore on the cornea, the clear front surface of the eye. It's often caused by infection (bacterial, viral, fungal, or parasitic), but can also result from severe dry eye, trauma, or inflammatory disorders. If left untreated, a corneal ulcer can lead to vision loss and even blindness.
Symptoms
Eye pain
Redness
Excessive tearing
Blurred vision
Sensitivity to light (photophobia)
Feeling like something is in your eye
Discharge from the eye
White spot on the cornea (may be visible)
Eyelid swelling
Causes
Infections:
Bacterial (e.g., Staphylococcus aureus, *Pseudomonas aeruginosa*) - often associated with contact lens wear.
Viral (e.g., Herpes Simplex Virus (HSV), Varicella Zoster Virus (VZV))
Fungal (e.g., Fusarium, *Aspergillus*) - can occur after eye injury with plant matter or in immunocompromised individuals.
Parasitic (e.g., Acanthamoeba) - associated with contact lens wear, especially improper cleaning and storage.
Trauma: Scratches, abrasions, or foreign bodies in the eye.
Dry Eye: Severe dry eye can damage the corneal surface, making it susceptible to ulceration.
Inflammatory Disorders: Conditions like rheumatoid arthritis or lupus can sometimes cause corneal ulcers.
Contact Lens Use: Improper use, cleaning, or storage of contact lenses greatly increases the risk.
Bell's Palsy: When the eyelid does not close completely.
Medicine Used
Antibiotics: For bacterial infections (eye drops or ointment).
Antivirals: For viral infections (eye drops, ointment, or oral medication).
Antifungals: For fungal infections (eye drops, oral medication, or sometimes intravenous medication).
Anti-parasitic: For parasitic infections, specifically Acanthamoeba (eye drops).
Cycloplegics: To dilate the pupil and relieve pain (eye drops).
Pain relievers: Oral pain medications may be prescribed.
Artificial Tears: To lubricate the eye, especially for dry eye related ulcers.
Steroid eye drops In certain cases to reduce inflimation (Use with extreme caution and under close supervision as they can worsen some infections).
Is Communicable
Whether a corneal ulcer is communicable depends on the underlying cause.
Infectious ulcers (bacterial, viral, fungal, parasitic): Some can be communicable. Viral ulcers (like those caused by Herpes Simplex Virus) are contagious through direct contact with the infected eye or its secretions. Some bacterial and fungal infections can also spread, though less commonly. Acanthamoeba is not typically spread person-to-person.
Non-infectious ulcers (trauma, dry eye, inflammatory disorders): These are NOT communicable.
Precautions
Good Hygiene: Wash hands frequently, especially before touching your eyes.
Contact Lens Care: Follow your eye doctor's instructions for proper cleaning, disinfecting, and storage of contact lenses. Never use tap water to rinse or store lenses. Replace lenses as recommended.
Avoid Touching Eyes: Reduce the risk of introducing bacteria or other pathogens.
Prompt Treatment: Seek immediate medical attention for any eye pain, redness, or vision changes.
Protective Eyewear: Wear safety glasses or goggles when working in environments with potential eye hazards (e.g., construction, woodworking).
Avoid Sharing: Do not share eye makeup, towels, or other personal items that could transmit infection.
Manage Underlying Conditions: Properly manage dry eye or other inflammatory conditions.
Vaccination: Consider vaccination against Herpes Zoster (Shingles) to reduce the risk of corneal ulcers caused by VZV.
How long does an outbreak last?
The duration of a corneal ulcer outbreak varies significantly depending on the cause, severity, and promptness of treatment.
With prompt and effective treatment: Bacterial ulcers may heal within a few days to a couple of weeks. Viral ulcers may take several weeks to months to fully resolve, and recurrence is possible. Fungal ulcers tend to be more chronic and can take weeks to months to heal. Acanthamoeba ulcers are often very slow to heal and can take months or even years to eradicate.
Without treatment or with delayed treatment: Corneal ulcers can worsen rapidly, leading to significant vision loss, scarring, and potential complications requiring surgery.
How is it diagnosed?
Eye Exam: A comprehensive eye exam, including visual acuity testing and assessment of the cornea using a slit lamp (a microscope with a bright light).
Fluorescein Stain: A special dye (fluorescein) is applied to the eye to highlight any corneal defects or ulcers.
Corneal Scraping/Culture: A sample of the ulcer is scraped and sent to a laboratory to identify the causative organism (bacteria, virus, fungus, or parasite). This helps determine the appropriate treatment.
Confocal Microscopy: In some cases, this imaging technique may be used to visualize the cornea at a cellular level.
Review of Medical History: The doctor will ask about contact lens use, previous eye infections, underlying medical conditions, and any recent eye injuries.
Timeline of Symptoms
The timeline of symptoms can vary, but generally follows this pattern:
Initial Stage: Mild eye pain, redness, tearing, and blurred vision.
Progression: Pain increases, photophobia develops, a white spot may become visible on the cornea, and vision worsens. Discharge may be present.
Advanced Stage (without treatment): Severe pain, significant vision loss, potential corneal perforation (a hole in the cornea), and spread of infection to other parts of the eye. This timeline can be compressed into a very short period (e.g., 24-48 hours) with aggressive bacterial infections, particularly those caused by Pseudomonas.
Important Considerations
Emergency: A corneal ulcer is a serious eye condition requiring immediate medical attention.
Treatment Adherence: Follow your eye doctor's instructions carefully regarding medication use and follow-up appointments.
Contact Lens Wear: Discontinue contact lens wear immediately if you suspect a corneal ulcer and do not resume until cleared by your doctor.
Potential Complications: Untreated corneal ulcers can lead to significant vision loss, corneal scarring, glaucoma, and even the need for corneal transplantation.
Prevention: Emphasize preventative measures, especially proper contact lens hygiene and protection from eye injuries.
Differential Diagnosis: Other conditions, such as corneal abrasions or keratitis, can mimic some of the symptoms of a corneal ulcer. Accurate diagnosis is crucial for appropriate treatment.
Underlying Conditions: Consider and address any underlying medical conditions that may contribute to the development of corneal ulcers.