Corneal Ulcer
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What is Corneal Ulcer?
A corneal ulcer is a serious condition involving a defect in the corneal epithelium that extends into the underlying stroma. It commonly affects individuals who wear contact lenses and typically presents with symptoms such as eye pain, blurry vision, and sensitivity to light.
Prompt treatment is crucial as corneal ulcers can lead to significant vision loss and various complications, including corneal scarring or perforation, glaucoma, cataracts, and synechiae formation. If left untreated, bacterial keratitis, which can result from corneal ulcers, may progress to endophthalmitis, potentially leading to loss of the eye.
In the United States, the annual incidence of corneal ulcers ranges between 30,000 and 75,000 cases, with a notable portion of corneal transplants being performed to manage infectious keratitis. Recognizing the signs of corneal ulcers promptly is crucial to initiating treatment and arranging urgent ophthalmologic evaluation.
Symptoms
Treatments
Precautions
Symptoms
- Pain: Ranging from mild to severe, with Acanthamoeba keratitis often causing intense pain.
- Photophobia: Sensitivity to light, causing discomfort or pain.
- Conjunctival Injection: Redness or inflammation, especially in bacterial and HSV keratitis.
- Blurred Vision: Particularly noticeable in HSV keratitis or fungal infections.
- Foreign Body Sensation: Feeling of something gritty in the eye, common in HSV and bacterial keratitis.
- Dendritic Lesions: Branching patterns seen in HSV keratitis.
- Gray-White Feathery Lesions: Dry, gray-white feathery lesions in fungal infections.
- Superficial, White, Raised Colonies: White, raised colonies with defined borders in yeast-related ulcers.
- Pain Out of Proportion: Severe pain disproportionate to exam findings, seen in Acanthamoeba keratitis.
- Crescent-Shaped Damage: Crescent-shaped damage in the limbal region seen in peripheral ulcerative keratitis due to autoimmune disease.
Treatments
- Bacterial Ulcers: Topical fluoroquinolone antibiotics like ciprofloxacin or ofloxacin are first-line. Severe cases may need hospitalization with systemic antibiotics such as ceftriaxone, especially for gonococcal ulcers. Corneal culture is recommended for large, central ulcers.
- Herpetic Ulcers (HSV): Topical antivirals like trifluridine or acyclovir are used, often with adjuvant topical steroids. Oral antivirals like acyclovir or valacyclovir may also be prescribed.
- Fungal Ulcers: Natamycin is the primary treatment, with amphotericin B as an alternative. Voriconazole is less effective and has more toxicity.
- Acanthamoeba Keratitis: Treatment involves epithelial debridement and months of antiamoebic therapy, typically with chlorhexidine and polyhexamethylene biguanide. Additional agents may be added in severe cases.
- Peripheral Ulcerative Keratitis (PUK): Requires systemic immunosuppressants and cytotoxic agents, managed jointly by a rheumatologist and ophthalmologist. Close monitoring and frequent blood work are essential.
Precautions
- Avoid Eye Rubbing: Prevents worsening or introducing more bacteria/fungi.
- Eye Protection: Wear protective eyewear to prevent trauma.
- Hygienic Contact Lens Use: Proper cleaning and avoiding wearing lenses in water.
- Seek Prompt Medical Attention: Address symptoms promptly to prevent complications.
- Adhere to Treatment: Strictly follow prescribed regimen for effective healing.
- Avoid Irritants: Stay away from substances that can worsen eye inflammation.
- Monitor for Complications: Watch for worsening symptoms and report promptly.
- Regular Follow-up: Attend scheduled appointments to track progress and adjust treatment.
Types of Corneal Ulcer
Corneal Ulcer
Before Surgery
During the Surgery
After the Surgery
Before Surgery
- Topical and Systemic Antibiotics: Prescribed to reduce infection risk, especially for severe cases caused by bacteria like gonococcus.
- Antiviral and Antifungal Medications: Administered for HSV or fungal ulcers, such as trifluridine or natamycin.
- Antiamoebic Therapy: Used for Acanthamoeba keratitis, involving epithelial debridement and agents like chlorhexidine.
- Immunosuppressants: Given for autoimmune-associated ulcers like peripheral ulcerative keratitis, under rheumatologist and ophthalmologist co-management.
- Patient Education: Emphasize compliance with treatment and post-operative care instructions.
- Timely Medical Attention: Instruct patients to seek prompt medical help for worsening symptoms or complications.
During the Surgery
- Applying topical antibiotics to reduce infection risk.
- Conducting culture tests to identify the pathogen.
- Administering systemic antibiotics for severe cases.
- Considering corticosteroids for specific conditions.
- Treating associated infections like HSV or fungal keratitis.
- Monitoring closely for any complications.
After the Surgery
- Follow-up Appointments: Attend regular check-ups with the ophthalmologist to monitor healing and detect any issues.
- Medication Adherence: Strictly follow prescribed medications to prevent infection and aid healing.
- Symptom Management: Learn to manage common post-operative symptoms like pain and blurred vision.
- Eye Protection: Wear protective eyewear to prevent injury and reduce infection risk.
- Avoid Irritants: Steer clear of substances that could worsen inflammation.
- Continued Education: Stay informed about proper wound care and signs of complications.
- Visual Therapy: Consider rehabilitation to optimize vision, if necessary.
- Lifestyle Adjustments: Make changes like avoiding contact lens use to minimize ulcer recurrence risk.
Corneal Ulcer FAQs
How will Vitamin A deficiency cause corneal ulcers?
What is the prognosis of corneal ulcer?
How can corneal ulcer be prevented?
Some ways to prevent a corneal ulcer are to seek medical attention immediately for any eye symptoms.
Wear eye protection if you are exposed to small particles that can enter your eye.
Use contact lenses safely.
How can doctors tell if I have a corneal ulcer?
Doctors diagnose a corneal ulcer by looking at your eye. They’ll do a full eye exam, including checking your vision, and may also Scrape off a sample of the corneal ulcer for testing.
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