Corneal ulcers are open sores that form on the cornea, the clear outer layer of the eye. These ulcers are often caused by infections but can also result from severe dry eye, physical eye trauma, or the presence of foreign bodies in the eye.

Definition of Corneal Ulcers

A corneal ulcer, medically referred to as keratitis, occurs when an area of the cornea becomes inflamed and breaks down, leading to an open sore. This breakdown can be due to bacterial, viral, fungal, or parasitic infections. Non-infectious causes might include autoimmune diseases, extensive dry eyes, and traumatic injuries that disrupt the corneal surface.

• Severe Pain and Discomfort: If the pain in the eye becomes unbearable, it could indicate a deep infection or an ulcer that is worsening.
• Sudden Vision Changes: Any sudden decrease in vision or blurring, especially if it progresses quickly, is a critical sign that the ulcer is impacting the deeper layers of the cornea or leading to complications.
• Increasing Redness: An increase in redness around the eye or within the eye itself suggests spreading inflammation.
• Light Sensitivity: Intense sensitivity to light, causing significant discomfort or making it difficult to open the eye, can be a sign of a severe ulcer.
• Visible Infiltrates: If you can see white or grey spots on the cornea or it appears cloudy, it’s essential to seek immediate medical help.
• Unresponsive to Initial Treatment: If symptoms do not improve or worsen after starting treatment, urgent reassessment and possibly more aggressive treatment are necessary.

These symptoms indicate that the corneal ulcer is at a stage where without immediate and effective treatment, the risk of long-term damage increases significantly. Prompt intervention by an eye care specialist is crucial to manage the condition effectively and preserve vision.

Get Professional Treatment for Corneal Ulcers from Our Experts

At Insight Vision Center Optometry, our expert team—Dr. Nathan Schramm, Dr. Ariel Chen, Dr. Valerie Lam, and Dr. Nhi Nguyen—provides swift and effective emergency eye care. With specialized training and access to the latest technology, our doctors are prepared to address eye injuries, infections, and sudden vision changes with the highest level of care.

Common Causes and Types

The most common causes of corneal ulcers are:

• Bacterial infections, often related to improper use of contact lenses, such as sleeping in contacts not designed for overnight wear or inadequate disinfection of lenses.
• Viral infections, including the herpes simplex virus (commonly causes cold sores) and the varicella-zoster virus (known for causing chickenpox and shingles).
• Fungal infections, which can occur after the cornea is damaged by an injury involving plant material, or in an agricultural setting.
• Parasitic infections, such as Acanthamoeba keratitis, particularly in contact lens wearers who are exposed to water.

Each type of infection can lead to different types and severities of corneal ulcers, characterized by their cause and the specific pathogens involved.

Polymicrobial Infections

Polymicrobial infections are increasingly recognized in cases of keratitis, with approximately 43% of cases involving multiple microorganisms. These infections can complicate diagnosis and treatment, as they involve various types of bacteria, fungi, and sometimes protozoa co-inhabiting the same cornea. Accurate microbial identification through culturing is crucial in such scenarios to ensure appropriate and effective treatment is administered.

Risk Factors for Corneal Ulcers

Contact Lens Wear and Hygiene

• Primary risk factor: Improper care of contact lenses, including extended and overnight wear, increases the risk of corneal ulcers. Not following proper lens hygiene protocols, such as using homemade cleaning solutions or wearing lenses in pools, significantly raises the likelihood of infections.

Trauma and Foreign Bodies

• Physical injuries: Small particles like dust or plant material can scratch the cornea, leading to ulcers. Chemical and thermal injuries also pose risks, underscoring the need for protective eyewear during activities like yard work or construction.

Ocular Surface Changes and Diseases

• Pre-existing conditions: Chronic eye diseases such as dry eye syndrome and blepharitis, or previous surgeries that alter the corneal surface, can predispose individuals to keratitis.

Age-Related and Systemic Factors

• Health conditions: Older adults and those with systemic conditions like diabetes or immunosuppression face a higher risk due to weakened immune responses and compromised wound healing.

Understanding these risk factors is vital for prevention, particularly for contact lens users and individuals with chronic eye conditions or systemic health issues. Regular eye check-ups and proper eye care can help mitigate the risk of developing corneal ulcers.

Clinical Signs and Symptoms

Common Symptoms

Corneal ulcers, also known as bacterial keratitis, present with a set of common symptoms that can cause significant discomfort and distress. Patients typically experience a rapid onset of ocular pain, often described as stabbing or throbbing. Redness of the eye is another prominent symptom, accompanied by sensitivity to light (photophobia), making it difficult for patients to keep their eyes open in bright environments. Additionally, there is usually a watery discharge, and some patients may notice a decrease in vision clarity, which can range from slight blurriness to more significant impairment.

Typical Signs Observed in Examinations

Healthcare providers examining the cornea will typically use fluorescein staining, a yellow dye, to highlight areas of epithelial cell loss, which can confirm the presence of an ulcer. Understanding these visual cues during an examination is critical for both local optometrists and ophthalmologists in diagnosing bacterial keratitis accurately and can provide referral sources with the guidance needed for appropriate patient management.

Management Overview

General Treatment Approaches

Managing corneal ulcers, also known as keratitis, requires a swift and methodical approach due to the potential vision-threatening implications of the condition. Patients often present with severe discomfort, highlighted by symptoms such as persistent eye pain and excessive tearing, which pose significant distress and anxiety. Immediate intervention can prevent complications such as corneal scarring or even loss of the eye. Our clinic is well-equipped to address corneal ulcers with expert precision, ensuring timely and effective interventions.

The cornerstone of corneal ulcer management involves immediate discontinuation of contact lens wear, which is a common risk factor. This is followed by the initiation of topical antibiotics to combat bacterial infections. For cases with deep corneal ulcers or those involving risk of scleral involvement, oral antibiotics might also be prescribed.

Our approach to treatment prioritizes the patient’s history and symptoms, enabling us to customize therapy. We initiate broad-spectrum antibiotic therapy based on clinical findings and further refine treatment as specific organism cultures become available. This ensures a targeted therapy addressing the precise causative agents, largely influenced by local microbial profiles.

Specific Medical Therapies

In our practice, fluoroquinolone drops are frequently employed for smaller ulcers due to their broad-spectrum efficacy. For ulcers with more significant epithelial defects or visible anterior chamber reactions, these antibiotic drops are administered every hour until a noticeable improvement is recognized. In larger or vision-threatening ulcers, fortified antibiotics like vancomycin and tobramycin are used in combination, adjusting the regimen according to culture sensitivity results. Pain management through cycloplegic medications is important in mitigating discomfort and preventing further complications like posterior synechia.

For suspected viral keratitis, we also incorporate antiviral medications promptly, exemplifying our comprehensive approach to cover all potential infectious etiologies.

Role of Corticosteroids and Adjunctive Treatments

The role of corticosteroids in the treatment of bacterial keratitis can be contentious, but they are considered once antibiotics have had a chance to work and the causative organism is identified. Evidence supports that initiating topical corticosteroids within two to three days of antibiotic treatment can improve visual outcomes, especially in central or severe ulcers. These are employed with care, excluding specific infections like Acanthamoeba or fungal keratitis where steroids may exacerbate the condition.

Adjunctive treatments are utilized in recalcitrant cases. Techniques such as corneal crosslinking have emerged as promising solutions, especially for ulcers resistant to standard treatments. This procedure aids in halting corneal melt by strengthening collagen fibrils while also having germicidal properties. Other supportive treatments may include vitamin C supplementation and tetracyclines like doxycycline to prevent tissue breakdown in severe infections.

At Insight Vision Center Optometry, our expert team—Dr. Nathan Schramm, Dr. Ariel Chen, Dr. Valerie Lam, and Dr. Nhi Nguyen—provides swift and effective emergency eye care. With specialized training and access to the latest technology, our doctors are prepared to address eye injuries, infections, and sudden vision changes with the highest level of care.

Surgical Interventions

Indications for Surgery

Corneal ulcers, a serious concern for vision health, can sometimes progress to a state where surgical intervention becomes necessary. The decision to move forward with surgery is generally based on several key indications, including:

• Lack of response to medical treatment: If intensive antibiotic therapy fails to improve the condition, and ulcers persist or worsen, surgical intervention becomes critical to prevent further corneal damage and preserve vision.
• Significant corneal perforation: Large perforations, typically over 2mm, especially those centrally located, may require immediate surgical action to stabilize the cornea.
• Severe stromal melting: This condition can threaten the structural integrity of the cornea, requiring surgical reinforcement.
• Polymicrobial infections: Ulcers involving multiple pathogens, or those suspected to be fungal, amoebic, or mycobacterial, may necessitate a surgical approach due to their complex pathology.

Types of Surgical Procedures

Various surgical techniques are adopted based on the severity and specifics of the corneal ulcer. Here are the common types of surgery performed:

• Penetrating Keratoplasty (PK): This full-thickness corneal transplant is often recommended for severe cases, especially with central perforations or extensive stromal involvement. PK can restore corneal clarity significantly but comes with potential risks of graft rejection.
• Lamellar Keratoplasty: When the ulcer is less severe or more peripheral, this procedure, which involves replacing only part of the corneal layers, can be effective. It helps maintain the structural integrity of the cornea while minimizing risk compared to full grafts.
• Amniotic Membrane Transplantation: Used as an adjunctive therapy, this technique supports healing by providing a biological bandage known for its anti-inflammatory and anti-scarring properties.

Challenges in Treating Corneal Ulcers

Antibiotic Resistance

A major challenge in treating corneal ulcers is the rising antibiotic resistance among pathogens like Staphylococcus aureus, with some strains showing troubling resistance levels. This complicates treatment, necessitating careful antibiotic selection and monitoring, especially for resistant strains like MRSA.

Complexity of Mixed Infections

Corneal ulcers can involve multiple pathogens, including bacteria, fungi, and viruses, making precise diagnosis and tailored treatment crucial. Up to 43% of cases may be polymicrobial, requiring detailed cultures to identify the involved organisms and guide appropriate treatment.

Patient Compliance

Effective treatment depends significantly on patients adhering to their prescribed medication regimens, which often involve multiple daily doses of antibiotic drops and possibly oral medications. Noncompliance can lead to prolonged infections and increased resistance, worsening outcomes. For healthcare providers, simplifying treatment plans and ensuring clear communication about the importance of adherence are key to managing these cases effectively.

Book Your Eye Exam Today

Located in Costa Mesa, Insight Vision Center Optometry serves patients from Irvine, Huntington Beach, Santa Ana, and the surrounding Orange County area for emergency eye care.

Guidelines for Patients and Families

• Proper Contact Lens Care: Always wash your hands before handling your lenses. Clean and disinfect them daily, and never sleep with contacts in unless specifically designed for overnight wear.
• Avoid Eye Trauma: Wear protective eyewear during activities that could harm your eyes, such as sports or DIY projects that involve handling chemicals or sharp objects.
• Regular Eye Check-ups: Routine eye examinations can help detect potential problems early, providing a chance for timely treatment and preventing complications.
• Compliance with Treatment: Follow your eye doctor’s instructions explicitly, taking prescribed medications as directed and attending all follow-up appointments. This will help ensure effective healing and preserve vision quality.

If you or your child experience any eye-related symptoms or have concerns about eye health, please reach out to us. Our team is here to provide expert care, answer your questions, and guide you toward healthy vision.

Urgent Eye Care Specialists in Costa Mesa

When it comes to emergency eye care, Insight Vision Center Optometry stands out as the top choice in Orange County. Located in Costa Mesa, our state-of-the-art facility is trusted by patients from nearby cities such as Irvine, Huntington Beach, and Santa Ana. Our experienced eye doctors are available to provide urgent treatment for eye injuries, infections, and sudden vision changes. For those in need of immediate care, our clinic is fully equipped with advanced technology to address all eye-related emergencies swiftly and effectively.