Corneal Ulcer

Andrew A. Dahl, MD, FACS

Andrew A. Dahl, MD, is a board-certified ophthalmologist. Dr. Dahl's educational background includes a BA with Honors and Distinction from Wesleyan University, Middletown, CT, and an MD from Cornell University, where he was selected for Alpha Omega Alpha, the national medical honor society. He had an internal medical internship at the New York Hospital/Cornell Medical Center.

Charles Patrick Davis, MD, PhD

Dr. Charles "Pat" Davis, MD, PhD, is a board certified Emergency Medicine doctor who currently practices as a consultant and staff member for hospitals. He has a PhD in Microbiology (UT at Austin), and the MD (Univ. Texas Medical Branch, Galveston). He is a Clinical Professor (retired) in the Division of Emergency Medicine, UT Health Science Center at San Antonio, and has been the Chief of Emergency Medicine at UT Medical Branch and at UTHSCSA with over 250 publications.

Corneal ulcer facts

There are a wide variety of
causes of corneal ulcers, including infection, physical and chemical trauma,
corneal drying and exposure, and
contact lens overwear and misuse.

Corneal ulcers are a serious problem and may result in loss of vision or blindness.

Most corneal ulcers are preventable.

With appropriate and timely treatment, the majority of corneal ulcers will improve with minimal adverse effect on vision.

What is a corneal ulcer?

A corneal ulcer is an open sore on the cornea, the clear structure in the front of the eye. The cornea overlies the iris, which is the colored part of the eye.

What does a corneal ulcer look like?

A corneal ulcer will often appear as a gray to white area on the normally transparent cornea. Some corneal ulcers may be too small to see without adequate magnification and illumination. See the first reference for pictures of a corneal ulcer.

What are the causes of a corneal ulcer?

Most corneal ulcers are caused by infections. Bacterial infections cause corneal ulcers and are common in people who wear contact lenses. Bacteria can directly invade the cornea if the corneal surface has been disrupted. Some bacteria produce toxins that can cause ulceration of the cornea. Viruses that may cause corneal ulcers include the herpes simplex virus (the virus that causes cold sores) and the Varicella virus (the virus that causes chickenpox and shingles).
Fungal infections can cause corneal ulcers and may occur with improper care of contact lenses or overuse of eyedrops that contain steroids.

Tiny cuts or scratches in the corneal surface may become infected and lead to corneal ulcers. For example, metal, wood, glass, or almost any type of particle that strikes the cornea can cause minor trauma. Such injuries damage the corneal surface and make it easier for bacteria to invade and cause a corneal ulcer. A corneal abrasion is a larger loss of the corneal surface and may ulcerate if left untreated.

Disorders that cause dry eyes can leave the eye without the germ-fighting
protection of the tear film and cause or aggravate corneal ulcers.

Disorders that affect the eyelid and prevent the eye from closing completely, such as Bell's palsy, can dry the cornea and make it more vulnerable to ulcers.

Any condition which causes loss of sensation of the corneal surface may increase the risk of corneal ulceration.

Chemical burns or other caustic (damaging) solution splashes can injure the cornea and lead to corneal ulceration.

People who wear contact lenses are at an increased risk of corneal ulcers. The risk of corneal ulcers and other complications are lowest with daily wear disposable lenses. The risk of corneal ulceration increases at least tenfold when using extended-wear lenses. Extended-wear contact lenses are those contact lenses that are worn for several days without removing them at night.

Scratches on the edge of the contact lens can
scrape the cornea's surface and make it more open to bacterial infections. Similarly, tiny particles of dirt trapped underneath the contact lens can scratch the cornea. Bacteria may be on the improperly cleaned lens and get trapped on the undersurface of the lens. If lenses are left in eyes for long periods of time, bacteria can multiply and cause damage to the cornea. Wearing lenses for extended periods of time can also block oxygen to the cornea, making it more susceptible to infections.

In addition, some patients with immunological disorders(immunosuppressed,
rheumatoid arthritis, lupus, and others) may develop corneal ulcers as a complication of their disease.

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Corneal Ulcer

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