Corneal Ulcer

What Is a Corneal Ulcer?

A corneal ulcer is an open sore on your cornea, the thin clear layer over your iris (the colored part of your eye). It’s also known as keratitis.

Corneal Ulcer Symptoms

A corneal ulcer can cause:

  • Redness
  • Severe pain
  • The feeling that something is in your eye
  • Tears
  • Pus or thick discharge from your eye
  • Blurry vision
  • Pain when looking at bright lights
  • Swollen eyelids
  • A round white spot on your cornea

When to call your doctor

Talk to your doctor right away if you notice:

  • Vision changes
  • Severe pain
  • Discharge from your eye

It’s especially important to watch for problems if you’ve scratched your cornea before or if you’ve been around chemicals or small particles like sand, metal, or glass.

 

Corneal Ulcer Causes

Infections cause most corneal ulcers.

  • Viral infections such as the herpes simplex virus (which causes cold sores) or the varicella virus (which causes chickenpox and shingles)
  • Fungal infections such as Fusarium, Aspergillus, or Candida, possibly after an injury by something natural like a branch or twig. These infections are rare.
  • Parasitic infections with Acanthamoeba, an amoeba found in fresh water and dirt

Corneal Ulcer Risk Factors

People who wear contact lenses are more likely to get corneal ulcers. This risk is 10 times higher if you use extended-wear (overnight) soft contacts.

Bacteria on the lens or in your cleaning solution could get trapped under the lens. Wearing lenses for long periods can also block oxygen to your cornea, raising the chances of infection.

Scratches on the edge of your contact might scrape your cornea and leave it more open to bacterial infections. Tiny particles of dirt trapped under the contact could also scratch your cornea.

Other things that may make you more likely to have a corneal ulcer include:

  • Steroid eye drops
  • Disorders that cause dry eyes
  • Eyelid inflammation (blepharitis)
  • Eyelashes that grow inward
  • Eyelids that turn inward
  • Conditions that affect your eyelid and keep it from closing all the way, like Bell’s palsy
  • Chemical burns or other cornea injuries

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Corneal Ulcer Diagnosis

See your eye doctor right away. They’ll use a drop of dye and a special microscope called a slit lamp to look for problems.

If your doctor thinks you have an infection, they may take a small sample from the ulcer for analysis in a lab. This can help them decide on the best treatment.

Corneal Ulcer Treatment

Medications

Depending on the cause of your ulcer, you’ll probably get antibiotic, antiviral, or antifungal eye drops. You might need to use these as often as once an hour for several days.

To treat pain, your doctor may also give you oral painkillers or drops to widen (dilate) your pupil.

Surgery

If medications don’t help or if the ulcer is severe, you might need a corneal transplant. Your doctor takes out your cornea and replaces it with a healthy one from another person.

Treatment Follow-up

You’ll need to see your doctor every day until they tell you to stop. Call them right away if your symptoms get worse, such as blurry vision, pain, or discharge.

Corneal Ulcer Home Care

Your doctor may also recommend some steps you can take at home to ease symptoms:

  • Put cool compresses on your eye. But be very careful to keep water away from your eye.
  • Don’t touch or rub your eye with your fingers.
  • Limit the spread of infection by washing your hands often and drying them with a clean towel.
  • Take over-the-counter pain medications such as acetaminophen or ibuprofen

Corneal Ulcer Prevention

If you have any eye problems, see your doctor as soon as possible. Even minor injuries can lead to an ulcer.

Wear eye protection when you’re around small particles.

If you have dry eyes or if your eyelids don’t close all the way, use artificial tears to keep your eyes moist.

If you wear contact lenses, be very careful about how you clean and wear them.

  • Take out your lenses every evening. Carefully clean them with solution, not tap water.
  • Never sleep with your contacts in.
  • Store the lenses overnight in disinfecting solution.
  • Take out your lenses whenever your eyes are irritated. Don’t put them back in until your eyes feel better.
  • Regularly clean your lens case.
  • Follow your doctor’s instructions on when to throw out and replace your contacts.

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Corneal Ulcer Outlook

A corneal ulcer is a medical emergency. Without treatment, it might spread to the rest of your eye, and you could lose some or all of your eyesight in a short time. You can also get a hole in your cornea, scarring, cataracts, or glaucoma.

With treatment, most corneal ulcers get better in 2 or 3 weeks.

If you have trouble seeing because of scars from a corneal ulcer, you might need a corneal transplant.

WebMD Medical Reference Reviewed by Whitney Seltman on June 15, 2020

Sources


SOURCES:
American Academy of Ophthalmology: “What Is a Corneal Ulcer (Keratitis)?”

Merck Manual Consumer Version: “Corneal Ulcer.”

StatPearls: “Corneal Ulcer.”

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