A corneal ulcer forms when the surface of the cornea is damaged or compromised. Ulcers may be sterile (no infecting organisms) or infectious. The term infiltrate is commonly used along with ulcer. Infiltrate refers to an immune response causing an accumulation of cells or fluid in an area of the body where they don't normally belong.
Whether or not an ulcer is infectious is an important distinction for your optometrist to make and determines the course of treatment. Bacterial ulcers tend to be 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, cause little if any 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.
Contact Lens Wear
There are many causes of corneal ulcers. Contact lens wearers (especially soft) have an increased risk of ulcers if they do not adhere to strict regimens for the cleaning, handling, and disinfection of their lenses and cases. Soft contact lenses are designed to have very high water content and can easily absorb bacteria and infecting organisms if not cared for properly. Pseudomonas is a common cause of corneal ulcer seen in those who wear contacts.
Signs and Symptoms
The symptoms associated with corneal ulcers depend on whether they are infectious or sterile, as well as the aggressiveness of the infecting organism.
- Red eye
- Severe pain (not in all cases)
- White spot on the cornea, that depending on the severity of the ulcer, may not be visible with the naked eye
- Light sensitivity
Detection and Diagnosis
Corneal ulcers are diagnosed with a careful examination using a slit lamp microscope. Special types of eye drops containing dye such as fluorescein may be instilled to highlight the ulcer, making it easier to detect.
If an infectious organism is suspected, contact lens wear must be suspended and treatment with antibiotic eye drops is a must.
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.