What Is a Corneal Ulcer? 

A corneal ulcer is an open sore or wound on the cornea — the transparent, dome-shaped surface that covers the front of the eye and focuses light into it. Often beginning as keratitis (inflammation of the cornea) from an eye infection, injury, or other cause, corneal ulcers are considered a medical emergency that can lead to vision loss if left untreated. In the United States, there are an estimated 30,000 to 75,000 yearly cases of corneal ulcers. Each year, keratitis, the precursor to corneal ulcers, accounts for about one million clinic and emergency department visits.e60dc2a1-f33c-4a05-9b50-8e3e8e597629e47c25fd-eb1e-4382-8fea-0260fd14cf55
Types of Corneal Ulcers Types There are two broad categories of corneal ulcers: infectious and noninfectious.e60dc2a1-f33c-4a05-9b50-8e3e8e59762928907fa2-415d-4faf-8fe9-7f8c2cecb987 Infectious corneal ulcers can be further divided by their specific cause: Bacteria Viruses Fungi Parasites Noninfectious corneal ulcers include those caused by: Autoimmune disorders and inflammatory diseasese60dc2a1-f33c-4a05-9b50-8e3e8e59762962dfa818-5237-4fbb-9fcb-38a844bba823 Very dry eyes Corneal injury Eyelid disorders Allergies Toxins Degenerative eye diseasee60dc2a1-f33c-4a05-9b50-8e3e8e597629f4c97cdb-b706-40c4-8d25-bc95af5fcc78 Nutritional deficienciese60dc2a1-f33c-4a05-9b50-8e3e8e5976293dc6468b-def9-4a63-a5a9-94288891d50b
Signs and Symptoms of Corneal Ulcers Symptoms Common signs and symptoms of corneal ulcers include: Significant eye pain Eye redness Foreign body sensations (as if something is in the eye) Excessive tearing Photophobia (light sensitivity) Blurred or decreased vision White or grayish spot on the cornea Pus or discharge from the eyee60dc2a1-f33c-4a05-9b50-8e3e8e597629ba0e0026-2d67-4491-a949-8f7ad31d6980 Eyelid swelling Itchy eyese60dc2a1-f33c-4a05-9b50-8e3e8e5976299c3d2997-9202-4838-bcf7-13b420c40ea7
Causes and Risk Factors of Corneal Ulcers Causes Contact lens use is the biggest risk factor for corneal ulcers, especially the infectious types.e60dc2a1-f33c-4a05-9b50-8e3e8e597629a3dcd789-47c4-4719-a7c4-230a338ba069 Your risk increases if you: Wear contacts to bed Wear soft contacts that have expired Wear disposable contacts longer than recommended Don’t properly clean and store contacts, particularly if you use tap water to clean them instead of contact lens solution Use contaminated lenses (by not washing your hands before putting them in, for example) or lens solutions Various other conditions can also increase your risk of corneal ulcers, including: Malnourishment Diabetes Alcohol or drug addiction Cancer AIDS Weakened or suppressed immune system Previous eye or eyelid surgery Irregular or prolonged use of corticosteroids Work in agriculture Infectious Corneal Ulcer Causes Bacteria Many species of bacteria can cause corneal ulcers, sometimes called bacterial keratitis. The most common of these are:e60dc2a1-f33c-4a05-9b50-8e3e8e5976296be7e282-4418-4823-9b22-80565b0cac95 Staphylococcus aureus Coagulase-negative staphylococcus P seudomonas aeruginosa Staphylococcus epidermidis and Staphylococcus fusarium (dual infection)e60dc2a1-f33c-4a05-9b50-8e3e8e59762942297c7c-28e0-4ac1-9541-8e732f8ca742 Staphylococcus pyogenes Staphylococcus pneumoniae Viruses Herpes simplex virus, which causes cold sores , is the most common cause of viral corneal ulcers, or viral keratitis. After initially infecting a person, the virus will live in a dormant state until triggered by external factors like stress, sunlight, and immune suppression.e60dc2a1-f33c-4a05-9b50-8e3e8e5976291d9392bc-02ab-4d83-bb72-3c08cc19474b Herpes zoster, the virus behind chicken pox and shingles , can also cause corneal ulcers. Fungi The fungi that most commonly cause fungal corneal ulcers include: Aspergillus Fusarium Scedosporium apiospermum Candida albicans and other candida species Fungal keratitis is more common in warmer, humid parts of the United States and world, and it usually develops after eye trauma or getting plant material in your eye (people who work in agriculture or landscaping have an increased risk). Fusarium keratitis is usually associated with contact lens use.e60dc2a1-f33c-4a05-9b50-8e3e8e5976298f663fb3-5631-44cb-a0b2-3ecea0eb6074 Parasites The amoeba Acanthamoeba can cause parasitic corneal ulcers, primarily in people who use contact lenses. They’re most commonly found in freshwater habitats and soil, but you can also be exposed to them through tap water, swimming pools, and hot tubs. The parasitic, fungus-like organism Pythium insidiosum can cause severe corneal ulcers that closely resemble fungal keratitis. It’s usually found in aquatic habitats in tropical, subtropical, and temperate regions and most often affects males, especially those who work in fields.e60dc2a1-f33c-4a05-9b50-8e3e8e5976294393868e-6b5d-4348-ae83-a5dad204a082 Noninfectious Corneal Ulcer Causes There are numerous causes of noninfectious corneal ulcers, including: Dry eye disease Eyelid conditions like chronic blepharitis (eyelid inflammation), ectropion (eyelid inversion), trichiasis (eyelash misalignment), and Bell’s palsy (nerve problem that can prevent the eyelid from closing completely)e60dc2a1-f33c-4a05-9b50-8e3e8e59762929ba9d28-b1f7-4edc-9021-655ad1d5c62ee60dc2a1-f33c-4a05-9b50-8e3e8e597629227e86cb-6765-4390-9c25-8bd2618f90d1 Autoimmune or inflammatory diseases like rheumatoid arthritis and Sjögren’s syndrome e60dc2a1-f33c-4a05-9b50-8e3e8e5976290b3239e5-8e6d-48e0-a670-40d22c252993 Vitamin A deficiency Protein deficiency Corneal injury from abrasions (scratches, scrapes, and cuts) and burns from corrosive chemicals Neurotrophic keratitis, or keratopathy, a degenerative disease of the corneae60dc2a1-f33c-4a05-9b50-8e3e8e597629b1debef0-8702-44fb-a062-85e0608d1fe1 Severe allergic eye diseasee60dc2a1-f33c-4a05-9b50-8e3e8e597629d086e28a-fc8a-4add-8a83-49b6bb0bd8f7
How Are Corneal Ulcers Diagnosed? Diagnosis Diagnosis of corneal ulcers begins with your ophthalmologist (eye specialist) asking you about your: History and severity of symptoms Contact lens use Prior eye surgery or trauma Lifestyle and occupation to determine your exposure to microorganisms and chemicalse60dc2a1-f33c-4a05-9b50-8e3e8e5976299d8a0ad1-43dd-49a2-baff-900d60066fd3 Use of immunosuppressant medications History of systemic diseases like diabetes and rheumatoid arthritise60dc2a1-f33c-4a05-9b50-8e3e8e597629fea351a9-d273-4974-ae0d-9fd127d99331 Your provider will then conduct a thorough examination of your eyelids and eyes, looking for issues like eyelid inversion, inflammation (indicative of uncontrolled autoimmune disease), and corneal injury. Specific tests include: Visual acuity testse60dc2a1-f33c-4a05-9b50-8e3e8e597629fea351a9-d273-4974-ae0d-9fd127d99331 Fluorescein dye stain and slit lamp examination, which uses a special dye and microscope to reveal any abrasions, debris, or ulcers on your corneae60dc2a1-f33c-4a05-9b50-8e3e8e5976299e9082ad-b2da-4746-b030-70434f267533 Microbial cultures of corneal scrapingse60dc2a1-f33c-4a05-9b50-8e3e8e597629d922ef00-4253-49b5-9713-ef3db6ef8729 Confocal microscopy, an imaging technique that can reveal organisms like fungi and Acanthamoeba in different layers the corneae60dc2a1-f33c-4a05-9b50-8e3e8e5976292175a0d2-7636-423e-b352-29ba73aa507c
Treatment and Medication Options for Corneal Ulcers Treatment The specific treatment for a corneal ulcer depends on its underlying cause.e60dc2a1-f33c-4a05-9b50-8e3e8e5976294ac62b1c-8b19-4f4c-9a24-1876661495f3 Bacterial corneal ulcers are treated with frequent doses of one or more broad-spectrum antibiotic eye drops called fluoroquinolones. Because most corneal ulcers are bacterial, corneal ulcer treatment usually begins with these antibiotics even if the exact cause is unknown: Moxifloxacin Gatifloxacine60dc2a1-f33c-4a05-9b50-8e3e8e59762916c400df-afad-4037-a816-1da04235a078 Besifloxacine60dc2a1-f33c-4a05-9b50-8e3e8e5976297673ed86-dbaa-4f33-b3bc-78b5714c7024 Vancomycin Tobramycin Cefazolin Ceftazidime Gentamicine60dc2a1-f33c-4a05-9b50-8e3e8e597629fcdd56c3-c598-4109-8c5e-6ceb5d0bbeec Viral corneal ulcers are treated with antiviral medications such as trifluridine drops, ganciclovir gel, and oral valacyclovir or acyclovir, while fungal corneal ulcers are treated with antifungal medications such as natamycin, amphotericin B, and voriconazole. Acanthamoeba keratitis is treated with antiamoebic drops including: Propamidine Neomycin Polyhexamethylene biguanide Chlorhexidine Pythium keratitis is mainly treated with various antibacterial medications, the most common of which are linezolid and azithromycin.e60dc2a1-f33c-4a05-9b50-8e3e8e59762991dad58d-1414-4817-bb9f-2e7d5fc1462d For noninfectious corneal ulcers, treatment focuses on correcting the underlying cause — such as using immunosuppressant drugs for autoimmune diseases — and managing the ulcer with supportive antibiotics or lubricating ointments. If your ulcer is sterile (there’s no infection present), your provider may also prescribe you steroid eye drops to help with:e60dc2a1-f33c-4a05-9b50-8e3e8e59762957c9ea80-ab13-439a-a038-bc11470796e5 Wound healing Scar prevention Pain Light sensitivity But steroids are generally only recommended if you need to return to normal functioning quickly, such as if you need to get back to work or drive.e60dc2a1-f33c-4a05-9b50-8e3e8e59762916c400df-afad-4037-a816-1da04235a078 Other options that can help your wound heal include specialty contact lenses like scleral lenses and bandage contact lenses, and tarsorrhaphy, a procedure that temporarily sutures your eye closed.e60dc2a1-f33c-4a05-9b50-8e3e8e597629050644bd-5034-4a2c-a87e-a19818cd332b If you don’t respond to any of these treatments or the ulcer has left a perforation (hole) in your cornea, you may need a corneal transplant.e60dc2a1-f33c-4a05-9b50-8e3e8e5976292355ebd7-41d6-4125-b50d-371b3ca98c74
Prevention of Corneal Ulcers Prevention Some habits that can prevent corneal ulcers include: Good contact lens hygiene: Use lenses as recommended (clean them with lens solution, never sleep with them in, replace them as necessary). Wash your hands before touching your contact lenses or eyes. Use protective eyewear during high-risk activities. Treat dry eye and eyelid disorders promptly. Manage autoimmune and other chronic diseases.
Lifestyle Changes for Corneal Ulcers Lifestyle Changes If you’re recovering from a corneal ulcer, make sure to wear an eye shield or protective lenses to prevent accidental trauma, and take pain medications, as recommended.e60dc2a1-f33c-4a05-9b50-8e3e8e59762959c1c367-75a2-42ef-a298-9806f411563d Also avoid: Eye makeup Contact lenses Touching or rubbing your eyes Swimming Strenuous activities that may injure your eyes or expose them to dirt, dust, or other irritantse60dc2a1-f33c-4a05-9b50-8e3e8e59762994129e9c-f854-4b0f-b156-bca714d2a836 Seek immediate care if you experience worsening symptoms, such as increased eye pain and redness, sensitivity to light, and decreased vision.
Corneal Ulcer Prognosis Prognosis and Outlook How quickly and how well your corneal ulcer heals varies widely depending on: The cause, size, severity, and location of the ulcer How well you respond to the treatment Your overall eye health, immune status, and socioeconomic status Complicationse60dc2a1-f33c-4a05-9b50-8e3e8e597629a7d802e2-7a69-4881-9ba0-15a09d2e1e50 But most people recover successfully with treatment with only a minor change in vision.e60dc2a1-f33c-4a05-9b50-8e3e8e5976291d169837-fe36-4f5b-8021-0e095385ca92
Complications of Corneal Ulcers Complications Left untreated, corneal ulcers can lead to:e60dc2a1-f33c-4a05-9b50-8e3e8e59762904fe291f-3f8f-47b0-9e77-c4227d3e99b8 Permanent corneal scarring Corneal perforation Vision loss or blindness Glaucoma Cataracts Irregular astigmatism Serious eye inflammation
Research and Statistics: Who Gets Corneal Ulcers? Research and Statistics Corneal ulcers are most common in people who wear contact lenses, especially extended-wear lenses. They are much more common in developed regions like the United States and Europe, because these places have higher rates of contact lens use.e60dc2a1-f33c-4a05-9b50-8e3e8e597629b9d2005a-e105-412d-8ec7-fc2638d38076 One study in California found that nearly 8 in 100,000 people were diagnosed with corneal ulcers in emergency departments each year. They were more common in people who were:e60dc2a1-f33c-4a05-9b50-8e3e8e5976290ae05023-05d7-460f-b201-30f12894d664 Male Black Primarily English speaking Age 20 to 60 years
Related Conditions of Corneal Ulcers Related Conditions Many conditions can cause red, painful eyes similar to corneal ulcers, including:e60dc2a1-f33c-4a05-9b50-8e3e8e597629c13e7cc8-e139-4ba5-98d3-a9ceab283854 Conjunctivitis (pink eye) Iritis (iris inflammation) Chemical burns Foreign bodies Corneal abrasions Dry eye syndrome The Takeaway Corneal ulcers can develop quickly and lead to serious, lasting consequences, including vision loss. They’re also highly treatable with medications when caught early. To prevent corneal ulcers, protect your eyes, practice good contact lens hygiene, and promptly treat or manage any chronic conditions you may have.
Resources We Trust Mayo Clinic: Cornea TransplantCleveland Clinic: Corneal DiseaseAmerican Academy of Ophthalmology: What Is a Corneal Ulcer (Keratitis)?MedlinePlus: Corneal Ulcers and InfectionsMSD Manual: Corneal Ulcer

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