Corneal Ulceration Disease

BASICS

DESCRIPTION

Corneal ulcers represent an infection of the cornea by bacteria, virus or fungi as a result of breakdown in the protective epithelial barrier. If left untreated, corneal ulcers can result in blindness. Ulcerations may be central or marginal.

System(s) affected: Nervous
Genetics: None
Incidence/Prevalence in USA: Common
Predominant age: None
Predominant sex: Male = Female

SIGNS AND SYMPTOMS

Eyelid and conjunctiva become inflamed
Mucopurulent discharge
The corneal epithelium will be absent with underlying ulceration and infiltration of the corneal stroma with leukocytes
Foreign body sensation
Blurred vision
Light sensitivity
Pain

CAUSES

Corneal ulcers are predisposed by the presence of an entry to the external eye. Dry eye, burns, abrasion, contact lenses, inappropriate use of topical anesthetics, antibiotics, or antiviral drops, immunosuppressant drugs, diabetes, immunodeficiency.
Causative agents for foreign entry:
- Gram positive organisms (staphylococci, streptococci, and bacilli)
- Anaerobes (cocci, bacilli)
- Gram negative organisms (diplococcus, rods, and anaerobes)
- Pseudomonas
- Viruses such as herpes

RISK FACTORS

Any abrasive injury
Contact lenses (especially soft lenses)
Chronic topical steroid use

DIAGNOSIS

LABORATORY

Culture the ulcer

Drugs that may alter lab results: Pretreatment with topical antibiotics or corticosteroids may delay diagnosis
Disorders that may alter lab results: N/A

PATHOLOGICAL FINDINGS

Scrapings for Gram's and Giemsa's stain may demonstrate bacteria, yeast, or intranuclear inclusions which may aid in the diagnosis

SPECIAL TESTS

N/A

IMAGING

N/A

DIAGNOSTIC PROCEDURES

Scrapings of the corneal ulcer may be necessary to identify the underlying organism. The sample should be plated onto the culture media directly.

TREATMENT

APPROPRIATE HEALTH CARE

Outpatient or inpatient for severe ulcer or noncompliant patient
All cases of corneal ulceration should be promptly referred to an ophthalmologist

GENERAL MEASURES

Aggressive topical antibiotic treatment directed toward the causative agent should be instituted immediately while culture studies are pending
Supplemental topical cycloplegia reduces the inflammation and aids in patient comfort
Bandaging the eye should be avoided and topical steroids should never be used. Daily evaluation is necessary and prompt consultation with an ophthalmologist or corneal specialist is advised.

SURGICAL MEASURES

N/A

ACTIVITY

Reduced, until vision returns to normal and healing is complete

DIET

No special diet

PATIENT EDUCATION

Prevention of abrasions and proper handling of contact lenses can prevent recurrence of corneal ulcers

FOLLOW UP

PREVENTION/AVOIDANCE

Avoid corneal abrasion or injury and improper contact lens handling

POSSIBLE COMPLICATIONS

Scarring of the cornea and loss of vision

EXPECTED COURSE AND PROGNOSIS

Corneal ulcerations should improve daily and heal with appropriate therapy
If healing does not occur or the ulcer extends, then consideration should be given to an alternative diagnosis and treatment

MISCELLANEOUS

ASSOCIATED CONDITIONS

Chronic ulcerations may be associated with neurotrophic keratitis due to lack of fifth nerve innervation of the cornea. Individuals with thyroid disease, diabetes, immunosuppressive conditions are particularly at risk.

AGE-RELATED FACTORS

Pediatric: N/A
Geriatric: Ring ulceration more common
Others: N/A

PREGNANCY

N/A

OTHER NOTES

N/A

ABBREVIATIONS

N/A

Clinical Investigations

ROLE OF HOMOEOPATHY

Holistic healing that treats the person, not just the disease. Experience gentle, lasting wellness with expert constitutional care.