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

Eye anatomy.
  • 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 without infection
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 diagnosis
  • Grey white corneal lesion on gross vs slit lamp examination
  • Fluorescein uptake
  • Visual Acuity
  • Topical anesthetic (ie proparacaine or tetracaine) may assist in patient cooperation with exam once open globe excluded.
    • Repeated doses or Rx for topical anesthesia is contraindicated given concerns for impaired healing

Corneal abrasion vs. corneal ulcer

Characteristic Corneal abrasion Corneal ulcer
History *Acute pain immediately after injury *Delayed pain frequently 2-3 days or more after initial event
Lesion viewable on fluorescein exam *Yes *Yes
Lesion viewable on white light exam *No *Yes
Lesion morphology *Frequently linear, punctate, patterned, and/or irregular *Commonly circular

Management

  • Emergent ophtho consultation
  • Topical antibiotics
    • Vigamox 1 drop qhour OR
    • Ciprofloxacin
      • 2gtt q15 min x6 hours, then q30min x18h, then q1h x1 day, then q4h x12d
  • Consider antiviral or antifungal if high suspicion for viral or fungal cause (rare)
  • Cycloplegic may help if iritis present
  • Do not patch the eye

Disposition

  • Discharge with ophtho followup within 24-48 hours

See Also

References