Corneal Ulcer: Symptoms, Causes, and Treatment

A corneal ulcer is one of the more serious and acute conditions that can affect the eye. Once a patient is diagnosed, the doctor moves quickly to start a treatment plan that can sometimes end with a surgical procedure such as a corneal transplant to save the eye. So if you have this condition — or know someone with the symptoms we'll cover below — read on to understand what a corneal ulcer is, what causes it, what the symptoms look like, how it's treated, and how to protect yourself from it.

First, What Is a Corneal Ulcer?

A corneal ulcer — sometimes called keratitis — is an erosion or open sore on the surface of the cornea, usually triggered by an injury or infection. It's an acute and serious condition: any delay in treatment can leave permanent damage to vision and the eye.

Quick reminder: the cornea is the clear front layer of the eye through which we see. Any erosion, inflammation, or scarring on this layer can cause significant vision problems, especially if treatment is delayed.

Causes of Corneal Ulcer

Corneal ulcers are most often caused by infection:

• Bacterial infection: common in contact lens wearers, especially those who wear lenses for extended periods.
• Viral infection: the same virus that causes cold sores (herpes simplex virus) can attack the cornea after stress, weakened immunity, or sun exposure. The virus that causes chickenpox and shingles (varicella-zoster) can also cause corneal ulcers.
• Fungal infection: improper contact lens use or steroid eye drops can lead to fungal infection, which in turn can cause a corneal ulcer. Plant matter entering the eye can also trigger fungal keratitis.
• Parasitic infection (Acanthamoeba): a microscopic single-celled amoeba commonly found in fresh water and soil. When it enters the eye it can cause a severe infection — particularly in contact lens users. As you can see, improper contact lens hygiene is one of the biggest risk factors for serious corneal infection. But infection isn't the only cause:
• Dry eye disease: if the eyelids don't blink and lubricate the surface properly, the cornea dries out and an ulcer can develop.
• Vitamin A deficiency.
• Scars or burns from a corneal injury: scratches and lacerations can become infected and lead to ulceration. These injuries often come from fingernails, paper cuts, makeup brushes, and similar everyday objects.
• Poor blood flow to the eye area, which can result from systemic conditions such as diabetes.

Symptoms of Corneal Ulcer

Now that we've covered the causes, here are the most common symptoms:

• Eye redness.
• Severe eye pain and a foreign-body sensation.
• Pus or unusual discharge from the eye.
• Blurred vision and severe light sensitivity.
• Eyelid swelling.
• A feeling of white spots or scarring in the eye that you may not be able to see in a mirror.
• Itching or burning.
• General eye discomfort.

Treatment Options for Corneal Ulcer

1. Medication: the treating physician will prescribe medication based on the underlying cause — typically eye drops, antibiotics, antivirals, or antifungals depending on the case. Pain relievers are often added to control the discomfort.

2. Surgery: if medication isn't enough or the ulcer is severe, you may need a corneal transplant. The damaged cornea is removed and replaced with healthy donor tissue. This requires a specialist surgeon and the right type of corneal transplant for your case.

Best Cornea Specialists in Egypt

Dr. Ahmed Shaarawy is a lecturer and consultant in cornea and refractive surgery at the Research Institute of Ophthalmology, with a PhD and a fellowship in cornea surgery from the Devers Eye Institute in Oregon, USA — where he trained under leading American cornea surgeons. He was the first surgeon in Egypt to perform S-stamp DMEK (endothelial keratoplasty), and has helped train many physicians in this technique through international and regional conferences. Dr. Shaarawy is recognized as one of Egypt's leading ophthalmologists, known for his outcomes and his use of the latest cornea surgery techniques. He has also published a novel approach to lamellar keratoplasty for cases where the standard technique was previously impractical.

Who Is at Higher Risk of Corneal Ulcer?

You are at higher risk if you are:

– A contact lens wearer.

– Someone with a history of cold sores, chickenpox, or the other infections mentioned above.

– Using steroid eye drops.

– Living with dry eye disease.

– Living with eyelid disorders that prevent the lids from closing properly.

How to Protect Your Eyes From Corneal Ulcer

• Always use the necessary eye protection during activities that require it.
• Follow your doctor's instructions on contact lens wear and care to the letter.
• Avoid wearing contact lenses for extended periods.
• Don't sleep in your contact lenses.
• See a doctor immediately if you notice any change in your eye or after any eye injury.

Finally, your eyes are your most precious asset — don't hesitate to consult a specialist whenever something feels off.