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Corneal Ulcer

Cornea is the window through which we see the world. Corneal ulcers may begin with a corneal injury, which then becomes infected with bacteria, fungi, or the protozoan Acanthamoeba (which lives in contaminated water). Patients suspected of having a bacterial corneal ulceration are usually treated with frequent application of topical antibiotics , with or without initial cultures. The collagen fibers cross the full diameter of the cornea in a strictly parallel fashion and allow 99 percent of the light to pass through without scattering . Certain types of bacteria, such as Pseudomonas , are extremely aggressive and can cause severe damage and even blindness within 24-48 hours if left untreated.   When the eyelids do not close properly, the cornea may become dry and irritated; such irritation can lead to injury and the development of a corneal ulcer. Mooren ulcer is a rapidly progressive, painful, ulcerative keratitis, which initially affects the peripheral cornea and may spread circumferentially and then centrally. Indolent ulcers (chronic erosions) are superficial ulcers that tend to heal very slowly unless special techniques are performed such as a minor surgical procedure called multiple punctate keratotomy (MPK), or the placement of a bandage contact lens. Patients with severely dry eyes , difficulty blinking, or are unable to care for themselves, are also at risk.  Other causes of ulcers include:  herpes simplex viral infections, inflammatory diseases, corneal abrasions or injuries, and other systemic diseases.

A corneal ulcer forms when the surface of the cornea is damaged or compromised. Ulcers can also occur if a foreign object lodges in the eye or the eye is irritated by a contact lens, especially when contact lenses are worn during sleep or are not adequately disinfected. Other causative agents include fungi, acanthamoeba (a parasite), which typically occurs in contact-lens wearers who swim with the lenses in, or herpes simplex virus infection.  Peripheral ulcerative keratitis (PUK) is a complication of rheumatoid arthritis (RA) that can lead to rapid corneal destruction (corneal melt) and perforation with loss of vision There are many causes of corneal ulcers such as injuries, abnormal eyelashes that irritate the surface, lack of tear production, infections, and many types that we don't understand very well. The prognosis for good vision depends on the extent of infection. Delayed or ineffective treatment of corneal infections may lead to devastating consequences through intraocular infection or corneal scarring. Some cases will require corneal transplantation (penetrating keratoplasty) despite early presentation and proper management. 

Causes of Corneal ulcer

The common Causes of Corneal ulcer :

• Infection with HSV may interfere with corneal sensation, resulting in corneal anesthesia.
• Traumatic corneal injury
• Bacterial infections cause corneal ulcers and are common in people who wear contact lenses.
• Disorders that affect the eyelid and prevent your eye from closing completely, such as Bell's palsy , can dry your cornea and make it more vulnerable to ulcers.
• Dogs that rub their face with their paw, scratch to the eye by another animal, thorns, grass seeds, and foreign objects are all common causes for ulcers.
• Corneal ulcers also occur as complications of herpes simplex keratitis, chronic blepharitis, conjunctivitis (especially bacterial), trachoma, gonorrhea , and acute infectious diseases.
• Such injuries damage the cornea and make it easier for bacteria to invade and cause a more serious ulcer.
• Most corneal ulcers are centered, but some occur at the periphery of the cornea (ie, marginal ulcers).
• Fungal ulcers are caused by Candida, Fusarium, Aspergillus, Penicillium, Cephalosporium , and mycosis fungoides species.

Symptoms of Corneal ulcer

Some common Symptoms of Corneal ulcer :

• Severe pain (not in all cases)
• Discharge 
• White spot on the cornea, that depending on the severity of the ulcer, may not be visible with the naked eye
• Severe pain
• Blurry vision
• The eye may appear infected.
• Swollen eyelids
• Watery eyes
• Eye pain
• A hypopyon (accumulation of white cells or pus in the anterior chamber) may produce cloudiness or color change.
• Corneal ulcer
• Sensitivity to light (photophobia)

Treatment of Corneal ulcer

• If you wear contact lenses, remove them immediately.
• Limit spread of infection by washing your hands often and drying them with a clean towel.
• Corneal injuries produced by organic matter or dirt, as well as those associated with tissue necrosis and those associated with entrance of dirt or organic material into the conjunctival sac, should be considered dirty (ie, tetanus-prone) injuries and require boosters within 5 years.
• Broad antibiotic coverage is started and then more specific antibiotic, antiviral, or antifungal eye drops are prescribed (as soon as the agent which causes the ulcer has been identified).
• Apply cool compresses to the affected eye.
• Limit spread of infection by washing your hands often and drying them with a clean towel.
• Your ophthalmologist will remove your contact lenses if you are wearing them.
• Patients usually start treatment with antibiotic that is effective against many bacteria.
• Choice of medications should be left to the treating ophthalmologist but generally include broad-spectrum topical antibiotics and cycloplegic drops.

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