Corneal Ulcer

Definition:  Corneal infiltrate that may be sterile or infectious in origin and caused by a variety of viruses, fungi, bacteria and parasites.   

Because corneal infections do not have universal or absolute features, clinical diagnosis specific to each requires the clinical skill of an eye care specialist. 

Signs/Symptoms: 

• Red eye

• Pain

• Photophobia

• Decreased vision

• Discharge

• Focal white opacity within the corneal stroma with possible loss of corneal epithelium (fluorescein positive test)

• Hypopion (pus in the anterior chamber)

• Upper eyelid edema.   

Differential Diagnosis:

• Bacterial origin:  

  • Most common infectious origin.  

  • This is generally considered the cause of a corneal ulcer until proven otherwise   

  • Gram negative and gram positive bacteria

• Viral origin:  

  • Herpes simplex

• Parasitic origin:  

  • Acanthamoeba (painful, associated with poor contact lens hygiene)

• Fungal origin:  

  • Consider with trauma with vegetable matter (tree branch)                            

Causes: Generally the most common cause of corneal ulcers is contact lens, and can be debilitating requiring medvac.

Evaluation:

• Visual acuity

• History

  • Contact lens related

  • Previous corneal disease

• Slit lamp evaluation if possible

• Describe the size of the infiltrate, and location on the cornea

• Fluorescein instillation to evaluate the corneal epithelium for intactness

Treatment:

• Bacterial

  • Ciprofloxacin one drop every 5 minutes for 3 doses, then 1 drop every 15 minutes for 6 hours, then 1 drop every 30 minutes around the clock

• Scopolamine 1/4 % 1 drop 4 times a day

• Oral analgesics may be needed to control pain.

• MedVac as soon as possible to closest MTF with an ophthalmologist.  

Prognosis:

• With aggressive antibiotic therapy patients vision may be saved

• Inadequate treatment may result in vision loss from corneal scarring, or infection. 

This section provided by CAPT Robert B. North, Jr., MC, USN

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*This web version is provided by The Brookside Associates, LLC.  It contains original contents from the official US Navy NAVMED P-5139, but has been reformatted for web access and includes advertising and links that were not present in the original version. The medical information presented was reviewed and felt to be accurate in 2001. Medical knowledge and practice methods may have changed since that time. Some links may no longer be active. This web version has not been approved by the Department of the Navy or the Department of Defense. The presence of any advertising on these pages does not constitute an endorsement of that product or service by either the US Department of Defense or the Brookside Associates. The Brookside Associates is a private organization, not affiliated with the United States Department of Defense.

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