An old farmer came to our clinic with complaint of pain in right eye, light intolerance, redness, and discharge. He gave us history of trauma with leaves while working in the field. His vision was compromised to finger counting close to face at the time of presentation as he came to us after self-treatment with desi medicines. Can you imagine a trivial trauma causing such a catastrophic reaction in the eye? He was diagnosed as corneal ulcer and got good treatment at our hospital and we could save his eye from getting blind.
WHAT IS A CORNEAL ULCER?
Ulcer is a breach in continuity of surface. The front segment of eye is overall spherical & transparent which is known as cornea. When such discontinuity in surface occurs on front portion of the eye (Cornea), it is called corneal ulcer.
CAUSES CORNEAL ULCERS?
A) Infections is the most common cause:
Bacterial and parasitic corneal ulcer are more common in person using contact lenses. Proper precautions should be followed during contact lens use. Viruses like herpes simplex & H. zoster can cause recurrent corneal ulcers. Fungal corneal ulcers are very common in farmers. Overuse of steroids is one of the risk factor for fungal corneal ulcer.
B) Physical trauma to cornea can cause corneal ulcer
C) Dry Eyes : Tear film over cornea protects it from invading pathogens. Dryness of eyes is a predisposing factor for development of corneal ulcer.
D) Bell’s palsy and Ectropion (outward turning of eyelid), Entropion (Inward turning of lids): Lids form physical barrier whenever any foreign object tries to touch cornea. Lid function gets affected in above mentioned conditions making eyes more prone for infection.
E) Loss of sensation of cornea : It makes eyes prone for infection e.g. excessive use of anaesthetic drop, post herpes zoster infection, Diabetes, few congenital conditions in children.
SIGNS AND SYMPTOMS :
1. Red eyes
2. Severe pain in the eyes
4. Sticky discharge
5. Blurred vision
6. Intolerance to light
7. Swelling of your eyelids
If corneal ulcer left untreated, it may lead to complications like Endophthalmitis (Spread of infection to inner structures of eyes), Perforation of cornea, glaucoma (raised intraocular pressure), complete melting of cornea, auto evisceration, adherent leucoma, permanent loss of vision.
One should immediately visit ophthalmologist if any of the above symptoms appears in eye. Thorough slit lamp examination, corneal scrapping (Microbiological evaluation of ulcer causing microbes), Culture & sensitivity (provides information regarding ideal drugs to be administered for controlling infection) are needed for successful treatment of ulcer.