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
  • Risk factors include: incomplete lid closure (e.g. secondary to Bell’s palsy) and soft contact lenses use (especially sleeping in contacts)

Causes

Clinical Features

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

Differential Diagnosis

Unilateral red eye

^Emergent diagnoses

^^Critical diagnoses

Evaluation

  • Gray/white corneal lesion (will have fluorescein uptake)
  • Requires careful physical exam as 40% of lesions < 5mm
  • Hypopyon may be present
  • Iritis signs may be present (miotic pupil, Consenual photophobia)

Management

  • Emergent ophtho consultation
  • Topical antibiotics
  • Consider antiviral or anti-fungal if high suspicion for viral or fungal cause (rare)
  • Cycloplegic may help if iritis present
  • Do not patch the eye

Disposition

  • Discharge with ophtho followup within 24-48 hours

Complications

  • Corneal scarring
  • Corneal perforation
  • Anterior/posterior synechiae
  • Glaucoma
  • Cataracts

References