A corneal ulcer forms when the surface of the cornea is damaged or compromised.  Ulcers may be sterile (no infecting organisms) or infectious.  The term infiltrate is also commonly used along with ulcer. Infiltrate refers to an immune response causing an accumulation of cells or fluid in an area of the body where they don't normally belong.

Bacterial ulcers may be associated with diseases that compromise the corneal surface, creating a window of opportunity for organisms to infect the cornea.  Patients with severely dry eyes, difficulty blinking, or are unable to care for themselves, are also at risk.  Other causes of ulcers include:  herpes simplex viral infections, inflammatory diseases, corneal abrasions or injuries, and other systemic diseases.

• Red eye 
• Severe pain (not in all cases)
• Tearing
• Discharge 
• White spot on the cornea, that depending on the severity of the ulcer, may not be visible with the naked eye
• Light sensitivity

Treatment

The course of treatment depends on whether the ulcer is sterile or infectious.  Bacterial ulcers require aggressive treatment.  In some cases, antibacterial eye drops are used every 15 minutes.  Steroid medications are avoided in cases of infectious ulcers.  Some patients with severe ulcers may require hospitalization for IV antibiotics and around-the-clock therapy.  Sterile ulcers are typically treated by reducing the eye's inflammatory response with steroid drops, anti-inflammatory drops, and antibiotics.  

Transplanted Cornea	Keratoconus

Detection and Diagnosis

Corneal ulcers are diagnosed with a careful examination using a slit lamp microscope.  Special types of eye drops containing dye such as fluorescein may be instilled to highlight the ulcer, making it easier to detect.  

If an infectious organism is suspected, the doctor may order a culture.  After numbing the eye with topical eye drops, cells are gently scraped from the corneal surface and tested to determine the infecting organism.