Corneal Ulcers (Keratitis)

The cornea is a clear structure over the iris in the front of the eye, separated by fluid in the anterior chamber of the eye.

A corneal ulcer is an open sore or epithelial defect with inflammation of the cornea. It may look gray or white on the cornea, but also may not be visible without a doctor’s tools.
Corneal ulcers can occur in the eye for many reasons:
– Fungi;
– Bacteria (can produce toxins that ulcerate the cornea, as in keratitis);
– Parasites (acanthamoeba);
– Ocular herpes simplex or other viruses, often triggered by stress, impaired immune system, or exposure to sunlight;
– Dry eyes;
– Eye allergies;
– Immune disorders (such as rheumatoid arthritis, lupus);
– Inflammatory diseases;
– Trauma such as corneal abrasion;
– Disorders such as Bell’s palsy;
– Chemical burns.

A doctor uses a dye called fluorescein and examines the cornea with a microscope called a slit lamp.

In most cases, treatment will resolve corneal ulcers, but they can result in loss of vision or blindness.

– Pain;
– Redness;
– Feeling like the eye is scratched or something is in it;
– Sensitivity to light;
– Discharge;
– Swelling of the eyelid;
– Blurry vision.

Contact lens users are at particular risk of corneal ulcers, and extended-wear contact lenses that are not removed at night increase the risk of corneal ulceration tenfold. To help prevent ulcers from infections and small wounds:
– Wash your hands before handling your lenses;
– Make sure you are wearing your lenses the correct way;
– Keep your fingernails short while you are learning to remove your lenses to avoid scratching your eye;
– Insert lenses before applying makeup;
– Use non-allergenic makeup and replace your eye makeup every three months;
– Remove your lenses before swimming.
Non-contact-wearers can also reduce their risk by wearing eye protection when using power tools or welding, treating dry eyes or conjunctivitis, protecting eyes with sunglasses, and treating other underlying disorders.

Infections and ulcers can occur despite your best precautions. There are many potential treatments for keratitis.
– Culture and topical antibiotics;
– Anti-fungals;
– Oral anti-virals;
– Treatment of underlying immune disorder;
– Pain medication;
– Surgery;
– Corneal membrane;
– Amniotic membrane.

Amniotic Membrane
Amniotic membrane transplantation, with or without sutures, can be used as an adjuvant treatment for keratitis. It is anti-microbial and can act as a drug delivery system. It can reduce the inflammation that is so destructive to the eye. Steroids are a controversial treatment for keratitis because they can increase infection, but amniotic membrane transplantation can help to counteract this potential risk.

Image of a damaged eye from keratitis, or corneal ulcers.