Anyone who feels the symptoms of a light-sensitive, red, painful and watery eye could possibly be suffering from a corneal ulcer (corneal ulcer). Therefore, it is advisable to see an ophthalmologist quickly if you experience these signs.
What is a corneal ulcer?
In a corneal ulcer, there is an increasing melting at the edge of the cornea, which is caused by infectious agents. The particular pathogens can enter through a superficial injury to the cornea; the result is a red and irritated eye. Since the cornea is enormously important for the ability to see, a corneal ulcer should be treated immediately by an ophthalmologist. Vision can be severely affected by a corneal ulcer because the refractive power of the cornea is disturbed by such an irregularity. Due to the sensitive nerve supply to the eye, a corneal injury can usually be noticed by pain and uncontrollable tearing. Due to corneal injury, the corneal ulcer may eventually develop.
Causes
The cause in corneal ulcer is due to an infection, which is caused by a certain pathogen. Certain factors can favor the formation of a corneal ulcer, such as dry eyes, frequent wearing of soft contact lenses and pre-existing injuries of the cornea on its surface. In addition, inflammation of the lacrimal sac or cornea can be promoting. Additional risk factors include diabetes mellitus, rheumatic diseases, or advanced age.
Symptoms, complaints, and signs
The symptoms of a corneal ulcer can develop acutely and worsen dramatically. Generally, they resemble those of corneal inflammation. Most prominent here is severe and persistent eye pain. A typical further sign is a noticeable reddening of the affected eye. Affected individuals also complain of significantly impaired vision. There is also increased sensitivity to light. The symptoms increase when the affected person looks directly into the light. Another characteristic of a corneal ulcer is the appearance of a foreign body sensation in the eye. Most patients also complain of visual disturbances. The affected person is also no longer able to control the flow of tears. The eye keeps watering. In many cases, a corneal ulcer also leads to a clearly swollen conjunctiva.
The disease is also easily visible directly on the cornea. Thus, the ulcer itself appears as a grayish-white opacity. The center is thinned and the edges are raised. If left untreated, the above symptoms usually worsen significantly on their own. As an extreme consequence, complete blindness of the eye at this stage may also be a sign of the corneal ulcer.
Diagnosis and course
The diagnosis of corneal ulcer is not difficult for the specialist, among other things, based on the history of the affected person. If, in addition, the above-mentioned factors are added, this may already indicate corneal damage. The corneal ulcer can be clearly detected by means of an examination with a so-called slit lamp, which is performed by the doctor in case of suspicion. Often, the lacrimal ducts are also flushed to clean them or to prevent them from narrowing. In order to prepare and adjust the subsequent therapy, the ophthalmologist takes a swab from the conjunctiva and from the corneal ulcer. In this way, the pathogens responsible for the corneal ulcer are determined. In order to avoid a bad course, the corneal ulcer should be examined or treated immediately after the onset of symptoms. Within a few hours, vision can deteriorate to such an extent that a kind of scar remains on the cornea after treatment. The vision may be permanently impaired. The most fatal course would be blindness of the affected eye.
Complications
A corneal ulcer can cause an infection in the eye, which of course can cause various complications. At the first sign of an exacerbation, a doctor should definitely be consulted so that any subsequent damage can be detected early and treated accordingly. An infection is usually noticeable by a strongly reddened eye. A significantly increased tear flow can also be an indication of an infection.Affected persons should consult a doctor directly in such a case, so that the inflammation can be effectively and quickly alleviated with appropriate medication. However, if medical treatment is not sought at this point, then there is a risk of significant aggravation. In particularly bad cases, pus may even form, so that a doctor should be consulted immediately at the latest. Otherwise, the cornea may be permanently damaged, resulting in permanent consequential damage to the eye. Therefore: A corneal ulcer should not be taken lightly. If this clinical picture remains without any treatment, serious complications threaten. If you want to avoid these complications at an early stage, you should see a doctor at the first signs of inflammation. With the right medication, an infection in the eye can be treated effectively and quickly.
When should you go to the doctor?
If symptoms such as eye pain, sensitivity to light, and reddened eyes are noticed, a corneal ulcer may be underlying. A visit to the doctor is indicated if the symptoms appear suddenly and persist for more than two to three days. If further symptoms occur, the ophthalmologist must be consulted on the same day. A corneal ulcer can worsen within a few hours to such an extent that a scar remains after treatment. To avoid scarring or even blindness, the condition must be promptly examined and treated. People who have suffered from dry eyes for a long time or wear soft contact lenses are particularly susceptible to corneal ulceration. People with rheumatic diseases or diabetes mellitus also belong to the risk groups and should see a doctor immediately if they have the above-mentioned symptoms. If pus forms, vision suddenly decreases sharply, or severe pain occurs, the affected person must be taken to the hospital. Children should be taken to a pediatrician if they show signs of a corneal ulcer.
Treatment and therapy
The therapy of corneal ulcer is mainly carried out locally; narrowed tear ducts are flushed directly in this case. Those who wear contact lenses should absolutely refrain from wearing them until they are completely healed. Antibiotic drops are prescribed to combat the pathogens. If the middle eye skin is inflamed at the same time, treatment with antibiotics in tablet form must take place. If the corneal ulcer is very advanced or the cornea is already perforated, surgery is performed, during which a corneal transplantation is performed. It is possible that further surgery will have to follow if the transplanted cornea does not heal directly. If there is still no improvement after conservative therapy with eye drops and tablets, surgery may be necessary even then. Such treatment of a corneal ulcer sometimes extends over several weeks. In any case, the transplantation must be performed before the pathogens migrate to the edge of the cornea, so that they cannot infect the new cornea again. If the corneal ulcer is caused by rheumatism, surgery is often necessary in this case as well. However, there is a risk of new formation of rheumatic ulcers. If a scar remains after conservative therapy that severely impairs vision, a corneal transplant can still be performed as well.
Outlook and prognosis
The prognosis of corneal ulcer is evaluated according to the time of the possible start of treatment. In acute situations, there may be a significant increase in symptoms within a few hours as the ulcer grows unabated. The later it is possible to start treatment, the more difficult the further course of the disease and the better the chances of recovery. In severe cases, the patient is threatened with permanent impairment of vision or blindness. This is especially true if the patient does not seek medical care or if the therapy performed remains unsuccessful. In an emergency operation, if possible, a transplantation of the cornea must be performed so that there is a chance of improving vision. Alternatively, the patient is threatened with blindness. In case of an additional inflammation of the interior of the eye, a significant delay of the healing process is to be expected. The pathogens have already spread further in the eye and must be treated.If treatment with medication takes place as quickly as possible, a rapid decline in symptoms can be observed in most cases. The germs are killed and transported out of the organism. The ulcer recedes completely and recovery is possible. If there is damage to the retina, permanent clouding of vision may occur or a persistent restriction of natural vision will occur.
Prevention
Corneal ulceration can be prevented if damage to the cornea is avoided, for example, by early treatment of inadequate eyelid closure. In addition, careful hygiene is advisable when wearing contact lenses, so that no germ foci can form there; both on the lenses and in the storage boxes. Contact lenses should generally not be worn for too long during the day and should definitely be taken out before sleeping.
Aftercare
In most cases of corneal ulceration, the patient has very few measures and options for direct aftercare. In the first instance, this disease requires immediate treatment to prevent the ulcer from continuing to spread throughout the affected person’s body. The earlier the disease is detected by a doctor, the better the further course of the disease usually is, so that the patient should consult a doctor already at the first symptoms of the disease. Whether this disease leads to a reduced life expectancy cannot generally be predicted. In the worst case, the affected person suffers blindness. If the treatment of the disease is carried out by taking antibiotics, the affected person should pay attention to a regular intake and also to the correct dosage of the medication. It should also be noted that antibiotics should not be taken together with alcohol. Likewise, eye drops should be used regularly. However, in severe cases, surgical intervention is necessary to relieve the symptoms. After such an operation, the region of the eyes should be particularly well protected. The further course depends thereby very strongly on the time of the diagnosis, so that thereby no general prediction can be made.
What you can do yourself
A corneal ulcer can be prevented by various measures of hygiene. However, the patient is always dependent on treatment by a physician to avoid complete vision loss. If the patient is dependent on contact lenses, they should always be disinfected. It is also advisable to take out the contact lenses before sleeping and not to keep them on the eyes. Treatment of corneal ulcer is usually done with the help of eye drops or antibiotics. In this case, the affected person must pay attention to regular intake and possibly renounce other medicines if they would interfere with the effect of the antibiotics. In this case, however, consultation with a physician is advisable. Medications should never be discontinued or changed without consulting a physician. A corneal ulcer can also lead to blindness. In this case, psychological discomfort and depression must be prevented. The help of friends and acquaintances can make the patient’s everyday life much easier and also prevent psychological upsets. Furthermore, conversations with other patients are helpful. Corneal transplantation can prevent blindness in severe cases.
