Corneal ulcers can be both infectious and non-infectious in nature, although infectious etiologies are often more common and more severe.
What is a Corneal Ulcer?
But what exactly is a corneal ulcer? How does it differ from a normal eye infection?
The textbook definition of a corneal ulcer is a disruption of the corneal epithelium with underlying stromal inflammation (i.e. an infiltrate).
Essentially, something causes the epithelium to erode, creating a pit in the epithelium.
How Serious is a Corneal Ulcer?
Corneal ulcers are extremely painful, as the cornea contains many small nerve endings. Those suffering from a corneal ulcer often note severe pain, light sensitivity, excess tearing, and extreme redness, especially near the borders of the ulcer.
A corneal ulcer often presents as a grey or white spot on the front of the cornea. Under magnification and with special dye, your doctor will be able to see heaped up, disrupted epithelium with underlying inflammation.
Corneal ulcers can be small or large and will grow in size without medical interference. It is of upmost importance to see an eye doctor immediately if you have a corneal ulcer to get treatment initiated and reduce risk of future damage.
Corneal ulcers pose significant threat for loss of vision as ulcers almost always scar as a part of the healing process. Thus, it is important to keep the ulcer under control and limit ulcer growth not only to reduce pain and inflammation, but also to prevent white, opaque scar tissue from obscuring vision.
Even small ulcers can be detrimental to vision if they occur within the line of sight, or central area of the cornea.
What are the Causes?
Causes of corneal ulcers include bacteria infection, viral infection, parasitic infection, fungal infection, contact lens overwear, ocular trauma, andextreme dry eye.
Some of the most common causes of infectious corneal ulcers are Herpes (both simplex and zoster), Acanthamoeba, and staph infections (most commonly seen in contact lens wearers).
Infectious corneal ulcers pose even more of a risk to the eye as infectious ulcers tend to grow rapidly as the bacteria, fungus, or parasite actively consumes the cornea, enlarging the ulcer.
In some rare and severe cases, the infection can become so great that the cornea perforates. In other words, the ulcer expands wider and deeper to affect all layers of the cornea, and the cornea actually breaks open, exposing the inner parts of the eye.
Corneal perforation is considered an ocular emergency as the individual is at risk for ocular structural damage, further infection, and even loss of the eye.
Treatment Options
Treatment for corneal ulcers involves trying to get the underlying etiology under control. If it’s a bacterial infection, your doctor may recommend staying out of contact lenses and prescribing antibiotics. If it’s a fungal infection, your doctor may recommend a variety of prescription anti-fungals. If it’s extreme dry eye, your doctor may recommend copious amounts of artificial tears, temporarily taping the eyelid closed, and/or preventative antibiotics.
Whatever the underlying cause, you will need to get things under control and try to limit growth of the ulcer. In many cases, simply resolving the underlying cause and limiting expansion is sufficient, resolving only to a small scar that does not interfere with vision.
In other cases, however, corneal damage and subsequent scarring is too great, and a person’s vision is permanently reduced. At this point, once inflammation has resided completely, your doctor may recommend a corneal transplant.
The most commonly performed transplant method post-corneal ulcer is a full thickness corneal transplant called a penetrating keratoplasty (PK).
Visual outcomes post corneal transplant are often significantly improved, although the individual needs to be careful to avoid future ulcers.
To learn more about corneal transplants, be sure to check in to our next article! We’ll be discussing the different types of corneal transplants and what to expect post-transplant.
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