A corneal ulcer is a lesion or sore on the cornea, which is the clear dome that covers the pigmented part of your eye (iris).

Causes

In most cases, corneal ulcers occur as the result of an eye infection. The types of eye infections that may lead to corneal ulcers include the following:

• Bacterial infections (may be more common in soft contact lens wearers)
• Viral infections, such as herpes simplex (the virus that causes cold sores) and varicella (the virus that causes shingles and chickenpox)
• Fungal infections, which may occur as a result of improper contact lens care or overuse of steroid eye drops

Corneal ulcers may also be caused by direct trauma to the eye, such as scratches, which may cause tiny tears in the cornea, making it easier for bacteria to invade. Eyelid disorders that prevent the eye from closing completely, such as Bell’s palsy, may cause dryness of the cornea, which can make your eye more susceptible to ulcers.

Contact lens-related ulcers

Because dryness or injury of the cornea can potentially lead to corneal ulcers, contact lens wearers may be at increased risk of developing corneal ulcers. People who use extended wear contact lenses (those worn overnight) are 10 times more likely to develop this condition. The following are some ways in which contact lenses can contribute to corneal ulcers: scratches on the lens that may tear the cornea; particles of bacteria trapped beneath the lens; bacteria on the lens from improper cleaning methods; and restriction of oxygen to the cornea due to extended contact lens wear.

Symptoms

The symptoms of a corneal ulcer include pain in the eye, redness, foreign body sensation (the feeling that something is in your eye), tearing, pus or discharge, blurred vision, discomfort or pain when looking at bright lights, and swelling of the eyelids. In addition, if the ulcer is large, it may be visible and may appear as a white or gray round spot. If you notice a change in your vision, severe pain, or obvious discharge coming from your eye, you should see your ophthalmologist.

Treatment

If you wear contact lenses, your doctor will most likely have you remove them immediately. Because corneal ulcers are often associated with infection, your ophthalmologist will probably prescribe antibiotic eye drops. Depending on the size of the infection, you may need to administer these drops as often as once an hour. The doctor may also prescribe oral pain medications, or possibly eye drops that can control the pain. Antibiotic, antifungal or antiviral drops may also be prescribed, depending on the source of your corneal ulcer and infection. Very severe ulcers and those that do not respond to medications may require corneal transplant surgery.

At Home Regimen

There are also things you can do at home to help a corneal ulcer to heal more quickly. Applying cool compresses to your eyes may relieve discomfort and reduce inflammation. You can also take over-the-counter pain medications such as ibuprofen and acetaminophen. It is important to remember that during this time, you should wash your hands often and not touch the affected eye with your fingers. You should refrain from wearing contact lenses until your doctor says it is appropriate to do so, and you should contact your ophthalmologist if your symptoms get worse.

Prevention

Prevention of corneal ulcers is preferable to any treatment, and there are several things you can do in the way of prevention, particularly if you are a contact lens wearer. The following are some steps contact lens wearers can take to ensure a healthy cornea:

• Carefully clean your lenses, and do not use tap water or saliva in any part of your cleaning, storage or lubrication regimen
• Clean your contact lens case on a regular basis, and replenish it with fresh lens solution rather than “topping off” a partially filled case
• Store your lenses in disinfecting solution overnight
• Do not sleep in your lenses

Although there are several lenses currently approved for wear overnight, these lenses may not be advisable for those with a tendency to develop corneal ulcers. Your doctor will advise you on future contact lens options.

In addition, if you tend to have dry eyes or any eyelid condition, use artificial tears to keep your cornea lubricated.