What is Corneal Ulcer (Keratitis)?
A corneal ulcer, also known as keratitis, refers to an erosion or an open sore on the cornea, which is the thin, transparent structure of the eye responsible for refracting light.
Should the cornea become inflamed as a result of infection or injury, an ulcer may develop
Symptoms of Corneal Ulcer (Keratitis)
- Redness
- Pain
- Watering
- Gritty sensation
- Blurry vision
- Discharge
- Burning
- Itching
- Light sensitivity
Causes of Corneal Ulcer (Keratitis)
Contact lenses – Impure solution, inadequate hygiene, excessive use, sleeping while wearing contact lenses, utilizing tap water, or swimming with contact lenses in place. Prolonged wear of lenses restricts oxygen flow to the cornea, rendering it vulnerable to infections.
1) Trauma – Chemical damage, thermal burn, bee sting, animal tail, cosmetic or plant material such as a tree branch, sugarcane
2) Post-surgery – Delayed healing, loose sutures
3) Lid deformities – The inward or outward turning of the eyelid, the misdirection of eyelashes that continuously rub against the cornea, and the incomplete closure of the eyes
4) Decreased nerve supply to the cornea – Observed in individuals with diabetes and patients suffering from Bell’s palsy
Allergic conjunctivitis
Vitamin A deficiency
Prolonged use of eye drops –
corticosteroids
5) Severe dry eyes – Caused by medical conditions like diabetes mellitus, thyroid disorder, vitamin A deficiency, rheumatoid arthritis, Sjogren syndrome, Stevens-Johnson syndrome
Risk factors of corneal ulcer (keratitis)
- Injury or chemical burns
- Eyelid disorders that prevent proper functioning of the eyelid
- Dry eyes
- Contact lens wearers
- people who have or have had cold sores, chicken pox or shingles
- Abuse of steroid eye drops
- Diabetics
Corneal Ulcer (Keratitis) Prevention
- Do not sleep with contact lenses on
- Do not overuse contact lenses
- Wash your hands before putting the lenses
- Advised to use daily disposable lenses
- Do not use tap water as lens solution
- While riding a bike, wear eye protection or visor to prevent foreign bodies from entering the eye.
- Do not rub your eye
- Proper instillation of eyedrops. The nozzle of the eye drop bottle should not touch the eye or the finger
- Use artificial tears in case of dry eyes
- Wear protective eyewear when working with wood or metals, especially when using a grinding wheel, hammering on metal, or welding.
- Do not use over-the-counter eye drops
Types of corneal ulcer (keratitis)
Multiple organisms are responsible for development of a corneal ulcer (keratitis).
The types of corneal ulcer (keratitis) are –
· Bacterial – Scratches or abrasions caused by fingernails, paper cuts, or makeup brushes on the cornea, if not treated, can result in an ulcer. This condition is frequently observed in individuals who wear contact lenses for extended periods.
· Fungal – Damage to the cornea caused by any organic material or incorrect application of steroid eye drops
· Viral – The virus responsible for chickenpox and shingles is also capable of causing ulcers.
· Parasitic – Infection resulting from exposure to fresh water, soil, or prolonged use of contact lenses.
Corneal ulcer (keratitis) Diagnosis
The ulcer undergoes a meticulous examination using slit lamp microscopy to assess its size, shape, margins, sensation, depth, inflammatory response, hypopyon, and the presence of any foreign objects. A fluorescein dye is applied to stain the ulcer to improve visibility of its characteristics and to detect any leakage.
The debridement of the ulcer is crucial for microbiological assessment to determine the causative organism. Following the application of an anesthetic drop in the eye, the edges and the base of the ulcer are scraped using a sterile disposable blade or needle. These samples are then stained and cultured to identify and isolate the organism. Additionally, scraping the ulcer facilitates improved absorption of the eyedrops.
If the patient wears contact lenses, those lenses will be forwarded for microbiological assessment. Random blood sugar levels will be monitored. Should the sugar levels be uncontrolled, a consultation with a diabetologist will be sought, as this can impact corneal wound healing. A gentle ultrasonography of the affected eye will be performed to assess for any posterior segment pathology.
Corneal Ulcer (Keratitis)Treatment:
Based on the laboratory findings, treatment will commence. Antibiotics, antifungals, or antivirals are administered in the form of tablets and eye drops, depending on the identified causative agent. In instances of significant or severe corneal ulcers (keratitis), fortified eye drops are initiated, which are formulated from available injectable solutions. This treatment is supplemented with oral analgesics, cycloplegic eye drops to alleviate pain, anti-glaucoma eye drops to lower intraocular pressure, and artificial tears. The frequency of administration is determined by the size of the ulcer. The use of corticosteroids is strictly forbidden in cases of fungal corneal ulcers (keratitis). Nevertheless, they may be considered for other types of ulcers at a later stage, but only with extreme caution and under close supervision.
In the event of a minor perforation, a tissue adhesive glue is applied to the perforation under sterile conditions, followed by the placement of a bandage contact lens to seal the perforation. Bandage contact lenses are also utilized in instances of recurrent epithelial erosions to promote better healing. Patients with eyelid deformities that result in an ulcer require corrective surgical procedures. If the corneal ulcer (keratitis) is caused by an eyelash growing inward, the problematic lash must be removed along with its root. Should it regrow abnormally, the root may need to be destroyed using a low-voltage electrical current. In situations where there is improper or incomplete eyelid closure, a surgical fusion of the upper and lower eyelids is performed. Additionally, small perforations can be treated with patch grafts, which involve taking either a full thickness or partial thickness graft from a donor cornea and anchoring it over the site of the perforation.
In cases of non-healing ulcers, surgical intervention becomes necessary. An amniotic membrane graft is applied to the cornea in a sterile environment to promote thickness and facilitate healing. Nevertheless, for larger perforations or significant scarring, corneal transplant surgery is performed, which entails the surgical excision of the affected corneal tissue and its replacement with healthy donor tissue.
Book appointment with an Ophthalmologist:
- If noticing decrease in vision
- Redness and foreign body sensation
- Discharge
- White spot forming in front of the eye
