Corneal Ulcer

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This is a painful red eye condition resulting from a raw discontinuity to the corneal epithelium. It may  be  caused  by  infection  (bacterial,  viral  e.g.  Herpes  simplex  virus  and  measles,  fungal,  trauma  (physical or chemical) and nutritional (Vitamin A deficiency). 

Clinical presentation 

  • Painful and red eye of acute onset
  • Excessive tearing
  • Severe photophobia
  • Poor vision
  • Gray/white     spot    on    the    cornea staining with fluorescein
  • Hypopyon  (Pus  or  white  cells  in anterior chamber)

Investigations 

  • Visual acuity
  • Slit Lamp bimicroscope
  • Corneal scrapping for Gram Stain and
  • Corneal scrapping for Potassium Hydroxide staining
  • Fluorescein sodium drops or a drop of local anesthetic on a fluorescein strip to assess the pattern of the ulcer and measure the size of corneal defect.

Pharmacological Treatment 

While waiting for laboratory results, give: 

C: ciprofloxacin 0.3%, ophthalmic drops, instill 1–2drops 1–2hourly for 3days then reduce  to 3–4hourly. 

OR 

D: ofloxacin 0.3%, ophthalmic drops, instill 1 drop 1–2hourly for 3days then reduce to 3–4hourly 

Give antifungal, if fungal infection is suspected or confirmed 

S: natamycin 5%, ophthalmic drops, instill 1 drop 1–2hourly for 3–4days (specialist use only). Then reduce to 1 drop 3-4hourly. Continue for 14–21days until resolution of infection 

OR 

S:  econazole  2%,  ophthalmic  drops,  instill  1  drop  1–2hourly  for  3–4days  (specialist  use only). Then reduce to 1 drop 3–4hourly. Continue for 14–21days until resolution of infection 

OR 

S: chlorhexidine 0.2%, ophthalmic drops, instill 1 drop 1–2hourly for 3–4days (specialist use  only).  Then  reduce  to  1  drop  3–4hourly.  Continue  for  14–21days  until  resolution  of  infection 

Give antiviral if viral causes are suspected after the examination of the eye 

C: acyclovir 3% eye ointment 5hourly a day until there is no corneal stain, then continue with treatment 8hourly a day for a maximum of 10–14days 

Note: Treatment may be changed depending on corneal scrapping results 

Referral:  Refer to the next level of care where there is an eye specialist when there is hypopyon  (white cells in anterior chamber)