A Family Doctor's Tale - CORNEAL ULCERS

DOC I HAVE A CORNEAL ULCER

Corneal ulcers are more common than most people thought. Damage to the cornea may be due to injury or scratches from contact lens. Infection is another cause.
Last year one of my patient developed herpes zoster (shingles) of the right upper forehead. 
Unfortunately the herpes infection also affect her eyesight from a corneal ulcer and opacity from the infection.
No eye drops could help the opacity from the corneal ulcer. She now has partial loss of vision from the opacity of her corneal ulcer.

Corneal ulcer ( A Simple Guide to Corneal Ulcers) is a inflammatory disease of the surface of the cornea which causes local destruction of the superficial layer of the cornea resulting in ulcers.


Corneal ulcers can be infectious(due to infection) or non infectious(due to damage)


Corneal ulcers may be present more frequently in patients with:
Vitamin A deficiency
autoimmune disease
neurological disorders like facial palsy


The causes of Corneal ulcers can divided into 2 type:
Infections:
1. Bacterial infection such as Streptococci, Staphylococci, pneumococci, pseudomonas


2. Viral infections such as herpes simplex( A Simple Guide to Herpes), herpes zoster( A Simple Guide to Shingles),


3. Fungal infection


Non-infection:
1.Injury due to hard contact lens, abrasions from trauma, accidental scratch


2.autoimmune disease


3.Systemic disease


Symptoms varies from mild to severe:

1.Severe pain in the eye or around the eye and eyebrow especially with infectious causes. 
Non-infectious causes may not give rise to pain.


2.Red eye - increased blood flow through inflamed eye shows up the blood vessels


3.Tearing -excess tears from inflammation


4.Discharge -may be pus discharge from eyes especially in the morning


5.Light sensitivity - sensitive to bright lights


Signs:

1.White spot on the cornea, that depending on the severity of the ulcer, may not be visible with the naked eye


2.increased dilated blood vessels present due to inflammation


The presence of a corneal ulcer can be seen using a slit lamp microscope.

Sometimes a dye fluorescein may be dropped into the eye making it more visible and easier to detect.


If the patient is suspected to have infection(pus discharge from the eyes), a tissue culture of the corneal cells(gently scraped from the ulcer) may be necessary to determine the type of micro-organism infecting the eye.


The complication is always the risk of :

1.Severe infection of the eye especially with pseudomonas infection causing infection of the anterior chamber of the eye and then spreading to the rest of eye resulting in loss of an eye.


2.Scarring of the corneal ulcer resulting in partial loss of vision


Treatment depends on the type of corneal ulcer:

Infection:
1.Bacterial infection requires more intense treatment with oral antibiotics and antibiotic eye drops given every 15 minutes


2.Viral infections are usually treated with acyclovir tablets orally and acyclovir eye cream


3.Fungal infections are less common but are usually treated with antifungal medicine and eye drops.


In all infection cases, corticosteroid medications are not given.
Painkillers such as paracetamol can be given for pain


Non-infection:
1.Corticosteroid eye drops are usually given to reduce the inflammation


2.Antibiotic are also given to prevent infections of the ulcer.


In all cases the eye should be covered with eye pad until the epithelium of the ulcer heals about 10-14 days.


The prognosis depends on the severity of the disease


Most cases can be healed if detected early.


There may be minimum scarring of the cornea with possible loss of some vision.


Rarely the eye may be lost if there is severe infection and no treatment.

Prevention of corneal ulcers are:
1.nutritious diet with vitamin supplements can strengthen the body resistance against illness.


2.Avoid the use of infected contact lens lotion


3.Soft lens are more prone to eye infection. Always wash the hands before using any contact lens.


4. Avoid rubbing the eyes with dirty hands or tissues


4. A healthy lifestyle with less stress and mild exercise is always good for the body.