Understanding Corneal Ulcers

The cornea is a clear section of tissue within the eye, located at the front and covering the iris, that allows light to filter through the eye. Also known as keratitis, a corneal ulcer occurs when the cornea has an open sore. It is the result of infection, erosion, or injury of the cornea.

What Causes a Corneal Ulcer?

A bacterial infection is one of the most common causes of corneal ulcers. Abrasions, injuries, and excessive dryness can allow bacteria to enter through tiny scratches or cuts. Several issues can provide entry for numerous types of bacteria.

Although excessive dry eye and injury from foreign objects in the eye, including dirt specks and shed eyelashes, are more common ways for bacterial corneal ulcers to occur, there are other ways as well. Improper wear and disinfection of contact lenses can also cause corneal damage and provide an optimal environment for bacterial infection.

A viral corneal ulcer is caused when a virus invades the cornea. It can occur similar to bacterial infections of the cornea. One of the most common viruses to cause an ulcer in the cornea is the herpes simplex virus type 1. 

HSV type 1 is the virus responsible for cold sores on the mouth. It is transmitted by direct contact with someone else that has the virus. To spread to the eye, a person with HSV type 1 often transfers the virus after touching their eyes.

A fungal infection is not as common as bacterial or viral infections. It is often the result of corneal injury that involves some sort of plant material that has a fungus present. Potting soil can contain fungi from infected plants as well.

Injury from plants can occur by getting parts of the plant in the eye when doing things such as gardening. It can also occur following direct injury to the cornea such as accidentally getting jabbed by a twig or branch. Additionally, transferring fungi from the hands to the eye can occur after touching an infected plant and then touching around the eye.

Symptoms of a Corneal Ulcer

Symptoms of infection may be noticed before the ulcer. Eye infection symptoms include itchiness, excessive watering, and a milky discharge. Redness and stinging may also be experienced. In some cases, a feeling of having debris in the eye is present.

The ulcer can cause more symptoms. If a corneal ulcer is too small to see without using a magnifier, called a loupe, symptoms can still be experienced. An ulcer can cause inflammation, soreness, blurry vision, and a white spot on the cornea. If left untreated, symptoms can lead to blindness.

Diagnosing a Corneal Ulcer

Corneal ulcers can be found during an eye exam with an ophthalmologist. Special staining eye drops are used to help make any corneal abnormalities more visible. The eye doctor will then use a slit lamp to look at the eye with magnification.

If an ulcer is found, the ophthalmologist will then determine the cause. A scraping of the ulcer is taken and sent for testing. This scraping will tell the eye doctor what time of infection is causing the ulcer so that correct treatment can be provided quickly.

How to Treat a Corneal Ulcer

The treatment of a corneal ulcer depends on the cause. One treatment type may not be as effective as one that is used to treat a specific cause. Eye drops are prescribed to deliver medication that targets the cause.

The eye drops given will be specific to the cause. For example, a viral cause will require antiviral eye drops while fungal infections are treated with anti-fungal eye drops. If the cornea has permanent damage, surgery to replace the cornea may be necessary.

Home Care Remedies

In addition to medical treatment provided, there are some things that can be done at home to help with healing and symptom relief. Cool compresses can be used to alleviate swelling and itchiness, but water should not get in the affected eye. Avoid rubbing the eye and washing hands frequently.

After treatment, excessive dryness or itchy eyes can be addressed using artificial tear eye drops. Avoid wearing contact lenses until the eye doctor says otherwise. After healing, avoid wearing contact lenses for longer periods than recommended and when eyes are irritated.

How Long Does a Corneal Ulcer Take to Heal?

The amount of time it takes for a corneal ulcer to completely heal will vary greatly. Influencing factors include the cause, the size of the ulcer, and how deep into the cornea the ulcer occurs. In some cases, it can take longer for an ulcer to heal if it is found along the edges of the cornea.

On average, proper treatment provides healing within three weeks. Abrasions and cuts often heal in about a week. If there is permanent damage, however, and a transplant is necessary, all signs of infection must be gone to avoid further complications during and after the surgery.

Prevention of Corneal Ulcers

Simple steps can be taken to prevent a corneal ulcer and corresponding infections. Thorough hand-washing is very important, especially before handling contact lenses. Follow proper contact lens procedures, including cleaning and wear time. 

Avoid touching around the eyes or rubbing itchy eyes. Care should be taken when working with things that can cause debris to get into the eyes. Wear goggles or safety glasses during these activities. If any foreign objects do get into the eyes, rinse they eyes immediately.

In most cases, corneal ulcers go away with proper treatment. It is important to see a doctor immediately if any abnormal eye symptoms are experienced, even if there is no vision impairments present. Any suspected injury should be examined to determine if treatment is needed. Infections can spread rapidly and cause permanent damage.