Corneal Ulcer

exp date isn't null, but text field is

This is a painful red eye condition resulting from a raw discontinuity to the corneal epithelium

Causes

  • Infection (bacterial, viral e.g. Herpes simplex and measles, fungal)
  • Trauma (physical or chemical)
  • Nutritional (Vitamin A deficiency)

Signs and symptoms

  • Painful and red eye of acute onset
  • Excessive tearing, severe photophobia, poor vision
  • Grey/white spot on the cornea staining with fluorescein
  • Hypopyon (pus or white cells in the anterior chamber)

Examination of the eye

In specialized eye units, the following should be done:

  • Examination of the eye with slit lamp microscope
  • Fluorescein sodium drops or a drop of local anaesthetic on a fluorescein strip to assess the pattern of the ulcer and measure the size of the corneal defect

Investigations

  • Corneal scrapping for Gram stain, microscopy and potassium hydroxide staining if bacterial and fungal organisms are suspected

Pharmacological treatment

While waiting for laboratory results, give:

Ciprofloxacin 0.3%, ophthalmic drops, instil 1-2 drops every hour for 3 days then reduce to every 3-4 hours from 3-14 days

OR

For suspected or confirmed fungal infection

Natamycin 5% ophthalmic drops

Instil 1 drop every 1-2 hours for 3-4 days (specialist use only).

Then reduce to 1 drop every 3-4 hours. Continue for 14-21 days until resolution of infection             

OR

Chlorhexidine 0.2% ophthalmic drops

Instil 1 drop every 1-2 hours for 3-4 days (specialist use only).

Then reduce to 1 drop every 3-4 hours. Continue for 14-21 days until resolution of infection

 

Antiviral for suspected viral causes

Acyclovir 3% eye ointment

Administer every 5 hours until there is no corneal stain, then continue with treatment every 8 hours for a maximum of 10-14 days

Note: Treatment may be changed depending on corneal scraping results

Referral

  • Refer for specialist ophthalmological care