Corneal Ulcer
A corneal ulcer forms when the surface of the cornea is damaged or compromised. Ulcers may be sterile (no infecting organism) or infectious. The term infiltrate is also commonly used along with ulcer. This refers to the immune response wherein inflammatory cells accumulate in the cornea where they do not normally belong.
Whether or not an ulcer is infectious is an important distinction for the physician to make and determines the course of treatment. Bacterial ulcers tend to be extremely painful and are typically associated with a break in the epithelium, the superficial layer of the cornea. In some cases, the inflammatory response involves the anterior chamber along with the cornea. Certain types of bacteria, such as Pseudomonas, are extremely aggressive and can cause severe damage and even blindness within 24-48 hours if left untreated.
Sterile infiltrates on the other hand, typically cause less pain. They are often found near the peripheral edge of the cornea and are not necessarily accompanied by a break in the epithelial layer of the cornea.
There are many causes of corneal ulcers. Contact lens wearers (especially soft) have an increased risk of ulcers, particularly if they do not adhere to strict regimens for the cleaning, handling, and disinfection of their lenses and cases. In addition, wearers who sleep in their lenses are at a higher risk. Other patients at risk include those who have severe dry eyes, difficulty blinking, or who are unable to care for themselves.
Other causes of corneal ulcers include viral infections, inflammatory diseases, corneal abrasions or injuries, and other systemic diseases.
The course of treatment depends on whether the ulcer is sterile or infectious. Bacterial ulcers require aggressive treatment. In some cases, antibacterial eye drops are used every 15 minutes. Topical steroid drops are avoided in infectious cases. Sterile ulcers, however, are typically treated with steroid and antibiotic eye drops.
