href="#"

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:
1. Bacteria
2. Virus
3. Fungus
4. Parasites

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
3. Watering
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.

TREATMENT :

First of all, patient is put on some empirical treatment then based on report of culture and sensitivity, specific treatment against the microbes is started. Along with antibiotic drops & ointment, few drops like homide, antiglacoma drops, lubricant drops are started.

Sometimes it happens, even with best line of treatment, infection does not get controlled with medicines. At that time surgical management comes into play. Therapeutic corneal transplant may be needed if there is impending perforation or if ulcer is non responsive to medical line of treatment.

PREVENTION IS BETTER THAN CURE :

Always wear protective glasses.

Avoid exposure to dust/ fumes.

Take proper precaution if you are daily contact lens user: Change of contact lens solution as and when required. Don’t share your contact lens with others. Contact should be removed at night before going to bed. Strict aseptic precautions to be followed while handling contact lens. Don’t use tap water to clean contact lens.

Contact your eye surgeon immediately if any of the above mentioned symptoms of ulcer appears. Early treatment of corneal abrasion can prevent catastrophe.