Treatment approach to corneal ulcer

Abstract

The cornea is the clear, anterior surface of the eye and is pivotal in maintaining vision. The article comprehensively reviews the diagnostic evaluations and therapeutic strategies for corneal ulcers, a potentially sight-threatening condition. Corneal ulceration results from various etiologies including infectious agents (bacteria, viruses, fungi, and parasites) and non-infectious factors (dry eye, autoimmune conditions, and trauma). Prompt and accurate diagnosis, often employing techniques such as slit-lamp examination, corneal scrapings, and laboratory cultures, is crucial to guide appropriate treatment. Antibiotic therapy remains the cornerstone for bacterial ulcers, with fortified antibiotics or a combination approach often used for severe infections. Viral ulcers, predominantly caused by the herpes simplex virus, are managed with antiviral agents, while fungal ulcers necessitate antifungal medications, often for prolonged periods. Parasitic infections like Acanthamoeba keratitis require dual-therapy with antiseptics and anti-amoebozoal drugs. In cases where the etiology is non-infectious, addressing the underlying cause (e.g., lubricating drops for dry eye or immunosuppressants for autoimmune conditions) is paramount. The article emphasizes the importance of regular monitoring, as some ulcers might require surgical interventions like corneal transplantation, especially if there's impending perforation or scarring affecting vision. Recent advancements, including the use of adjuvant therapies like corneal cross-linking and amniotic membrane transplantation, have shown promise in improving outcomes. In conclusion, the management of corneal ulcers is multi-faceted, requiring a tailored approach based on the underlying cause. Early detection, combined with the right therapeutic modality, is essential in preserving vision and preventing complications. This review serves as an invaluable guide for clinicians to navigate the challenges of diagnosing and managing corneal ulcers.

Keywords

• antibacterials
• antifungals
• bacteria
• corneal ulcer
• fungi
• virus