Understanding Corneal Ulcers: Prevention, Causes, and Treatment Options

Let's explore what causes them and how they can be treated, with insights from an experienced ophthalmologist.

What is a Corneal Ulcer (Keratitis)?

A corneal ulcer is an inflammatory condition affecting the cornea's surface. It occurs when there's damage to the corneal epithelium - the outermost protective layer of cells covering the cornea. Think of it as a small wound or depression on your eye's surface.

Common Causes

The primary causes of corneal ulcers include:

• Bacterial, viral, fungal, or protozoal infections

• Physical or chemical injury to the eye

• Extended exposure of the cornea to dry conditions

• Poor contact lens hygiene (notably the most frequent cause)

Risk Factors

Several factors can increase your likelihood of developing corneal ulcers:

• Wearing contact lenses, especially overnight or for extended periods

• Previous eye injuries or infections

• Chronic dry eye conditions

• Weakened immune system

• Eyelid disorders that prevent proper eye closure

• Working in environments with high exposure to eye irritants

• Use of topical eye steroids

• Prior eye surgery

• Vitamin A deficiency

• Autoimmune disorders affecting the eyes

Other Causes of Corneal Injury

Beyond ulcers, the cornea can be damaged in various ways:

• Foreign objects in the eye (like sand, dust, or metal shavings)

• Scratches from contact lenses

• Chemical splashes or burns

• UV light exposure (including tanning beds)

• Sports injuries

• Workshop or construction debris

• Rubbing eyes too vigorously

• Fingernail scratches

• Tree branches or plant material

• Airbag deployment in car accidents

These types of injuries can make the eye more susceptible to developing ulcers if not properly treated, as they can create entry points for infection. Any corneal injury should be evaluated by an eye care professional to prevent complications.

Treatment Approaches

Treatment is typically aggressive at first, as corneal ulcers can potentially lead to vision impairment if left untreated. The approach depends on the underlying cause:

For Infectious Cases:

• Prescription antibiotics

• Antiviral medications

• Antifungal treatments

• Treatment duration varies, particularly for viral, fungal, or protozoal infections

For Non-Infectious Cases:

• Immune suppression therapy

• Topical steroids

• Steroid-sparing medications

In severe cases, additional interventions might be necessary:

• Surgical debridement (removal of damaged tissue)

• Corneal transplantation (in rare instances)

• Systemic immunosuppression for severe inflammation

• Specialized procedures like segmental corneal transplants or conjunctival recession surgery

Important Notes on Recovery

Corneal ulcers almost always require professional treatment. While extremely rare cases of mild ulcers might resolve independently, this is not the norm and shouldn't be counted on.

Distinguishing from Corneal Erosion

Corneal ulcers are sometimes confused with corneal erosion, a similar but distinct condition characterized by:

• Recurring eye discomfort

• Redness

• Pain or irritation

• Treatment typically involves regular eye lubrication

• May have periods without active treatment

• Might require professional intervention for recurring cases

Prevention and Care

Remember these essential points:

• Regular eye check-ups are crucial

• Maintain proper eye hygiene

• Follow correct contact lens care procedures

• Seek immediate medical attention if you experience eye problems

• Untreated corneal ulcers can result in vision loss