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What Is a Corneal Ulcer? (Symptoms and Treatment)

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In the U.S., the annual incidence of corneal ulcers ranges from about 30,000 to 75,000 cases. This condition is considered a medical emergency.

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A corneal ulcer is a type of open sore than can develop on the cornea. It typically results from an infection.

This type of ulcer can cause a variety of discomforts. The severity of the symptoms varies greatly among individuals who develop the condition.

Due to the potential for serious complications, it is important to get a prompt diagnosis if you believe you might have a corneal ulcer. If one is suspected, go to the emergency room for faster testing and evaluation.

Ultimately, the cause of the ulcer determines the proper course of treatment. People often receive more than one medication to alleviate the symptoms of the ulcer and to treat the underlying cause.

Who Is at Risk for Corneal Ulcers?

Corneal ulcers affect all groups of people, but some groups are more apt to get them than others. They’re most prevalent in people who:

  • Have dry eye
  • Wear contact lenses for extended periods
  • Use steroid eye drops
  • Suffer an injury to or burn their cornea
  • Have an eyelid disorder

The most common instance is infection through bacteria. You are likely to catch it through corneal inflammation caused by a break, such as:

If you have the herpes simplex virus (HSV), you are more inclined to contract corneal ulcers. Other less-common viral risk factors include cytomegalovirus and Varicella-zoster.

Fungal organisms such as Candida albicans, Fusarium, and Aspergillus are also risk factors, although they account for less than 10 percent of all instances of corneal ulcers.

Another risk factor is having an autoimmune disease. Anterior uveitis and peripheral ulcerative keratitis (PUK) are the major causes of corneal ulcers. Of those, about half of PUK cases are from collagen vascular diseases, and another sizable portion is caused by rheumatoid arthritis.

If you catch the acanthamoeba protozoan and wear contact lenses, you are also at risk of contracting a corneal ulcer.

Corneal ulcers are most prevalent among women ages 25 to 34 at a rate of about 60 cases per 100,000 women. HSV is the culprit 95 percent of the time.

Corneal Ulcer Causes

man covering eye in pain

Preventing a corneal ulcer is the best choice since they have the potential to cause serious problems. Improper contact lens care and not protecting the eyes against injury are possible contributors to this condition. Corneal ulcers can also be caused by:

  • Viral infections. Viruses that cause cold sores have the potential to cause recurring attacks of corneal ulcers. Corneal ulcers may also result from the varicella virus.
  • Parasitic infections. An amoeba known as acanthamoeba can cause a corneal ulcer when it gets into the eye. This parasite is found in soil and fresh water.
  • Bacterial infections. Bacterial infections are common among people who wear contact lenses, especially those intended for extended wear.
  • Fungal infections. Improper use of steroid eye drops or contact lenses may cause this type of ulcer. A fungal infection can also develop if plant material gets into the eye.
  • Dry eye syndrome. Tears protect the eyes against infection. When the eyes are dry, infections that can cause corneal ulcers are more likely.

Possible Symptoms

migraine aura

If you have a corneal ulcer, the symptoms you experience usually cannot be ignored. The following are possible symptoms:

  • Redness
  • Tearing
  • White spot on the cornea
  • Burning
  • Light sensitivity
  • Pain
  • Discharge
  • Blurry vision
  • Itching

The pain that occurs with a corneal ulcer can be severe for some people. When they look at bright lights, it might intensify their pain. In some cases, people will notice vision impairment.

The ulcer is usually visible on the eye. It looks like a spot on the eye that should not be there. It may look yellow or white in color.

If the symptoms of a corneal ulcer are ignored, there is a risk for complications. Even with prompt and proper treatment, it is possible for people to have a vision-impairing cloudy scar after the ulcer resolves.

If you do not get treatment for this ulcer, the following complications are possible:

  • Deep infection
  • Displacement of the iris
  • Perforation of the cornea
  • Eye socket tissue destruction
Ophthalmologist doctor with the snellen chart

Diagnostic Methods

It is important to get an accurate diagnosis as soon as possible. A doctor needs to diagnose the corneal ulcer as well as the underlying cause. The following tests may be performed:

  • Ulcer sample: The doctor may scrape some of the ulcer from the eye and send it to the laboratory for further analysis.
  • Keratometry: This test is able to measure the cornea’s curvature. This lets the doctor determine how strong the cornea is.
  • Refraction test: This test is done to determine the prescription that you need for contact lenses or eyeglasses. It can help to determine if you have a refractive error.
  • Blood testing: The doctor may take blood samples to look for inflammatory disorders if one of these is suspected to be the underlying cause.
  • Visual acuity testing: This test is done to determine how sharp your vision is. It involves reading the Snellen eye chart.
  • Fluorescein stain of the cornea: This test allows doctors to look for foreign objects or damage to the cornea. It might be performed if the ulcer is suspected to be due to wearing contacts or an eye injury.
  • Pupillary reflex response: This test looks at your pupillary response. It can help the doctor to determine if there might be an underlying neurological issue.
  • Slit-lamp examination: This test allows the doctor to better examine the eye’s frontal structures. It uses a thin beam of high-intensity light.

If your doctor thinks that dry eye might be contributing to the ulcer, they may perform additional tests to evaluate tear quality and production. Your doctor will also ask about your overall health to narrow down any underlying conditions that might have caused the corneal ulcer.

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Treatment for Corneal Ulcers

man using eyedropper on left eye

A corneal ulcer can lead to blindness and vision loss, so the treatment approach needs to be aggressive.

Minor corneal ulcers are often treated with antibacterial eye drops. If another pathogen, such as a virus, is the underlying cause, your doctor may still prescribe an antibacterial eye drop to reduce the risk of a secondary infection. If basic antibacterial eye drops are not powerful enough, your doctor may prescribe antibiotic eye drops that are specially formulated.

On occasion, your doctor might prescribe a steroid eye drop if you are experiencing significant inflammation in the affected eye. If your doctor determines that a parasite or fungus caused the ulcer, they will prescribe medicine that targets the specific one that was found during the diagnostic process.

Since this ulcer can be painful, short-term use of a prescription pain medication might be recommended. Other supportive treatments might be suggested, depending on the symptoms.

While the ulcer is healing, it is important to keep the following in mind:

  • Do not wear contact lenses until the doctor says it is safe to start wearing them again.
  • Wear protective glasses according to your doctor’s guidelines.
  • Do not wear any eye makeup until your doctor says it is okay.

Even if you receive prompt treatment, it is possible to experience thinning or scarring of your cornea. If this happens, you could require a cornea transplant at some point in your life. This surgery might be considered if the cornea problems are significantly interfering with your vision. The transplant could help to restore your vision.

If the ulcer is not healing despite treatment, your doctor might recommend an amniotic membrane. This sits on the cornea to promote healing. The doctor usually leaves it in place for about 7 to 10 days.

Get Help Immediately

If you suspect you have a corneal ulcer, it is imperative to seek a definitive diagnosis from a doctor as soon as possible. There are treatment options that can start healing the ulcer right away to reduce your risk of blindness.

References

  1. Confront Corneal Ulcers. American Academy of Ophthalmology.
  2. Corneal Ulcer. Cedars-Sinai Hospital.
  3. Who Is at Risk for Corneal Ulcers? American Academy of Ophthalmology.
  4. Corneal Ulcers: An Overview. Verywell Health.
  5. Corneal Ulcer. Merck Manual Consumer Version.
  6. Corneal Ulcers and Infections. MedlinePlus.
  7. Keratitis (Corneal Ulcers). Kellogg Eye Center Michigan Medicine.
  8. Corneal Ulcer. (August 2021). National Center for Biotechnology Information.

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