Corneal ulcers are open sores on the cornea, the clear front surface of the eye, usually caused by infections, trauma, or underlying eye conditions. Treating corneal ulcers effectively requires a combination of approaches tailored to the cause, severity, and progression of the ulcer.
The primary treatment for corneal ulcers involves **medicated eye drops** to combat infection and promote healing. These include:
– **Antibiotic eye drops** for bacterial ulcers, often fortified with strong antibiotics like vancomycin or tobramycin in severe cases to cover resistant bacteria.
– **Antiviral eye drops or oral medications** for viral ulcers, especially those caused by herpes simplex virus.
– **Antifungal eye drops** for fungal ulcers, which require prolonged treatment due to the stubborn nature of fungal infections.
– **Anti-amoebic agents** such as biguanides and diamidines for amoebic keratitis, a rare but serious cause of corneal ulcers.
Pain relief is also important, often managed with oral painkillers and sometimes cycloplegic drops to reduce eye muscle spasms.
When infection is controlled or in cases of non-infectious ulcers, **corticosteroid eye drops** may be used cautiously to reduce inflammation and scarring, but only under strict medical supervision because steroids can worsen infections if used improperly.
If the ulcer is not healing or is worsening despite medical therapy, several additional treatments and interventions may be necessary:
– **Mechanical debridement** involves carefully removing dead or infected tissue from the ulcer to improve medication penetration and reduce microbial load.
– **Bandage contact lenses** can protect the cornea and promote healing in some cases.
– **Nutritional support**, including adequate protein and vitamin C intake, supports collagen synthesis and epithelial repair.
In severe or complicated cases, **surgical options** become important:
– **Corneal gluing** with cyanoacrylate adhesives can temporarily seal small corneal perforations (less than 2 mm) to prevent fluid leakage and maintain eye integrity.
– **Tarsorrhaphy**, a procedure to partially sew the eyelids together, may be used in patients with poor eyelid closure or neurotrophic keratitis to protect the cornea.
– **Corneal transplantation** is reserved for ulcers that cause extensive corneal damage or perforation. Different types of keratoplasty (corneal transplant) include:
– **Penetrating keratoplasty (PK)**, which replaces the full thickness of the cornea.
– **Deep Anterior Lamellar Keratoplasty (DALK)**, which replaces the front layers of the cornea while preserving the healthy inner layers.
– **Descemet’s Stripping Automated Endothelial Keratoplasty (DSAEK)** and **Descemet’s Membrane Endothelial Keratoplasty (DMEK)**, which replace only the diseased endothelial layer, used mainly for endothelial dysfunction but sometimes relevant in ulcer complications.
Emerging therapies are also being explored for difficult-to-heal ulcers, such as:
– **Photodynamic therapy** using riboflavin and ultraviolet-A light to eradicate pathogens and strengthen the corneal stroma.
– **Stem cell therapy** and **gene therapy** to promote regeneration in non-healing ulcers.
– **Anti-tumor necrosis factor (anti-TNF) agents** for autoimmune-related ulcers.
Close and frequent follow-up is critical throughout treatment to monitor healing, adjust medications, and detect complications like corneal perforation, scarring, or infection spread. Hospitalization may be necessary for severe cases requiring intensive treatment and monitoring.
The prognosis depends on factors like the ulcer’s size, depth, location, cause, and the patient’s overall eye health. Early diagnosis and prompt, appropriate treatmen
