Corneal ulcer

(Redirected from Corneal Ulcer)

A corneal ulcer is also often referred to as bacterial keratitis, although these terms are not directly interchangeable because a cornea may harbor a bacterial infection (i.e bacterial keratitis) without having a loss of tissue (an ulcer), and a cornea may have an ulcer without a bacterial infection.

Background

Corneal ulcer without infection
  • Major cause of impaired vision and blindness worldwide
  • Break in epithelial layer allows infectious agents to gain access to the underlying stroma
  • Risk factors include: incomplete lid closure (e.g. secondary to Bell's palsy) and soft contact lens use (especially sleeping in contacts)

Causes

Clinical Features

Corneal ulcer infected with Pseudomonas spp.
  • Redness and swelling of lids and conjunctiva
  • Ocular pain or foreign body sensation
  • Decreased visual acuity (if located in central visual axis or uveal tract is inflamed)
  • Photophobia
  • Gray/white corneal lesion (will have fluorescein uptake)
  • Requires careful physical exam as 40% of lesions < 5mm
  • Hypopyon may be present
  • Iritis signs may be present (miotic pupil, consensual photophobia)

Complications

  • Corneal scarring
  • Corneal perforation
  • Anterior/posterior synechiae
  • Glaucoma
  • Cataracts

Differential Diagnosis

Unilateral red eye

^Emergent diagnoses ^^Critical diagnoses

Evaluation

  • Clinical

Management

Disposition

  • Discharge with ophtho followup within 24-48 hours

See Also

References