Corneal ulcer

Disease Description (Causes and Symptoms)

• Definition: A condition in which the corneal epithelium is defective, most often accompanied by infection (infectious keratitis). If inflammation (melting) of the corneal stroma progresses after epithelial loss, there is a risk of perforation.
• Causes: Improper contact lens use (especially sleeping while wearing lenses), trauma (trauma involving plants or soil carries a risk of fungal infection), use of topical steroids, ocular surface diseases (eyelid disease and dry eye), viruses (e.g., herpes), immunosuppression, and others.
• Pathophysiology: Epithelial defect → pathogen penetration and inflammatory response → melting (necrosis) of the corneal stroma → if it deepens, perforation or spread of inflammation into the anterior chamber (inside the eye) may occur.
• Main symptoms: Tearing, severe pain, photophobia (light sensitivity), redness, discharge, and decreased vision. If hypopyon (intraocular inflammation) is present, pain and vision loss may be more severe.

Treatment Methods

• Initial management and principles: Begin diagnosis and treatment at an ophthalmology clinic as soon as possible. Targeted treatment according to the cause (bacteria, fungi, or viruses) determines the prognosis.
• Medication
  • Suspected bacterial infection: Immediately use broad-spectrum topical antibiotic eye drops (e.g., a powerful fluoroquinolone antibiotic eye drop or, in severe cases, alternating fortified antibiotics). In severe cases initially, the medication may be administered hourly.
  • Suspected fungal infection (after trauma or trauma involving soil/plants): Use antifungal eye drops (e.g., natamycin).
  • Suspected viral infection (herpes): Use antiviral medication (topical and oral); combined steroid use is limited and only under a specialist's judgment.
  • Pain control: Use a cycloplegic to relax the pupil and relieve pain. Analgesics may be used if needed.
  • Steroids: Use cautiously after the infection is controlled to prevent scar formation (an ophthalmologist's instructions are essential).
• Procedures and surgery
  • Mechanical removal of the cornea (debridement) or a minor surgical procedure to remove pathogens.
  • In severe cases (progressive stromal damage, risk of perforation, or actual perforation), tissue adhesive, emergency suturing, or therapeutic keratoplasty (corneal transplantation) may be necessary.
• Indications for hospitalization: Severe pain, a large central ulcer, anterior chamber inflammation (suspected endophthalmitis), cases requiring frequent high-dose eye drops, problems with treatment adherence, and others.
• Lifestyle management and precautions
  • Stop wearing contact lenses immediately. Never wear them again during infection treatment (reevaluation is required after the doctor gives permission).
  • Take precautions against contamination and cross-infection when using eye drops yourself (wash your hands and do not let the tip of the container touch anything).
  • Do not use topical steroids on your own (an ophthalmologist's instructions are required).
  • If symptoms occur, such as worsening pain, worsening vision, purulent discharge, or inability to tolerate light, seek emergency medical care immediately.

Checklist Before an Outpatient Visit (Including Items to Bring and Sample Questions)

• Items to bring
  • A list of all medications currently being taken (including oral and topical medications) and a history of allergies (medications and foods).
  • Any eye drops used recently (name and purpose), and whether steroids have been used.
  • Whether contact lenses are worn; the type of lenses, storage solution, wearing time, whether they are worn while sleeping, and the lens case (bring it if possible).
  • When the symptoms began and how they have progressed (when they started and whether they have worsened), and whether there was any trauma (especially involving plants or soil).
  • Results or photographs from previous ophthalmologic examinations, and any previous corneal history (such as herpetic keratitis).
• Examinations that may be performed at the outpatient visit
  • Slit-lamp examination (essential) and fluorescein staining (green fluorescence) to confirm the epithelial defect.
  • Corneal scraping (smear), culture, and susceptibility testing (when bacterial or fungal infection is suspected).
  • If necessary, eye photographs, assessment of corneal thickness and depth, and evaluation of anterior chamber (intraocular) inflammation.
• Sample questions for the outpatient visit (patients may also write these down in advance)
  • On what date did the symptoms begin, and what was the first symptom to appear?
  • Have you recently had any trauma to the eye? Have you worn contact lenses?
  • What medications are you currently taking, and what allergies do you have?
  • Have you previously had a similar eye condition (such as herpes or recurrent ulcers)?

General Sample Questions to Ask the Doctor

• "What do you think is causing this ulcer (bacteria, fungi, viruses, etc.)?"
• "What is the purpose of the medication you prescribed, and what side effects should I expect?"
• "How long is treatment expected to take, and how often will I need to visit the clinic?"
• "What is the likelihood of vision recovery (prognosis), and how likely is it that a scar will remain?"
• "If any situation or change in symptoms occurs, when should I go to the emergency room immediately?"

Examples of Condition-Specific Questions

• "Which antibiotics will I use while waiting for the culture results, and how will treatment change depending on the results?"
• "How can we tell whether there is a risk of corneal perforation, and if perforation occurs, what emergency treatments and surgical options are available?"