A corneal ulcer is an open sore that can happen to anyone with poor eye hygiene. It can happen to farmers, factory workers, or those with extreme work environments.
That does not mean it won’t happen to your loved ones, who sit at home and actively engage in digital communication all day. We will get into that causes part later.
Corneal ulcers are responsible for tissue excavation, infiltration, and necrosis, which can be hazardous if left untreated. By the end of the blog, you understand the causes, symptoms, clinical features, and treatment options in Nepal.
Bacteria corneal ulcers occur when bacterial pathogens completely invade and disrupt corneal layers. It is a critical ocular emergency (epithelial erosion) caused by common bacterial pathogens like:
| Bacterial Pathogens | Key Characteristics |
|---|---|
| Staphylococcus aureus | Deep central stromal ulcer |
| Streptococcus viridans | saucer-shaped defect |
| Pseudomonas aeruginosa | central ulcer and liquefactive necrosis |
| Escherichia coli | A rare but serious ocular infection that originates from the gastrointestinal tract |
There are four distinct pathological stages progressive infiltration, active ulceration, regression, and cicatrization which doctors thoroughly analyze.
This condition is caused by progressive tissue destruction when bacteria successfully disrupt the epithelial barrier. And that’s possible with entry points like trauma, contact lens use, and ocular surface compromise.
Did you know Herpes simplex virus (HSV) can lead to infectious corneal blindness? This can happen if you are infected and triggered by stimulants like stress, or sunlight exposure. It can be your weak immune response failing to fight against HSV, that causes unilateral vision loss.
Fungal keratitis is a common cause of corneal ulcers in developing nations like Ghana, and Bangladesh, and sadly it is 17% in Nepal. Agricultural workers are at greater risk as this can occur following ocular trauma from vegetable matter. Some of the key characteristics include,
Those who wear contact lenses regularly are at increased risk of parasitic ulcers. It is not suggested to wear contact lenses when you have some wounds or scars in your eyes. These atypical wounds are at risk of being invaded by pathogens protozoa, helminths, and arthropods.
Acanthamoeba keratitis is one of the common parasitic ulcers observed in Nepal. This eye disease can progress as it is often associated with contaminated water exposure
Associated with conditions like:
| Conditions associated with Corneal Ulcer | Ocular manifestations |
|---|---|
| Rheumatoid arthritis | Corneal melting and systemic vasculitis |
| Wegener's granulomatosis | mild conjunctivitis and episcleritis at first, but can progress to keratitis, scleritis, uveitis, and retinal vasculitis |
| Peripheral ulcerative keratitis (PUK) | peripheral corneal thinning |
| Systemic lupus erythematosus | Keratoconjunctivitis sicca and sometimes permanent blindness |
| Characteristics | Inflammatory Corneal Ulcers | Infectious Corneal Ulcers |
|---|---|---|
| Causes | Autoimmune processes | Caused by bacteria, viruses, fungi, and protozoa |
| Onset | Gradual progression | Rapid progression |
| Pain | Moderate | Intense |
| Inflammatory response | Less acute inflammatory response | More aggressive inflammatory response |
| Borders | Often undermined | Well-defined |
| Treatment | Immunosuppressants | Targeted antimicrobial |
| Pathological Mechanism | Genetic predisposition and T-lymphocyte dysfunction | Release toxins and lytic enzymes causing tissue damage |
| Bacterial Corneal Ulcers | Fungal Corneal Ulcers | Viral Corneal Ulcers | Acanthamoeba Corneal Ulcers | Autoimmune Corneal Ulcers |
|---|---|---|---|---|
| Rapid onset of pain | More indolent (slower) course | Dendritic (branching) lesion pattern | Intense pain disproportionate to physical findings | Ocular irritation, with intense and persistent pain |
| Grayish white infiltrates with distinct borders | Gray-white feathery lesions with irregular margins | Geographical defects | Ring-shaped perineural infiltrates | Larger than marginal keratitis |
| Stromal inflammation and edema | Dry, raised appearance | Sub-epithelial keratitis | Radial keratoneuritis | Crescentic shape |
| Conjunctival injection | Less impressive conjunctival injection | Stromal haze | Dendritic-like lesions | Local conjunctival injection |
| Gram-positive cocci cause localized round/oval ulceration | Satellite lesions possible | Reduced corneal sensation | Diffuse punctate epithelial lesions | Close to limbus |
| Gram-negative bacteria create a rapid, destructive inflammatory course | Superficial white-raised colonies with defined borders | Corneal thinning and potential vascularization | Severe photophobia | Associated with systemic autoimmune symptoms |
You can have a detailed microscopic evaluation of the cornea to identify the size, location, and shape of the ulcer. Slit-lamp examination is one of the preliminary tests, that helps to study infiltrate characteristics and extent of damage in our cornea.
Other microscopic examination techniques can also be used for the diagnosis of corneal ulcers like,
Not only does this process help to identify corneal abrasions but detects foreign bodies, infections, dry eye conditions, and tear firm irregularities.
Diagnosis involves examining the cornea's appearance but we need better treatment plans to potentially recover at this stage, which include,
The four stages of a corneal ulcer are epithelial defect, stromal infiltration, Descemetocele, and corneal perforation.
Eye doctors often look for eyelid abnormalities, corneal sensation, and inflammation in the anterior chamber at early stages. Before it progresses rapidly it is essential to analyze the depth of the epithelial defect using a Fluorescein staining test and recommend a timely treatment plan.
For immediate intervention, preservative-free lubrication is given to your eyes. If by any chance, it disrupts re-epithelialization, then we discontinue its use. Pressure patching is also considered a suitable option for relief.
This is the stage when our cornea starts to lose its transparency. The infiltrates can be both infectious and inflammatory but sometimes show no regular signs before developing into later stages.
Because stroma is being infiltrated by microorganisms, there will be painful discharge from the eyes, which is a sign of concern. This is a critical stage of corneal stage progression which can vary based on different types of pathogens causing the corneal ulcers.
| Bacterial ulcers | Necrotic stroma with pus discharge. |
| Fungal ulcers | Stromal infiltration with feathery edges. |
| Viral ulcers | Active virus replication with dendritic or geographic configurations. |
To prevent it in the early stage, we can timely diagnose it with the following tests like,
The Descemet membrane- the basement membrane between the stroma and the endothelial layer of the cornea, will now bulge outwards in the anterior chamber. At this stage of corneal ulcer, this phenomenon is known as herniation or anterior bulging, which can show infectious, autoimmune, or traumatic etiologies.
Patients with suspected descemetocele should be diagnosed in a timely manner using specialized tests like the Seidel Test, OCT, and cobalt blue light staining test for fluorescein to see active fluid leakage.
At this stage, symptoms are pretty evident like shallowing of the anterior chamber and leakage of the aqueous chamber. There are visual indicators to look for like brown iris pigment in the wound.
The advanced diagnostic tests for this stage will be,
At this stage, there will be low intraocular pressure and a sudden increase in tearing. It will be crucial to manage the ocular leakage and thereby assess both symptomatic and asymptomatic characteristics.
Corneal ulcers can be vision-threatening and cause severe other vision-related complications like,
Corneal ulcers while complicated in their timely diagnosis and treatment help ease symptoms. However, it cannot be guaranteed that they will continue to recover or continue to have morbidity and long-term ocular complications.
Today we discussed corneal ulcers and gave a general overview of how to treat them effectively. You can directly find top cornea clinics near you- before your condition gets any worse.
Vision Concern Clinic, where our top eye consultants are ready to hear your eye problems. Get comprehensive diagnostic technology and eye care services at a comprehensive cornea expert center in Nepal.
Yes, we provide emergency eye care for conditions like eye injuries, sudden vision loss, and infections. If you experience any urgent eye problems, please contact us immediately, and our team will assist you in getting the care you need.
Signs to watch for include blurry vision, floaters, sudden loss of vision, eye pain, redness, or sensitivity to light. If you experience any of these symptoms, it’s important to schedule an eye exam at Vision Concern Eye Clinic as soon as possible for early diagnosis and treatment.
If you’re experiencing blurred vision, headaches, or eye strain, it may be a sign that you need glasses or contact lenses. Our eye exams will help determine whether you need corrective lenses. We’ll also discuss your options based on your lifestyle and preferences, including glasses, contacts, or even refractive surgery like LASIK.
