Corneal Ulcer

Key Features

• Most commonly due to infection by bacteria, viruses, fungi, or amebas (see Keratitis, Infectious)

• Noninfectious causes include

  • Neurotrophic keratitis (resulting from loss of corneal sensation)

  • Exposure keratitis (due to inadequate eyelid closure)

  • Severe dry eye

  • Severe allergic eye disease

  • Various inflammatory disorders that may be purely ocular or part of a systemic vasculitis

Clinical Findings

• Pain, photophobia, tearing, and reduced vision

• Conjunctiva is injected

• Discharge may be purulent or watery

Diagnosis

• The corneal appearance varies according to the underlying cause (see Keratitis, Infectious)

• Some ulcers are most easily seen after instillation of fluorescein and examination with a blue light

Treatment

• Delayed or ineffective treatment of corneal ulceration may lead to devastating consequences with corneal scarring or intraocular infection

• Any patient with an acute painful red eye and corneal abnormality should be referred emergently to an ophthalmologist

• Contact lens wearers with acute eye pain, redness, and decreased vision should be referred immediately