Various infections can affect the cornea and these infections can often cause corneal ulcers to form on the cornea.

Symptoms

Signs of infection usually present themselves before you’re aware of a corneal ulcer.

Symptoms of an infection include:

• Itchy or watery eyes
• Pus-like discharge from the eye
• Burning or stinging sensation in the eye
• Redness
• Sensitivity to light

Symptoms of corneal ulcers include:

• Eye inflammation
• Excessive tearing
• Blurred vision
• Soreness
• White spot on the cornea
• Swollen eyelids
• Pus or eye discharge
• Sensitivity to light
• The feeling that something is in your eye

Sometimes corneal ulcers are too small to see without magnification, but the symptoms can still be felt. Other times, corneal ulcers are large enough to be seen and look like a gray or white area or spot on the usually transparent cornea. Symptoms of corneal ulcers are severe and should be treated immediately to prevent blindness. 

What Causes Corneal Ulcers?

These infections are among the most common causes of corneal ulcers:

Bacterial infection: This is the most common cause of corneal ulcers. Bacteria can enter the eye following eye injury or trauma and, for contact lens wearers, unhygienic practices like wearing contact lenses longer than advised and not properly sterilizing contact lens storage cases.

Acanthamoeba keratitis: Acanthamoeba microorganisms are commonly found in tap water, swimming pools, hot tubs, and other water sources. This amoebic infection most often occurs in contact lens wearers due to unhygienic practices like using water rather than disinfecting solution to clean contacts and keeping contact lenses in the eye while swimming.

Herpes simplex keratitis (ocular herpes): This is a common viral infection, caused by the same virus that produces cold sores. The infection can cause repeated flare-ups of inflammation and sores in the eye, often due to triggers like stress, sunlight, and a weakened immune system.

Treatment

Your eye doctor will examine the eye to determine the cause of the corneal ulcer and will then prescribe an antibacterial, antifungal, or antiviral eye medication to treat the underlying problem. If the eye is inflamed and swollen, corticosteroid eye drops may also be prescribed.

If the infection is severe enough and does not respond to medicated eye drops, your ophthalmologist may recommend a procedure called corneal collagen cross-linking.

Corneal Collagen Cross-linking (PACK-CXL)

Corneal collagen cross-linking is a procedure that uses a special type of ultraviolet light to stabilize and strengthen the cornea by creating new links between collagen fibers within the cornea. The procedure is used for patients with keratoconus, a disease that causes a weakening of the cornea, but the procedure also effectively destroys harmful pathogens in the eye, including bacteria and viruses.

During a corneal cross-linking procedure, your ophthalmologist will first apply riboflavin (vitamin B-12) eye drops and then shine a specific type of ultraviolet light directly onto your cornea. The procedure causes new corneal collagen cross-links to develop, leading to a stiffer, stronger cornea.

Corneal cross-linking is an outpatient procedure that typically lasts about an hour. Patients typically do not experience any discomfort during the procedure thanks to mild sedation and numbing anesthetic drops applied to the eyes.

Prevention

The best way to prevent corneal ulcers is to seek treatment as soon as you develop any symptom of an eye infection or as soon as your eye is injured.

Other preventive measures include:

• Taking contact lenses out before sleeping
• Cleaning and sterilizing contacts before and after wearing them
• Rinsing your eyes to remove any foreign objects
• Washing your hands before touching your eyes