What is a Corneal Ulcer? Is it an Eye Emergency?

Diagnosis of a corneal ulcer

• In the case of suspected fungal infections or Acanthamoeba, confocal microscopy may assist in the diagnosis.
• Culture of a corneal infection must be done to determine the exact cause of infection so that an accurate diagnosis is made prior to treatment. 
• Corneal topography can be performed to determine whether a patient has fungal keratitis.
• If the corneal ulcer is acute and superficial, fluorescein stain testing may only be necessary.
• Detailed imaging using anterior segment Ocular Coherence Tomography (AS OCT) is  an important tool in the evaluation and management of corneal ulcers, providing a detailed evaluation in a non-contact and safe way.

Who is at risk of a corneal ulcer?

• Agricultural workers may be more likely to develop fungal keratitis due to soil and plant exposure
• Sleeping in contact lenses or having poor contact lens hygiene puts contact lens wearers at higher risk of Pseudomonas Keratitis.
• Those who wear contact lenses in freshwater or wash them with water rather than contact lens solution are at risk for Acanthamoeba keratitis.
• Those with a cold sore, chicken pox, or shingles
• Patients with dry eye syndrome who use steroid eye drops
• Those whose eyelids do not function normally
• Diabetics or immunosuppressed patients are more prone to corneal ulcers. An endocrinologist should be consulted if the sugar levels are out of control since this can interfere with corneal wound healing.

Prevention of a corneal ulcer

• A corneal ulcer is most commonly caused by poor cleaning and handling of contact lenses. You must therefore use, disinfect, and store your contact lenses properly.
• You must always avoid wearing contact lenses while showering, swimming, or performing any activity that may cause your eyes to become wet.
• You should also avoid wearing contact lenses for long periods of time. When you get home from work, you can take out your contact lenses and switch to eyeglasses.
• An eye injury can lead to corneal ulcer. Therefore, it is advised to wear protective glasses if you are a construction worker, plumber, welder or an electrician.
• Keep eye makeup to a minimum because it can clog your eyes and cause infection.
• To reduce the risk of corneal ulcers, you should never share makeup, towels, or eye drops with anyone.

Treatment of a corneal ulcer

Treatment of corneal ulcer depends on the cause of the infection, which will be determined through a culture test of your cornea.

Antibiotics
If the corneal ulcer is not severe and is not a threat to your vision, antibiotic drops such as fluoroquinolones (moxifloxacin, besifloxacin, gatifloxacin) and bacitracin or erythromycin may be prescribed. It has now been shown in multiple studies that fluoroquinolones are effective in treating bacterial keratitis.

Culture
Culture testing of the cornea is recommended for corneal ulcers that are large and causing severe symptoms. The reason that this is important is that common ocular pathogens are becoming more and more resistant to antibiotics. Another reason is to determine the right antibiotic to treat your specific infection. Additionally, it should be done before the treatment begins.
After the infection has cleared, depending on how severe your infection was, our eye doctor may prescribe an anti-inflammatory eye drop or steroid eye drop to reduce inflammation and decrease corneal scarring.

Amniotic membrane
Surgery may be required for patients who are not responsive to medication. An amniotic membrane graft may be applied under sterile conditions to promote healing. In cases of severe scarring, a corneal transplant may be performed to replace diseased corneal tissue with healthy tissue from a donor.

Bandage contact lenses
Bandage contact lenses can be an effective way at treating corneal ulcers by both protecting the wound and enabling healing.