Corneal Ulcer

Question 1

What is a corneal ulcer?

Answer 1

Local necrosis of corneal tissue due to infection (usually bacterial), secondary to abrasion / foreign body / contact lens use.

Question 2

What are corneal ulcers associated with?

Answer 2

• Eye trauma (e.g. abrasion)
• conjunctivitis
• Blepharitis
• Keratitis
• Vitamin A deficiency

Question 3

Symptoms of corneal ulcer?

Answer 3

• Pain
• Photophobia
• Tearing
• Foreign body sensation
• Decreased visual acuity (if central ulcer)

Question 4

Appearance of corneal ulcer?

Answer 4

• Corneal opacity that necroses and forms an excavated ulcer with infiltrative base.
• Overlying corneal epithelial defect; stains w/ fluorescein.

Question 5

Do ulcers discharge?

Answer 5

Yes - they may.
Bacterial = purulent.
Viral = watery.

Question 6

Complications of corneal ulcers?

Answer 6

Decreased vision, corneal perforation, iritis, endophthalmitis.

Question 7

What is the Seidel Test?

Answer 7

Fluorescein drop on the cornea under cobalt blue filter is used to detect penetrating lesions. Any aqueous leakage will change dark orange dye to bright yellow-green at site of wound.

Question 8

Ix in corneal ulcer?

Answer 8

Seidel test

Question 9

Treatment corneal ulcer?

Answer 9

• Urgent opthal referral
• Culture prior to treatment
• Topical ABx q1h
• Treat vigorously!

Question 10

Time course ulcer v abrasion?

Answer 10

Abrasion = acute (instantaneous)
Ulcer = subacute (days).

Question 11

Abrasion v ulcer on slit lamp?

Answer 11

Abrasion appears clear; ulcer appears opaque.