Symptoms and Signs of Corneal Ulcer

Medical Author: John P. Cunha, DO, FACOEP
Medically Reviewed on 8/31/2021

Doctor's Notes on Corneal Ulcer

A corneal ulcer (ulcerative keratitis) is an open sore on the cornea, the clear structure overlying the iris, which is the colored part of your eye. Corneal ulcers are commonly caused by contact lens-related bacterial infections. Other causes of corneal ulcers include viruses such as the herpes simplex virus or the varicella virus, or fungal infections.

Symptoms of corneal ulcers include

  • eye redness,
  • eye pain,
  • feeling as if something is in the eye,
  • tearing,
  • pus or thick discharge draining from the eye,
  • blurred vision,
  • sensitivity and pain to bright lights,
  • inflammation of the eyelids (swelling, redness),
  • a white or gray round spot on the cornea visible with the naked eye if the ulcer is large,
  • associated uveitis (inflammation of the ciliary body), and
  • less commonly, changes in the retina (retinopathy) if the ulcerative keratitis has progressed to involve the entire eye (endophthalmitis).

What Is the Treatment for a Corneal Ulcer?

The treatment of a corneal ulcer depends on cause. Infections cause most corneal ulcers. The most common types of infections that cause a corneal ulcer include:

  • Bacterial infections secondary to eye injury or wearing contact lenses
  • Viral infections, commonly herpes simplex virus (which causes cold sores) or the varicella virus (which causes chickenpox and shingles)
  • Fungal infections such as Fusarium, Aspergillus, or Candida are a rare cause of infection
  • Parasitic infections with Acanthamoeba, an amoeba found in fresh water and dirt

Depending on the cause of the corneal ulcer, it is treated with antibiotic, antiviral, or antifungal eye drops. These as prescribed for use as often as once per hour for several days to weeks.

  • Corneal ulcers can be very painful and pain medications are often prescribed.
  • Cycloplegic drops can be used to dilate the pupil to decease discomfort.

When an ulcer worsens despite medical treatment, surgery for a corneal transplant may be considered.

Patients must have close follow-up with an ophthalmologist (an eye specialist) closely in the initial days of treatment. Call your eye doctor right away if symptoms worsen, such as blurry vision, pain, or discharge.

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REFERENCE:

Kasper, D.L., et al., eds. Harrison's Principles of Internal Medicine, 19th Ed. United States: McGraw-Hill Education, 2015.