Corneal ulcer

Background

Corneal ulcer without infection

• Major cause of impaired vision and blindness worldwide
• Break in epithelial layer allows infectious agents to gain access to the underlying stroma

Clinical Features

• Redness and swelling of lids and conjunctivae
• Ocular pain or foreign body sensation
• Decreased visual acuity (if located in central visual axis or uveal tract is inflamed)

Diagnosis

1. Slit-Lamp Exam
   1. Gray/white lesion
   2. Hypopyon may be present
   3. Iritis signs may be present:
      1. Miotic pupil
      2. Consenual photophobia

DDX

1. Bacteria
   1. Pseudomonas
   2. Strep pneumo
   3. Staph
   4. Moraxella
2. Viruses
   1. Herpes simplex
   2. Varicella zoster
3. Fungi
   1. Candida
   2. Aspergillus
   3. Penicillium
   4. Cephalosporium

Treatment

1. Emergent ophtho consultation
2. Topical abx
   1. Ciprofloxacin or ofloxacin otic, 1 drop qhr in affected eye
   2. Antiviral or anti-fungal if high suspicion for viral or fungal cause
3. Cycloplegic
   1. Helps w/ pain from accompanying iritis
   2. Cyclopentolate 1%
4. Do not patch the eye

Disposition

Refer to ophtho within 12-24hr

Complications

1. Corneal scarring
2. Corneal perforation
3. Ant/posterior synechiae
4. Glaucoma
5. Cataracts

Source

Tintinalli