Corneal Ulcer

Would you find it hard to believe if you were told that a simple wood shaving could leave you without vision in an eye? Well, the answer would be another question: Ever heard of how the smallest of things can create an avalanche?

What is a corneal ulcer?

A corneal ulcer is a wound on the surface of the cornea which is the transparent structure overlying the front surface of your eye.

What causes corneal ulcers?

·Infections are the most common cause:

1.       Bacteria: These are common in individuals who wear lenses for a prolonged period of time or do not follow cleaning regimes properly.

2.       Virus: Herpes simplex virus (the virus causing cold sores) and Varicella virus (the virus causing chicken pox and shingles) are commonly found responsible. The herpes simplex virus may cause recurring attacks or attacks that are typically triggered by a lowered immunity, stress or exposure to sunlight.

3.       Fungus: People with bad hygiene are at a greater risk. Overuse of steroid containing eye drops and lack of care of contact lenses can lead to fungal infections.

4.       Parasites: Acanthamoeba, the most common amoeba found in fresh water and soil may find its way into the eye and cause severe infection especially in contact lens users.

·Tear in the corneal surface: These may develop due to injuries by glass, metallic particles, tree branches, fingernails, wood shavings, paper cuts or make-up brushes striking the cornea. Burns caused by chemicals at the workplace or at home can also be a cause for trauma. A tear in the cornea provides easy access to bacteria.

·Dry Eyes: The germ fighting protective cover provided by tears is lost in some diseases causing dryness of eyes. This can go on to cause ulcers. (Who knew tears were so therapeutic, eh!)

·Bell’s palsy and other eyelid disorders: These do not allow the eyelids to function properly causing the cornea to dry out.

·Loss of sensation: Any condition that causes decreased sensation over the cornea can increase the risk.

 

 

Do I have corneal ulcer? (Signs and Symptoms)

Redness of your eyes

Severe pain in the eyes

Watery eyes

Pus or a thick discharge

Hazy or blurred vision

Sensation of foreign body in your eye

Increased sensitivity to light

Swelling of your eyelids

A white spot on your cornea (This may not be visible to you in the mirror)

What are the complications?

·Scarring which leads to permanent vision problems

·Melting ulcers which can lead to complete loss of the stroma (a layer of the cornea) within 24 hours

·Perforation with formation of fistulas

·Formation of synechia (adhesion of the iris to the cornea)

·Glaucoma (raised pressure inside the eye)

·Endopthalmitis (inflammation of the cavities inside the eye)

·Dislocation of the lens

What are corneal ulcers diagnosed?

Slit lamp examination

Corneal scraping with culture of sample (A small sample of the tissue is taken to determine the organisms which are causing the infection)

Sometimes corneal biopsy is also done if organism is not detected by corneal scrapping and culture

How is a corneal ulcer treated?

Medical treatment is the mainstay of treatment. It includes antibiotics, antifungal or antiviral eye drops depending on clinical suspicion or microbiology reports. Sometimes antifungal tablets may be given. Oral pain medications can be prescribed to you for your pain.

After the infection has decreased or gone, the swelling is taken care of. This is done by anti-inflammatory eye drops or steroids. This is required to prevent any scarring. It is very important that you do not use steroid eye drops without the supervision of your doctor.

If medications are not sufficient to treat the ulcer, surgery is indicated. A corneal transplant is done whereby your damaged cornea is replaced by that of a donor’s. This operation may have to be done in an emergency if a perforation is impending.

How do I prevent a corneal ulcer?

Wear protective eye gear when you are exposed to situations when small particles can enter your eyes. Do not try to remove any object that has been embedded in your eyeball. In case of a corneal scratch, rinse your eye with clean water and blink several times. Do not rub your eye after an injury.

If you suffer from dry eyes or if your eyelids do not close completely, use artificial tear drops for the lubrication of your eyes.

If you wear contact lenses:

·Never handle lenses without washing your hands first.

·Do not use saliva to lubricate your lenses because your mouth has bacteria which can harm your cornea.

·Never use tap water to clean your lenses.

·Store your lenses in disinfecting solutions overnight.

·Remove your lenses every evening and clean them carefully.

·Clean your contact lens case regularly.

·Do not share your contacts or swap colours with friends.

·Ensure that you get the exact brand, lens name, cylinder, sphere, power and axis.

·In case any redness or irritation occurs, remove the contacts and contact your eye doctor immediately.

 

Figure 2 Contact Lens Induced Corneal Ulcer

Thus, if you catch the first few snowflakes before they meet up with the others, you could prevent this avalanche!