What is Corneal Ulcer ?
Corneal Ulcers (Keratitis) is a condition in which the cornea of the eye (the clear front portion of the eye), becomes inflamed. They are typically caused by infection, but can also be caused by injury. With immediate treatment, most ulcers can be treated without much vision loss. But if the infection is left untreated or is too severe, ulcers can permanently harm your eyes.
What are the causes of Corneal
Ulcer?
What are the causes of Corneal Ulcer?
- Eye injury
- Dirty contact lenses
- Infective organisms (Virus, bacteria, fungus, parasites)
- Dirty water
- Environmental causes (exposure due to inability to close eyes properly, exposure to ultraviolet rays)
- Immune related
What are the risk factors leading to Corneal Ulcer?
- Reduced immunity
- Warm climate
- Corticosteroid eye drops
- Eye injury
- Contact lenses
To reduce the risk of Corneal Ulcers:
- Do not wear contact lenses while swimming or for longer than recommended
- Always clean lenses properly with the correct solution
- Avoid bathing in rivers or dirty water
What are the symptoms of Corneal Ulcer?
- Red eyes
- Eye pain
- More tears than normal
- Difficulty opening your eyelid
- More sensitive to light
- Feeling like something is in your eye
- Blurry vision
- Discharge
What are the tests for Corneal Ulcer?
Your doctor would do a detailed eye examination (slit lamp), and decide on further line of management. Depending on the findings,
- If the eye doctor feels that the Corneal Ulcer is bacterial / fungal, he or she would advise for corneal scrapping (to send the material to a microbiologist for microscopic examination) so as to detect the type of causative organism.
- If you are a contact lens user your eye doctor may ask for the used contact lens and contact lens case for microbiology examination.
- Your eye doctor may advise for blood tests to rule out diabetes or any other systemic autoimmune diseases (since certain systemic auto immune condition may lead to Corneal Ulcer).
What are the treatment options for Corneal Ulcer?
Treatment for corneal ulcers depends on the cause of the Corneal Ulcer. The treatment can be broadly divided into:
- Medical
- Infectious Keratitis can progress rapidly and generally requires urgent treatment in the form of antibacterial, antifungal, or antiviral therapy to eliminate the causative organism. Antiviral eye drops are not a “cure” and the virus may return.
- Contact lens wearers are advised to discontinue using their contact lenses and replace the contaminated lens and lens case.
- Mydriatic / Cycloplegic eye drops (atropine / homatropine) are commonly used to relieve the pain and photophobia (increased sensitivity to light). These however, may lead to temporary decrease in vision.
- Steroid eye drops / systemic steroids may be of less use in infective keratitis, but they are very useful in patients with systemic auto immune conditions leading to Corneal Ulcers.
- Lubricating eye drops may be prescribed by your doctor.
- Surgical
- In large Corneal Ulcer unresponsive to medical management, a procedure called as Therapeutic keratoplasty, is done. In this procedure the inflamed cornea is removed and a donated cornea is transplanted in its place.
- In some cases the inflamed cornea may give rise to corneal stromal thinning (descemetocele) leading to corneal perforation. In such eyes, a surgical reconstruction of the eye with the help of donated cornea in the form of keratoplasty is done.
- After healing, Corneal Ulcers lead to scarring and opacification of the cornea causing decreased vision. In such eyes, keratoplasty is done with the help of a healthy donor tissue, so as to improve the vision.
Frequently Asked Questions (FAQ)
Once the medication starts healing the ulcer, the pain will start decreasing. Pain-killer tablets may also temporarily reduce the pain.
After the ulcer heals, you may require glasses or surgery to get better vision.
This depends on the size of the ulcer. Larger ulcers take longer to heal. The cause of the ulcer is also important. Fungal ulcers take longer to heal. For the fastest recovery, keep your diabetes under control and apply the eye drops as advised.
Whenever your doctor advises.
You may take a head bath when the ulcer is completely healed. Your doctor will tell you when it is okay.
Surgery is only used as a last resort. Once the ulcer heals, a surgery may be possible to improve vision. Also, if your ulcer does not heal with medicines, you might have to get a corneal transplantation.