Corneal Ulceration //
Corneal ulceration refers to the breakdown of the corneal surface, with accompanying inflammation and subsequent tissue loss. A corneal ulcer is a serious condition which is usually caused by an infection from a bacteria, virus, or fungus. This infection may spread rapidly (over hours or days), resulting in permanent loss of vision or even loss of the eye.
There are many predisposing causes for the development of a corneal ulcer. Corneal trauma (a fingernail injury, a foreign body, etc.) or contact lens wear are two of the most frequent. Dry eyes, lid margin inflammation (blepharitis), eyelid abnormalities, and misdirected eyelashes are also frequent catalysts. Occasionally systemic diseases such as rheumatoid arthritis or Parkinsonism may be associated with corneal ulceration.
When a corneal ulcer is diagnosed, cultures are obtained in order to determine exactly what organism (bacteria, fungus, or virus) is causing the infection. Initially, patients are treated with specially formulated antibiotic eyedrops as often as every thirty to sixty minutes around the clock. The frequency that the antibiotic drops are used and the type often change during the course of treatment. These adjustments are based on the culture results and clinical response to the initial antibiotics. Oral medications and injections of antibiotics around the eye may also be used under specific conditions.
Patients often need to be examined daily until evidence of a therapeutic response and healing occurs. Most corneal ulcers respond to therapy. Occasionally, the infection may spread inside the eye, resulting in permanent damage or even loss of the eye. A corneal scar will remain following healing of the ulcer. Its effect on vision depends on the size, location, and density of the scarring. If a corneal ulcer is small, or in the periphery of the cornea, intensive treatment often results in rapid healing and full recovery of vision. Centrally located ulcers often heal with scarring or surface irregularity that causes subjective visual distortion and objective visual loss.