Corneal Ulcers

Corneal ulcers can be an eye emergency

A painful red eye, reduced vision, significant light sensitivity or a red painful eye in a contact lens wearer should be assessed urgently. Do not wait for symptoms to settle on their own.

A corneal ulcer is an open sore on the cornea. It is commonly caused by infection, although injury or severe inflammation can also damage the corneal surface. Because an ulcer can lead to scarring and permanent loss of vision, prompt diagnosis and treatment are important.

Symptoms of a corneal ulcer

• Moderate to severe eye pain
• Redness
• Blurred or reduced vision
• Sensitivity to light
• Excessive watering or discharge
• A feeling that something is stuck in the eye
• Swollen eyelids
• A white or grey spot on the cornea in some cases

What causes corneal ulcers?

The most common cause is infection. Bacteria, viruses, fungi and other organisms can infect the cornea, especially when its surface has been damaged.

• Contact lens wear, particularly sleeping in lenses or poor lens hygiene
• A scratch, foreign body or eye injury
• Severe dry eye or exposure of the cornea
• Herpes infection affecting the eye
• Reduced immunity or certain medical conditions
• Use of steroid eye drops without appropriate medical supervision

How is a corneal ulcer diagnosed?

An ophthalmologist examines the cornea with a slit lamp and may use fluorescein dye to show the damaged area. If infection is suspected, a small sample may be taken from the ulcer so laboratory testing can help identify the organism and guide treatment.

How are corneal ulcers treated?

Treatment depends on the cause and may require frequent antimicrobial eye drops. Some patients need drops as often as hourly at the start of treatment, and close follow-up is often required. Contact lenses should not be worn unless your ophthalmologist specifically advises otherwise. Severe ulcers may require hospital treatment, and a small number of cases may need corneal surgery if the cornea becomes very thin, perforates or is left with significant scarring.

What should I do if I wear contact lenses?

Remove the lenses and seek urgent eye care if you develop a painful or red eye, reduced vision or light sensitivity. Do not put the contact lens back in. Avoid using leftover antibiotic or steroid eye drops unless a clinician has assessed the eye and advised you to use them.