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Corneal Ulcer


Presentation

Corneal ulceration affects the eye and its vision. The signs and symptoms include the following:

Disability
  • BACKGROUND: Corneal ulcer, a major cause of monocular blindness in developing countries has consistently been listed as the major cause of blindness and visual disability in many of the developing nations in Asia, Africa and the Middle East, ranking second[ncbi.nlm.nih.gov]
Photophobia
  • We present the case of a 76-year-old male, admitted for sudden visual loss in the left eye, associated with ocular pain, tearing, and photophobia.[ncbi.nlm.nih.gov]
  • Topical corticosteroids do decrease the pain and photophobia, and speed the increase in visual acuity, significantly.[msdmanuals.com]
  • Sign In A 24-year-old man presented with a 2-day history of redness, photophobia, and blurry vision in the right eye. He reported no medical problems, similar previous episodes, fever, recent illnesses, or recent sexual contact.[nejm.org]
Blurred Vision
  • Other symptoms included pain, blurred vision and excessive yellowish-white discharge from both eyes. There was a history of multiple sexual partners.[ncbi.nlm.nih.gov]
  • Symptoms can include the following: Itching Irritation Burning sensation Redness Eye pain Excess tearing Discharge White spots on the cornea Light sensitivity Blurred vision Corneal ulcers are commonly caused by germs, so it is important to wash your[goeyesurgeons.com]
  • Other symptoms can include pain, redness, blurred vision, excessive tearing, and sensitivity to light. If left untreated, corneal ulcers can lead to serious vision loss, and even loss of an eye.[villageeyecare.net]
  • Corneal ulcer symptoms Symptoms of corneal ulcers include: redness of the eye severe pain and soreness of the eye the feeling of having something in your eye tearing pus or other discharge blurred vision sensitivity to light swelling of the eyelids a[aao.org]
  • Blurred vision. Glare, while looking at bright lights. Treatment Options: Prompt treatment is essential for all forms of corneal ulcer to prevent complications and permanent visual impairment.[aurolab.com]
Eye Pain
  • The best corrected visual acuity, location, size, and density of corneal infiltrates, the size and presence of a corneal epithelial defect, subjective eye pain (scale of 0-4) and time to pain resolution, the ability to conduct daily activities, and adverse[ncbi.nlm.nih.gov]
  • A 22-year-old male, seen in the ED 5 days prior (diagnosis: corneal abrasion), presents for a second visit due to persistent left eye pain and redness.[emdocs.net]
  • When to Call a Doctor See an ophthalmologist right away for any eye pain that persists for more than several hours. If you are wearing contact lenses, remove them at once.[healthcommunities.com]
  • Symptoms can include the following: Itching Irritation Burning sensation Redness Eye pain Excess tearing Discharge White spots on the cornea Light sensitivity Blurred vision Corneal ulcers are commonly caused by germs, so it is important to wash your[goeyesurgeons.com]
Red Eye
  • All patients presented with painful red eyes. The area of the corneal ulcer was central in three, and paracentral in three eyes. The corneal infiltrate was small in one eye, and medium in five eyes.[ncbi.nlm.nih.gov]
  • Symptoms can include the following: Itching Irritation Burning sensation Redness Eye pain Excess tearing Discharge White spots on the cornea Light sensitivity Blurred vision Corneal ulcers are commonly caused by germs, so it is important to wash your[goeyesurgeons.com]
  • Symptoms of corneal ulcers can include: Severe pain Red eyes Blurry vision Light sensitivity Discharge from the eye White spot on cornea Since corneal ulcers are often caused by infections, they are usually treated with eye drops.[chestercountyeyecare.com]
  • Keratitis is an inflammation or irritation of the cornea (the transparent membrane covering the iris and pupil) characterized by typical symptoms of red eye, foreign body sensation, pain, sensitivity to light, watery eyes, and blurred vision.[hopkinsmedicine.org]
  • On This Page: Causes Corneal ulcer treatment A corneal ulcer typically occurs as a painful, red eye , with mild to severe eye discharge and reduced vision. The condition results from a localized infection of the cornea , similar to an abscess.[allaboutvision.com]
Blepharitis
  • Often associated with blepharitis. Mooren Ulcer Autoimmune.[webeye.ophth.uiowa.edu]
  • He had a two-year history of chronic blepharitis and recurrent episodes of conjunctivitis that were treated with Tobramycin and corticosteroid eye drops over the years.[ncbi.nlm.nih.gov]
  • […] from the eye Causes of corneal ulcers: Infection Wearing contact lenses for excessive periods of time Inadequate contact lens sterilization Eye injury Lack of tear production Complications of herpes simplex keratitis, neurotrophic keratitis, chronic blepharitis[northdakotaeyeclinic.com]

Workup

A dye known as flurorescein is used to appropriately study the ulceration in the corneal region. The eyes are examined using a special microscope known as slit lamp. This lamp enables the ophthalmologist to completely and minutely study the cornea and make the diagnosis. Tests to study the tear production also need to be done.

A blood test may be carried out to determine the presence of any inflammatory disorders. In addition to these tests, the following diagnostic procedures are useful to study corneal ulceration.

  • Keratometry for studying the curvature of the cornea
  • Papillary reflex response
  • Refraction tests
  • Visual acuity to determine the vision [6]
Kingella
  • Clinical review describing initial presentation, course, and outcome of 1 patient with a corneal ulcer caused by Kingella denitrificans.[ncbi.nlm.nih.gov]
Streptococcus Bovis
  • The purpose of this study was to report the first case of Streptococcus bovis causing a perforating corneal ulcer in a healthy adult. Observational case report.[ncbi.nlm.nih.gov]
Chlamydia
  • Among them are bacteria, fungi, viruses, protozoa, and chlamydia: Bacterial keratitis is caused by Staphylococcus aureus, Streptococcus viridans, Escherichia coli, Enterococci, Pseudomonas, Nocardia, N. Gonorrhoea and many other bacteria.[en.wikipedia.org]
Chlamydia Trachomatis
  • Chlamydia trachomatis can also contribute to development of corneal ulcer. Superficial ulcers involve a loss of part of the epithelium. Deep ulcers extend into or through the stroma and can result in severe scarring and corneal perforation.[en.wikipedia.org]
Vibrio Vulnificus
  • To describe a corneal ulcer due to Vibrio vulnificus that resolved rapidly with antibiotic therapy alone. Case report and review of literature. This is the third reported case of corneal ulcer due to V. vulnificus.[ncbi.nlm.nih.gov]

Treatment

The treatment regime for corneal ulcer is cause dependant. It is necessary to initiate treatment as soon as diagnosis is made in order to avoid further damage to the eyes. If the infection is the source then antibiotic drops are administered. In addition, eye drops containing corticosteroids are also prescribed in order to reduce the pain and inflammation [7].

In certain cases, oral pain relieving medications may also be prescribed. Ophthalmic pain relieving solutions like bromfenac has been most effective and does not interfere with the corneal epithelialization process of healing [8]. Neurotrophic ulcers may benefit from the topical application of nerve growth factors on the cornea [9]. Severe cases of ulceration may call for a corneal transplant.

The use of a tectonic graft in the repair of corneal thinning and perforation has exemplified a good visual rehabilitation post operatively [10]. However, with prompt diagnosis and appropriate treatment regime a transplant can be avoided.

Prognosis

Prognosis of the disease condition is usually good with proper treatment regime. Some individuals completely recover, but can suffer minor changes in the eye vision [5]. However, some individuals in whom the condition has turned severe can cause irreversible damages to eye which cannot be treated.

Complications

It is necessary to immediately treat any underlying infection of the eye to prevent the development of corneal ulcers. Failure to do so can cause life threatening complications such as:

Etiology

Corneal ulcers are caused due to infections by bacteria, viruses, parasites and or fungi. The following is the list explaining the various infectious agents which are known to cause corneal ulcers.

  • Bacterial infections cause Acanthamoeba keratitis, a type of corneal ulcer which mostly strikes those individuals who wear contact lenses.
  • The herpes simplex virus cause is also a potential agent in causation of corneal ulcers. 
  • Use of eye drops containing steroid can contribute to fungal infections which can lead to corneal ulcers.
  • Fungal corneal ulcerations may occur post-operatively in immunocompromised hosts [2].

In addition to these infectious agents, there are also other factors that cause corneal ulcers. These include:

  • Various inflammatory diseases
  • The use of non-steroidal anti-inflammatory drugs directly on the eyes [3]
  • Allergic disease of the eye
  • Condition such as Bell’s palsy that prevents the eye lids from closing
  • Severe dry eyes
  • Repeated eye surgery [4]
  • Abrasions in the surface of the eye

Epidemiology

Corneal ulcer is a common problem caused either due to infections or due to other associated disease conditions. It has been stated that this form of eye disorder is one of the leading cause of blindness in the developing countries.

About 11.3 per 10,000 populations are known to suffer from corneal ulcer. Research also led to the finding that, during the period of 1997 to 2007 there was a significant increase in the incidence of viral ulceration.

Sex distribution
Age distribution

Pathophysiology

Individuals with a suppressed immune system fall easy prey to infections and develop corneal ulcerations. Individuals who wear contact lenses and that too for long duration are more prone to develop sores in the cornea.

The condition further aggravates when individuals make use of homemade lens solution. Such a solution is not sterile in nature and can be contaminated from various agents. The use of such non sterile homemade solution can call for development of corneal ulcers.

Any injury to the cornea of the eye by use of physical agents such as make up brush, fingernails, and branches of the tree can result in development of wound which can lead to corneal ulcers.

Prevention

Prevention is the best way to avoid corneal ulcerations. Adopting the following practices can help keep corneal ulceration at bay.

  • Washing hands properly while handling contact lenses is necessary to prevent infection.
  • It is advised to avoid wearing lenses overnight.
  • Slightest of discomfort in the eyes should be immediately shown to an ophthalmologist in order to prevent any serious damage.

Summary

Corneal ulcer in common terms can be described as development of open sores in the corneal region of the eye. This condition is also termed as ulcerative keratitis, marked by development of erosion in the outer layer of the cornea due to infection.

Most commonly affected are the populace of tropics and agrarian. In addition, children with vitamin A deficiency also fall prey to this condition.

Corneal ulcers are generally associated with disease conditions such as Sjogren syndrome, Mooren ulcer, systemic vasculitic disorder and rheumatoid arthritis. Autoimmune diseases like Hashimoto’s thyroiditis, psoriasis and Harada disease may also be associated with paracentral corneal melting [1]. Severe dry eyes and other disorders of the eye predispose an individual to develop corneal ulcers.

Patient Information

Definition

Corneal ulcers are open sores that develop in the cornea of the eye. It is a common condition and mostly affects those who wear contact lens. Infections are the major causative factor.

Cause

Infection due to bacteria, virus, parasites and fungi are the major factors for development of corneal ulcers. In addition, individuals who make use of contact lenses and improperly handle the same also fall prey to this condition. Dry eyes are also more prone to develop corneal ulcers.

Symptoms

Symptoms of corneal ulcers include pain and inflammation of the eyes, watery eyes, redness and itching sensation in the eyes, pus discharge from the eyes and sensitivity to light.

Diagnosis

Diagnosis involves examining the eyes by staining the cornea using fluroescein dye. The eyes are then studied using slit lamp microscope. Blood tests are done for evaluating the source of infection. In addition to these, tests to examine the vision and refraction test are also carried out.

Treatment

Treatment is geared towards the cause of the condition. If infection is the source then antibiotic drops are administered. Other eye drops that contain corticosteroids are also given along with oral medications to relieve pain and inflammation.

References

Article

  1. Paroli MP, Pinca M, Speranza S, Marino M, Pivetti-Pezzi P. Paracentral corneal melting in a patient with Vogt-Koyanagi-Harada's syndrome, psoriasis, and Hashimoto's thyroiditis. Ocul Immunol Inflamm. Dec 2003; 11(4):309-13. [
  2. Kim EC, Kim MS, Kang NY. Fungal corneal ulcer and bacterial orbital cellulitis occur as complications of bacterial endophthalmitis after cataract surgery in an immunocompetent patient. Semin Ophthalmol. 2013; 28(2):75-8 (ISSN: 1744-5205)
  3. Asai T, Nakagami T, Mochizuki M. Three cases of corneal melting after instillation of a new nonsteroidal anti-inflammatory drug. Cornea. Feb 2006; 25 (2):224-7.
  4. Schechter BA, Rand WJ, Nagler RS. Corneal melt after amniotic membrane transplant. Cornea. Jan 2005; 24(1):106-7.
  5. Suzuki A, Matsumoto Y, Uchino Y, Kawakita T, Shimmura S, Tsubota K. Risk factors of severe peripheral corneal ulcers.Nihon Ganka Gakkai Zasshi. 2011; 115(2):116-21 (ISSN: 0029-0203)
  6. Klamann MK, Maier AK, Gonnermann J, Klein JP, Bertelmann E, Pleyer U. Ocular surface temperature gradient is increased in eyes with bacterial corneal ulcers. Ophthalmic Res. 2013; 49(1):52-6 (ISSN: 1423-0259)
  7. Bullen CL, Liesegang TJ, McDonald TJ, DeRemee RA. Ocular complications of Wegener's granulomatosis. Ophthalmology. Mar 1983; 90(3):279-90.
  8. Schechter BA, Trattler W. Efficacy and safety of bromfenac for the treatment of corneal ulcer pain. Adv Ther. 2010; 27(10):756-61 (ISSN: 1865-8652)
  9. Lambiase A, Rama P, Bonini S, et al. Topical treatment with nerve growth factor for corneal neurotrophic ulcers. N Engl J Med. Apr 23 1998; 338(17):1174-80.
  10. Vanathi M, Sharma N, Titiyal JS. Tectonic grafts for corneal thinning and perforations. Cornea. Nov 2002; 21(8):792-7.

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Last updated: 2019-07-11 22:14