Emergency Care for Corneal Ulcers:What You Need to Know

A corneal ulcer is a serious eye infection or injury that can worsen quickly, leading to vision loss if left untreated. Symptoms like sudden eye pain, redness, or blurry vision mean you need immediate attention from an eye care specialist. Quick treatment can prevent complications and protect your long-term eye health. If you notice these signs, don’t wait urgent care is essential.

Request an Appointment

Corneal Ulcers Explained: Causes, Risks, and What to Watch For

A corneal ulcer, or keratitis, is an open sore on the cornea caused by infection, autoimmune disease, severe dry eye, or trauma. If left untreated, it can lead to pain, inflammation, and vision loss. Prompt diagnosis and treatment are essential to protect your eyesight.

When is a Corneal Ulcer an Emergency?

leading to vision loss or permanent eye damage. It is crucial to treat these ulcers as emergencies in the following situations:

Severe Pain and Discomfort: If the pain in the eye becomes unbearable, it could indicate a deep infection or an ulcer that is worsening.
Sudden Vision Changes: Any sudden decrease in vision or blurring, especially if it progresses quickly, is a critical sign that the ulcer is impacting the deeper layers of the cornea or leading to complications.
Increasing Redness: An increase in redness around the eye or within the eye itself suggests spreading inflammation.
Light Sensitivity: Intense sensitivity to light, causing significant discomfort or making it difficult to open the eye, can be a sign of a severe ulcer.
Visible Infiltrates: If you can see white or grey spots on the cornea or it appears cloudy, it's essential to seek immediate medical help.
Unresponsive to Initial Treatment: If symptoms do not improve or worsen after starting treatment, urgent reassessment and possibly more aggressive treatment are necessary.

These symptoms indicate that the corneal ulcer is at a stage where without immediate and effective treatment, the risk of long-term damage increases significantly. Prompt intervention by an eye care specialist is crucial to manage the condition effectively and preserve vision

Common Causes and Types

The most common causes of corneal ulcers are:

Bacterial infections, often related to improper use of contact lenses, such as sleeping in contacts not designed for overnight wear or inadequate disinfection of lenses.
Viral infections, including the herpes simplex virus (commonly causes cold sores) and the varicella-zoster virus (known for causing chickenpox and shingles).
Fungal infections, which can occur after the cornea is damaged by an injury involving plant material, or in an agricultural setting.
Parasitic infections, such as Acanthamoeba keratitis, particularly in contact lens wearers who are exposed to water.

Each type of infection can lead to different types and severities of corneal ulcers, characterized by their cause and the specific pathogens involved.

Polymicrobial Infections

Polymicrobial infections are increasingly recognized in cases of keratitis, with approximately 43% of cases involving multiple microorganisms. These infections can complicate diagnosis and treatment, as they involve various types of bacteria, fungi, and sometimes protozoa co-inhabiting the same cornea. Accurate microbial identification through culturing is crucial in such scenarios to ensure appropriate and effective treatment is administered.

Could You Develop a Corneal Ulcer? Know the Risks

Contact Lens Wear and Hygiene

Primary risk factor: Improper care of contact lenses, including extended and overnight wear, increases the risk of corneal ulcers. Not following proper lens hygiene protocols, such as using homemade cleaning solutions or wearing lenses in pools, significantly raises the likelihood of infections.

Trauma and Foreign Bodies

Physical injuries: Small particles like dust or plant material can scratch the cornea, leading to ulcers. Chemical and thermal injuries also pose risks, underscoring the need for protective eyewear during activities like yard work or construction.

Ocular Surface Changes and Diseases

Pre-existing conditions: Chronic eye diseases such as dry eye syndrome and blepharitis, or previous surgeries that alter the corneal surface, can predispose individuals to keratitis.

Age-Related and Systemic Factors

Health conditions: Older adults and those with systemic conditions like diabetes or immunosuppression face a higher risk due to weakened immune responses and compromised wound healing.

Understanding these risk factors is vital for prevention, particularly for contact lens users and individuals with chronic eye conditions or systemic health issues. Regular eye check-ups and proper eye care can help mitigate the risk of developing corneal ulcers.

Is Your Eye Trying to Tell You Something? Symptoms of Corneal Ulcers

Common Symptoms of Corneal Ulcers

Corneal ulcers, also known as bacterial keratitis, often cause symptoms that are distressing and painful. Key symptoms include:

Sharp or Throbbing Eye Pain: A sudden onset of pain, often described as stabbing or throbbing.
Eye Redness and Light Sensitivity: Redness in the eye along with photophobia, or sensitivity to light, which can make it difficult to keep the eyes open, especially in bright environments.
Watery Discharge and Blurred Vision: Patients may notice watery discharge from the eye and varying degrees of vision blurriness, from mild to significant.

Urgency in Treatment: If you or your child experience these symptoms, it’s essential to seek immediate medical care from a local eye specialist to prevent complications, including potential vision loss.

Note for Healthcare Professionals: Recognizing these symptoms quickly helps differentiate corneal ulcers from other eye conditions, ensuring timely and accurate treatment.

Signs Observed During Examinations

During an eye exam, several indicators may suggest a corneal ulcer:

Conjunctival Injection and Focal White Infiltrates: The cornea may appear red and show white infiltrates that signal inflammation under the corneal surface.
Tissue Thinning and Edema: Surrounding stromal inflammation can lead to corneal tissue thinning and swelling.
Severe Inflammation (Hypopyon): In more severe cases, hypopyon, or a collection of inflammatory cells in the anterior eye chamber, may indicate intense inflammation.

Diagnostic Tools: Eye care providers often use fluorescein staining, a yellow dye, to highlight areas of epithelial cell loss, confirming the presence of an ulcer.

Importance for Healthcare Providers: These visual indicators are crucial for both optometrists and ophthalmologists in accurately diagnosing bacterial keratitis, guiding timely referral and management for effective treatment.

Corneal Ulcer Care: Key Treatment Approaches

Specific Medical Therapies

For corneal ulcer cases, our practice follows a structured medical approach:

Fluoroquinolone Drops: Effective for smaller ulcers, these drops provide broad-spectrum coverage and are administered hourly in more severe cases.
Fortified Antibiotics: In larger or vision-threatening ulcers, we may use a combination of vancomycin and tobramycin based on culture sensitivities.
Pain Management: Cycloplegic medications help manage pain and prevent further complications, such as posterior synechia.
Antiviral Medications: For suspected viral keratitis, antivirals are promptly included to address potential viral causes.

Role of Corticosteroids and Adjunctive Treatments

The use of corticosteroids in treating bacterial keratitis can be controversial but may be beneficial in certain cases:

Corticosteroids: After initial antibiotic treatment, corticosteroids can improve visual outcomes, especially for central or severe ulcers. These are used cautiously, excluding conditions like Acanthamoeba or fungal keratitis where steroids could worsen the condition.
Adjunctive Treatments: In challenging cases, we may employ advanced techniques such as:
Corneal Crosslinking: Helps stop corneal melt by strengthening collagen and has germicidal properties, particularly useful for treatment-resistant ulcers.
Nutritional Support: Vitamin C and tetracyclines (e.g., doxycycline) are used to prevent tissue breakdown in severe infections.

Corneal Ulcer Surgery: When and Why It’s Necessary

Indications for Surgery

Corneal ulcers, a serious concern for vision health, can sometimes progress to a state where surgical intervention becomes necessary. The decision to move forward with surgery is generally based on several key indications, including:

Lack of response to medical treatment: If intensive antibiotic therapy fails to improve the condition, and ulcers persist or worsen, surgical intervention becomes critical to prevent further corneal damage and preserve vision.
Significant corneal perforation: Large perforations, typically over 2mm, especially those centrally located, may require immediate surgical action to stabilize the cornea.
Severe stromal melting: This condition can threaten the structural integrity of the cornea, requiring surgical reinforcement.
Polymicrobial infections: Ulcers involving multiple pathogens, or those suspected to be fungal, amoebic, or mycobacterial, may necessitate a surgical approach due to their complex pathology.

Types of Surgical Procedures

Various surgical techniques are adopted based on the severity and specifics of the corneal ulcer. Here are the common types of surgery performed:

Penetrating Keratoplasty (PK): This full-thickness corneal transplant is often recommended for severe cases, especially with central perforations or extensive stromal involvement. PK can restore corneal clarity significantly but comes with potential risks of graft rejection.
Lamellar Keratoplasty: When the ulcer is less severe or more peripheral, this procedure, which involves replacing only part of the corneal layers, can be effective. It helps maintain the structural integrity of the cornea while minimizing risk compared to full grafts.
Amniotic Membrane Transplantation: Used as an adjunctive therapy, this technique supports healing by providing a biological bandage known for its anti-inflammatory and anti-scarring properties.

Why Are Corneal Ulcers Hard to Treat? Key Challenges

Antibiotic Resistance

A major challenge in treating corneal ulcers is the rising antibiotic resistance among pathogens like Staphylococcus aureus, with some strains showing troubling resistance levels. This complicates treatment, necessitating careful antibiotic selection and monitoring, especially for resistant strains like MRSA.

Complexity of Mixed Infections

Corneal ulcers can involve multiple pathogens, including bacteria, fungi, and viruses, making precise diagnosis and tailored treatment crucial. Up to 43% of cases may be polymicrobial, requiring detailed cultures to identify the involved organisms and guide appropriate treatment.

Patient Compliance

Effective treatment depends significantly on patients adhering to their prescribed medication regimens, which often involve multiple daily doses of antibiotic drops and possibly oral medications. Noncompliance can lead to prolonged infections and increased resistance, worsening outcomes. For healthcare providers, simplifying treatment plans and ensuring clear communication about the importance of adherence are key to managing these cases effectively.

Cutting-Edge Treatments: What’s Next for Corneal Ulcer Care?

Use of Novel Therapies

When it comes to treating corneal ulcers, particularly those associated with infections like bacterial keratitis, novel therapies are reshaping our approach. For patients and caregivers concerned about treatment efficacy, these advancements offer hope for better outcomes and fewer complications.

An emerging option is the use of low-concentration topical povidone-iodine, which has demonstrated comparable efficacy to traditional topical antibiotics for bacterial keratitis. This promising alternative not only offers effective antimicrobial action but does so at a reduced cost, making it accessible to a wider range of patients. Additionally, its application could help minimize antibiotic resistance, a growing concern in the treatment of ocular infections.

Advances in Crosslinking and Povidone-Iodine

Corneal collagen crosslinking (CXL) is gaining traction as a treatment for bacterial keratitis that hasn't responded to conventional therapies. Traditionally used to manage conditions like keratoconus, CXL has shown potential in arresting corneal melting associated with infections. The procedure involves photoactivating riboflavin with ultraviolet A (UVA) light, creating cross-links within the collagen fibers that bolster the structural integrity of the cornea. Its antimicrobial activity is also noteworthy, preventing further tissue degradation.

Recent innovations include using riboflavin activated by green light (RGX) instead of UVA light. RGX has demonstrated efficacy, especially against resistant strains like methicillin-resistant Staphylococcus aureus (MRSA), and is being explored for its added benefits over traditional CXL methods.

Urgent Eye Care for Corneal Ulcers – Immediate Treatment in Cheshire

At ReFocus Eye Health in Cheshire, we understand that eye emergencies demand swift attention especially when it comes to corneal ulcers. If you’re experiencing severe eye pain, redness, blurred vision, or light sensitivity, don’t wait. These symptoms could indicate a serious infection that requires expert care right away.

We proudly serve patients from Cheshire, Southington, Wallingford, and Naugatuck, providing cutting-edge diagnostics and tailored treatments for bacterial, viral, and fungal corneal infections. With over 360 patient reviews and an outstanding 4.8-star rating, our dedication to exceptional eye care is clear. We offer same-day and emergency appointments because when it comes to protecting your vision, every second counts.

If you’re noticing sudden discomfort or vision changes, early treatment is key. Call our office today to schedule an urgent evaluation with our experienced specialists.

Contact Us

Make An Appointment

267-341-7389