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Corneal ulcers and infections

Bacterial keratitis; Fungal keratitis; Acanthamoeba keratitis; Herpes simplex keratitis

The cornea is the clear tissue at the front of the eye. A corneal ulcer is an open sore in the outer layer of the cornea. It is often caused by infection.

Causes

Corneal ulcers are most commonly caused by an infection with bacteria, viruses, fungi, or a parasite.

  • Acanthamoeba keratitis occurs in contact lens users. It is more likely to happen in people who make their own homemade cleaning solutions.
  • Fungal keratitis can occur after a corneal injury involving plant material. It may also occur in people with a suppressed immune system.
  • Herpes simplex keratitis is a serious viral infection. It may cause repeated attacks that are triggered by stress, exposure to sunlight, or any condition that lowers the immune response.

Corneal ulcers or infections may also be caused by:

  • Eyelids that do not close all the way, such as with Bell palsy
  • Foreign bodies in the eye
  • Scratches (abrasions) on the eye surface
  • Severely dry eyes
  • Severe allergic eye disease
  • Various inflammatory disorders

Wearing contact lenses, such as soft contacts that are left in overnight, may cause a corneal ulcer.

Symptoms

Symptoms of infection or ulcers of the cornea include:

Exams and Tests

Your health care provider will do the following tests:

Blood tests to check for inflammatory disorders may also be needed.

Treatment

Treatment for corneal ulcers and infections depends on the cause. Treatment should be started as soon as possible to prevent scarring of the cornea.

If the exact cause is not known, you may be given antibiotic drops that work against many kinds of bacteria.

Once the exact cause is known, you may be given drops that treat bacteria, herpes, other viruses, or a fungus. Severe ulcers sometimes require a corneal transplant.

Corticosteroid eye drops may be used to reduce swelling and inflammation in certain conditions.

Your provider may also recommend that you:

  • Avoid eye makeup
  • DO NOT wear contact lenses at all, or do not wear them at night
  • Take pain medicines
  • Wear protective glasses

Outlook (Prognosis)

Many people recover completely and have only a minor change in vision. However, a corneal ulcer or infection can cause long-term damage and affect vision.

Possible Complications

Untreated corneal ulcers and infections may lead to:

  • Loss of the eye (rare)
  • Severe vision loss
  • Scars on the cornea

When to Contact a Medical Professional

Call your provider if:

  • You have symptoms of corneal ulcers or an infection.
  • You have been diagnosed with this condition and your symptoms become worse after treatment.
  • Your vision is affected.
  • You develop eye pain that is severe or becoming worse.
  • Your eyelids or the skin around your eyes becomes swollen or red.
  • You have a headache in addition to your other symptoms.

Prevention

Things you can do to prevent the condition include:

  • Wash your hands well when handling your contact lenses.
  • Avoid wearing contact lenses overnight.
  • Get prompt treatment for an eye infection to prevent ulcers from forming.

References

Groos EB Jr, Chang BH. Complications of contact lenses. In: Tasman W, Jaeger EA, eds. Duane's Ophthalmology 2013 ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2013:vol 4; chap 27.

Keenan JD, McLeod SD. Bacterial keratitis. In: Yanoff M, Duker JS, eds. Ophthalmology. 4th ed. Philadelphia, PA: Elsevier Saunders; 2014:chap 4.12.

Keenan JD, McLeod SD. Fungal keratitis. In: Yanoff M, Duker JS, eds. Ophthalmology. 4th ed. Philadelphia, PA: Elsevier Saunders; 2014:chap 4.13.

Lin A, Bouchard CS. Noninfectious keratitis. In: Yanoff M, Duker JS, eds. Ophthalmology. 4th ed. Philadelphia, PA: Elsevier Saunders; 2014:chap 4.17.

Soukiasian SH. Peripheral ulcerative keratitis. In: Yanoff M, Duker JS, eds. Ophthalmology. 4th ed. Philadelphia, PA: Elsevier Saunders; 2014:chap 4.16.

Tuli SS, Kubal AA. Herpes simplex keratitis. In: Yanoff M, Duker JS, eds. Ophthalmology. 4th ed. Philadelphia, PA: Elsevier Saunders; 2014:chap 4.15.

Yanoff M, Cameron JD. Diseases of the visual system. In: Goldman L, Schafer AI, eds. Goldman-Cecil Medicine. 25th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 423.

    • Eye

      Eye - illustration

      The eye is the organ of sight, a nearly spherical hollow globe filled with fluids (humors). The outer layer or tunic (sclera, or white, and cornea) is fibrous and protective. The middle tunic layer (choroid, ciliary body and the iris) is vascular. The innermost layer (the retina) is nervous or sensory. The fluids in the eye are divided by the lens into the vitreous humor (behind the lens) and the aqueous humor (in front of the lens). The lens itself is flexible and suspended by ligaments which allow it to change shape to focus light on the retina, which is composed of sensory neurons.

      Eye

      illustration

      • Eye

        Eye - illustration

        The eye is the organ of sight, a nearly spherical hollow globe filled with fluids (humors). The outer layer or tunic (sclera, or white, and cornea) is fibrous and protective. The middle tunic layer (choroid, ciliary body and the iris) is vascular. The innermost layer (the retina) is nervous or sensory. The fluids in the eye are divided by the lens into the vitreous humor (behind the lens) and the aqueous humor (in front of the lens). The lens itself is flexible and suspended by ligaments which allow it to change shape to focus light on the retina, which is composed of sensory neurons.

        Eye

        illustration

      Review Date: 8/20/2016

      Reviewed By: Franklin W. Lusby, MD, ophthalmologist, Lusby Vision Institute, La Jolla, CA. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.

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