Q: I am a contact lens wearer, and I developed keratitis and then a corneal ulcer. Is this common? A: The cornea is the transparent area in the front of the eye that covers the pupil (the black part that allows light into the eye) and the iris (the colored part), and consists of five layers.
Q: I am a contact lens wearer, and I developed keratitis and then a corneal ulcer. Is this common?
A: The cornea is the transparent area in the front of the eye that covers the pupil (the black part that allows light into the eye) and the iris (the colored part), and consists of five layers.
A corneal abrasion is a scrape of the top layer, the epithelium, but does not go through the deeper Bowman’s layer underneath the epithelium. A corneal ulcer is an open sore/erosion (from inflammation or infection) that goes through Bowman’s layer into the deeper layers of the cornea.
Both corneal abrasions and corneal ulcers may manifest as a red and painful eye, sometimes with blurry vision and/or light sensitivity. Patients with corneal ulcers may also have a pus-like discharge from their eye.
Abrasions are from superficial scrapes and are very common, most often coming from a “scratch” of the cornea from a foreign object (for example, from something blowing into the eye or from direct contact or putting in or taking out contact lenses).
Corneal ulcers can be from deeper “gouges,” but most often are from invasion/infection by bacteria or another pathogen (fungus for example) of a more superficial injury. They can also develop in a previously intact cornea as a complication of inflammation (such as from keratitis). Vitamin A deficiency has been noted to increase the incidence of corneal ulcers. Corneal ulcers occur in about 25,000 Americans each year.
Keratitis is an inflammation of the cornea that typically manifests as pain and often vision changes. It is fairly common, particularly in extended soft contact lens wearers in whom it affects one to two per thousand per year.
There are many causes of keratitis, including autoimmune diseases (such as rheumatoid arthritis), overly dry eyes (for example from conditions that do not allow the eye to completely close such as certain strokes or Bell’s Palsy), severe exposure to ultraviolet light (sometimes called “welder’s eye”), other eye injuries and many types of infections.
The infections that may cause keratitis include viruses (for example species of herpes virus), bacteria (such as Staphyloccus species and, especially for contact lens wearers, Pseudomonas species), fungi (which can sometimes come from contaminated contact lenses or cleaning solutions), or even certain parasites (for example certain amoebic infections and in Africa even “river blindness” from Onchocerca).
Corneal abrasions, ulcers and keratitis are suspected based on the patient’s history and are diagnosed based on physical exam, usually using a slit lamp (basically a specialized telescope to better visualize the eye) and fluorescein (a “dye” that collects in any non-smooth part of the cornea allowing better visualization of scrapes, gouges, etc.).
Antibiotic eye drops are usually prescribed for corneal abrasions (typically to prevent an infection), corneal ulcers (often to treat a suspected infection) and, depending on the suspected cause, keratitis; the types of antibiotics required are different depending on the indication and the suspected cause.
Prior to starting antibiotic therapy, a corneal ulcer and keratitis will usually have a culture sent (not typically indicated for a corneal abrasion). Severe cases may require hospitalization and intravenous antibiotics, and in very severe cases might even require surgery and a corneal transplant.
Possible vision-threatening complications of corneal ulcers and/or keratitis include erosion into the eye (possibly leading to perforation with possible spread of infection inside the eye) and scarring. Therefore, evaluation and very close follow-up by a specialist is indicated.
Corneal abrasions usually heal within several days and with no loss of vision. Most promptly diagnosed and appropriately treated cases of corneal ulcers and/or keratitis also heal well.
If you develop eye pain, redness and/or visions changes, you should be seen immediately. Early treatment, especially for corneal ulcers and keratitis, can possibly save your vision.
Jeff Hersh, Ph.D., M.D., can be reached at DrHersh@juno.com.