A corneal ulcer is an open sore on your cornea, the thin clear layer over your iris (the coloured part of your eye). It's also known as keratitis.

There are various kind of ulcers but they can all have similar symptoms. Most ulcers are very serious and require immediate attention to reduce the risk of permanent sight loss through scarring, or even potentially the need to have a corneal transplant.

Symptoms of a corneal ulcer

A corneal ulcer can cause:

  • Redness
  • Severe pain
  • The feeling that something is in your eye
  • Tears
  • Pus or thick discharge from your eye
  • Blurry vision
  • Pain when looking at bright lights
  • Swollen eyelids
  • A round white spot on your cornea

If you get any of these symptoms you should seek attention, either via a local optometrist/optician or contacting NHS Wales 111

In Wales it is likely that an optometrist will be able to see you for free on the NHS, check with the practice you contact for advice,

Find a local optometrists/opticians

The following symptoms are more urgent

  • Vision changes
  • Severe pain
  • Discharge from your eye

It’s especially important to watch for problems if you’ve scratched your cornea before or if you’ve been around chemicals or small particles like sand, metal, or glass.

Causes of a corneal ulcer

Infections cause most corneal ulcers.

  • Bacterial infections most often caused by types of staphylococcus bacteria such as aureus, epidermidis or pneumonia.  They are commonly associated with contact lens wear, ocular surface disease, lid margin infection, ocular trauma, topical steroid use and in immunocompromised patients.
  • Viral infections such as the herpes simplex virus (which causes cold sores) or the varicella virus (which causes chicken pox and shingles)
  • Fungal infections such as Fusarium, Aspergillus, or Candida, possibly after an injury by something natural like a branch or twig. These infections are rare.  They can also be contact lens related.
  • Parasitic infections with Acanthamoeba, an amoeba found in fresh water and dirt.  These are rare in the general population but more common in contact lens wearers.

Corneal Ulcer Risk Factors

People who wear contact lenses are more likely to get corneal ulcers. This risk is 10 times higher if you use extended-wear (overnight) soft contacts.

Bacteria on the lens or in your cleaning solution could get trapped under the lens. Wearing lenses for long periods can also block oxygen to your cornea, raising the chances of infection.

Scratches on the edge of your contact might scrape your cornea and leave it more open to bacterial infections. Tiny particles of dirt trapped under the contact could also scratch your cornea.

If you think you may have a ulcer and you are a contact lens wearer, immediately remove your lenses and seek advice from your usual optometrist/optician.

Other things that may make you more likely to have a corneal ulcer include:

  • Steroid eye drops
  • Disorders that cause dry eyes
  • Eyelid inflammation (blepharitis)
  • Eyelashes that grow inward
  • Eyelids that turn inward
  • Conditions that affect your eyelid and keep it from closing all the way, like Bell’s palsy
  • Chemical burns or other cornea injuries

Treatment for Corneal Ulcers

How corneal ulcers are treated depends on the cause of the ulcer. If an ulcer is suspected your optometrist/optician is likely to refer you to hospital so they can do a test (a culture) to see what is causing the ulcer. If you are a contact lens wearer, they may ask you to take your contact lenses and the case that you store them in with you to the hospital.

Depending on the cause of your ulcer, you will likely be given antibiotic, antiviral, or antifungal eye drops. You might need to use these as often as once an hour for several days. To treat pain, your doctor may also give you drops to widen (dilate) your pupil.

If you are a contact lens wearer you will be advised when you will be able to start wearing lenses again by your doctor or optometrist.

The information on this page has been adapted by NHS Wales from original content supplied by NHS UK NHS website nhs.uk
Last Updated: 15/11/2021 11:35:25