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Corneal ulcers are most commonly due to infection by bacteria, viruses, fungi, or amoebas. Noninfectious causes—all of which may be complicated by infection—include neurotrophic keratitis (resulting from loss of corneal sensation), exposure keratitis (due to inadequate lid closure), severe dry eye, severe allergic eye disease, and inflammatory disorders that may be purely ocular or part of a systemic vasculitis. Delayed or ineffective treatment of corneal ulceration may lead to devastating consequences with corneal scarring and rarely intraocular infection. Prompt referral is essential.

Patients complain of pain, photophobia, tearing, and reduced vision. The conjunctiva is injected, and there may be purulent or watery discharge. The corneal appearance varies according to the underlying cause.

WHEN TO REFER

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.

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Cao  Y  et al. Peripheral ulcerative keratitis associated with autoimmune disease: pathogenesis and treatment. J Ophthalmol. 2017;2017:7298026.
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Gomes  BA  et al. Corneal involvement in systemic inflammatory diseases. Eye Contact Lens. 2015;41:141.
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Hazlett  L  et al. Challenges of corneal infections. Expert Rev Ophthalmol. 2016;11:285.
[PubMed: 28090214]  

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