Clinical approach to corneal ulcers

Abstract

A corneal ulcer is a break or defect in the surface epithelium of the cornea, accompanied by tissue decay in the nearby area, leading to stromal necrosis. On a pathological level, there are swelling and an influx of cells in the affected region. Corneal ulcers often arise due to bacterial, viral, fungal or parasitic infections. However, non-infectious causes, such as dry eye, inflammatory disorders and trauma, also have a role. Delayed treatment can lead to blindness. Accurate diagnosis and prompt management are essential. Initially, patient history provides clues. A history of contact lens wear is often linked to bacterial or Acanthamoeba infections. Scratches may herald fungal infections, especially in agricultural settings. Viral aetiologies often correlate with dendritic patterns. Next, the slit-lamp examination can highlight corneal defects and infiltrates. Fluorescein staining may enhance the visibility of epithelial defects. Diagnostic procedures may include corneal scraping for microscopy, culture or polymerase chain reaction (PCR). This aids in identifying causative agents and tailoring antimicrobial therapy. Empirical treatment, especially in severe or progressing ulcers, begins before culture results. Bacterial ulcers frequently receive broad-spectrum antibiotics initially. Fungal infections warrant antifungal therapy, often with natamycin. Acanthamoeba keratitis necessitates specific antiamoebic therapy. Refractory or complex cases might demand additional interventions, such as corneal cross-linking or therapeutic keratoplasty. Appropriate patient education, such as contact lens hygiene, can serve as a preventative measure. Overall, understanding the underpinnings and a systematic approach to diagnosis and management are vital in preserving vision and avoiding complications in corneal ulcer patients.

Keywords

• bacterial
• corneal ulcer
• dry eyes
• fungal
• viral