A corneal ulcer is an open sore of the cornea with infection or inflammation, usually caused by bacteria and strongly linked to contact lens wear, injury or a damaged eye surface. It is an eye emergency because it can perforate the cornea or leave a scar that permanently blurs vision.
Key symptoms
- Eye pain and redness
- Blurred or reduced vision
- Sensitivity to light
- Discharge and tearing
- Feeling of something in the eye
What you find on exam
- Visual acuity
- White or gray infiltrate on the cornea with an overlying defect that stains with fluorescein
- Ciliary flush and eyelid swelling
- Hypopyon in the anterior chamber in severe cases
- Look for causes: lens wear, eyelid problems, dry eye, poor lid closure
Tests
- Corneal scraping for Gram stain and culture before starting drops when possible
- Fungal and Acanthamoeba cultures after plant injury or water exposure
- Herpes testing if a branching (dendritic) pattern is seen
Treatment basics
- Same-day ophthalmology referral
- Intensive antibiotic drops: moxifloxacin, or fortified vancomycin and tobramycin for severe ulcers
- Cycloplegic drops such as cyclopentolate for pain
- Stop contact lenses, no patching
- Steroid drops only by the ophthalmologist after infection is controlled
Red flags
- Thinning cornea or leaking fluid (positive Seidel test)
- Hypopyon or a fast-spreading infiltrate
- Worsening despite 24 to 48 hours of treatment
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Related guides
Sources: NCCPA PANCE Content Blueprint; NBOME COMLEX-USA clinical presentations; AAMC Core Entrustable Professional Activities (Core EPAs). Written by Making Synapses. Making Synapses is not affiliated with these organizations.