Corneal ulcer

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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

  • Slit-lamp exam
    • Gray/white lesion
    • 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
    • Ciprofloxacin or ofloxacin otic, 1 drop qhr in affected eye
    • Antiviral or anti-fungal if high suspicion for viral or fungal cause
  • Cycloplegic
  • Do not patch the eye

Disposition

Refer to ophtho within 12-24hr

Complications

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

References