Corneal Ulcer - Causes, Symptoms, Diagnosis, and Treatment

What Is the Cornea?

The see-through layer that covers the front portion of the eyes is called the cornea. It covers the eye's center opening (pupil), the colored part of the eyeball (iris), and the fluid-filled anterior chamber of the eye. It serves as the window through which you see. The cornea bends the incoming light onto the lens and protects the other parts of the eye.

What Is the Meaning of a Corneal Ulcer?

An open sore or defect in the corneal epithelium, along with inflammation, is a corneal ulcer. Injury or infection of the eye can result in inflammation of the cornea, increasing the risk of an ulcer. Apart from physical injury and infection, chemical injury, eye dryness, and contact lens misuse can also result in corneal ulcers. If not treated promptly with medicines, it can permanently affect your vision and result in severe loss of vision or blindness. Most cases of corneal ulcers improve without affecting the vision to a greater extent.

What Are the Symptoms of Corneal Ulcers?

Before signs of corneal ulcers develop, most people notice signs of an infection. The symptoms of an eye infection are:

1. Itchy eyes.

2. Burning sensation in the eyes.

3. Sensitivity to light.

4. Eye redness.

5. Watery eyes.

6. Pink eye.

7. Pus discharge from the eyes.

In addition to these symptoms, the other signs and symptoms of corneal ulcer are:

1. Swollen eyes.

2. Eye pain.

3. Severe tearing.

4. Blurry vision.

5. Grayish-white spot on the cornea.

6. Eyelid swelling.

7. Foreign body sensation in the eye.

8. Inability to open the eye.

These symptoms are severe and need immediate treatment to prevent vision loss. Bigger corneal ulcers look like grayish-white spots on the cornea, while the smaller ones cannot be seen without magnification.

How Does a Corneal Ulcer Develop?

The following causes can result in the development of a corneal ulcer:

1) Infectious Causes:

• Parasites - A parasite found in water, Acanthamoeba, can result in an eye infection called Acanthamoeba keratitis. It commonly infects people who use contact lenses. The parasite gets on the lens when the person swims in a lake or walks in the woods. It is a rare infection but can result in blindness.

• Herpes Simplex Virus (HSV) - The herpes virus causes repeated sores in the eyes, mouth, and genitals. The eye infection caused by HSV is called herpes simplex keratitis. A weak immune system due to stress, too much sun exposure, etc., can trigger repeated eyesores.

• Bacteria - Eye inflammation or infection is most commonly caused by the bacteria Pseudomonas aeruginosa and Staphylococcus aureus. People who misuse contact lenses are at risk.

• Fungi - Aspergillus, Candida, and other fungi can result in fungal keratitis. Immunocompromised individuals and those who use contact lenses are most likely to develop this keratitis. Fungi can also enter your eyes outdoors or after a plant injures your eye.

2) Non-Infectious Causes:

• Cuts or Scratches - Metal, glass, wood, etc., can cut or scratch the corneal surface, resulting in minor injury. This makes it easy for bacteria and other microorganisms to enter and infect the eye.

• Corneal Abrasion - A larger scratch or cut on the corneal surface is called a corneal abrasion.

• Dry Eye Disease - Also called keratitis sicca or keratoconjunctivitis sicca, devoids the eye of the tear film, which leaves the eye without the capacity to fight germs.

• Eyelid Disorders - Inability to close the eyelid properly (Bell's palsy), lid turning inward, or eyelashes growing inward can cause corneal ulcers.

• Chemical Burns - Any chemical solution splashing into the eye.

• Immunological Disorders - Rheumatoid arthritis, lupus, and people with a suppressed immune system are more susceptible to developing corneal ulcers.

• Mooren's Ulcer - It is a painful condition due to recurrent corneal ulcers. The cause is unknown.

• Contact Lens Misuse - People who use extended-wear lenses, or wear lenses for prolonged periods, or sleep while wearing them increase the risk of ulcers. The edges of the contact lens or dirt trapped underneath can also scrape the corneal surface, making it easy for infections. Avoid swimming while wearing your contact lens.

• Photokeratitis - Exposure to sunlight.

• Vitamin A Deficiency - The deficiency of vitamin A makes the eyes dry and prone to ulcers.

How Does a Doctor Diagnose a Corneal Ulcer?

The ophthalmologist will examine your eye to diagnose corneal ulcers. They might use a test called fluorescein eye stain. Here, the doctor will drop an orange dye onto a blotting paper. By touching this blotting paper to your eye lightly, the doctor will transfer the dye into your eye. After this, the doctor will shine a violet light onto your eye with the help of a microscope called a slit-lamp to look for corneal ulcers. If there is any damage to the corneal surface, it will appear green under the violet light.

To know if infectious agents caused the corneal ulcer, the eye doctor will gently take a sample by scraping the ulcer after putting eye drops. The sample is then tested for the presence of bacteria, viruses, or fungi.

How Are Corneal Ulcers Treated?

As these ulcers can lead to some amount of vision loss or blindness, treatment has to be prompt and aggressive. The treatment options include:

1) For Non-Infectious Causes - If the symptoms are mild, then the doctor might only prescribe artificial teardrops. In severe cases, an eye patch and topical eye drops are prescribed. This includes steroid eye drops to reduce inflammation. You might also have to take Vitamin C supplements to reduce corneal scarring. An ulcer usually heals within a week. If not, the doctor will place an amniotic membrane on the cornea for a week.

2) For Infectious Causes -

• Bacterial - Antibacterial eye drops may be prescribed. But if the infection is severe, oral antibiotics might be needed.

• Fungal - Antifungal eye drops and oral antifungal medications are prescribed.

• Viral - Antiviral eye drops and oral antiviral medications might be needed. For some types of viral infections, only artificial teardrops are prescribed.

• Parasitic - For Acanthamoeba, antibiotic eye drops are used, but some of this parasite might be resistant. Severe cases might need a cornea transplant.

3) Cornea Transplant - If the ulcer does not heal with medications, or if vision gets impaired, the doctor might suggest a cornea transplant. Here, the corneal tissue is removed and replaced with donor tissue.

How to Prevent Corneal Ulcers?

As contact lens users are more prone to corneal ulcers, one should disinfect and use the lens properly. The following tips might help prevent corneal ulcers:

1. Daily-wear contacts are better.

2. Do not forget to take the lenses out before going to sleep.

3. Remember to wash your hands before touching your contact lenses.

4. Handle your lens gently while cleaning them. Rub them gently with a cleaning solution to avoid scratching them.

5. Replace your contact lenses and contact lens case as recommended.

6. The leftover contact lens solution should be discarded each time you disinfect the lenses.

7. Avoid wearing contact lenses while swimming.

Conclusion:

Never underestimate or ignore eye problems. Ignoring them in the earlier stages can lead to irreversible complications, after which vision loss becomes permanent or difficult to function as before. If you are suffering from symptoms of corneal ulcer, consult an ophthalmologist online now.