Corneal ulcer (Guidelines)

Causes:

1. Bacterial
2. Viral (Herpes simplex)
3. Others (rare) - Fungal, Acanthamoeba

Risk factors:

• Contact lens use
• Blepharitis (sticky eyelashes, red eyelids)
• Severe dry eye, especially elderly
• Previous Herpes simplex virus of eye or skin

Symptoms

• Red eye
• Watery eye
• Pain – strong foreign body sensation or more severe constant pain
• Photophobia - pain in bright light
• Reduced vision

Signs:

• Use Proxymetacaine local anaesthetic drops to reduce pain and allow examination / swabs
• Grey / white opacity in cornea - typically fairly central rather than at very edge of cornea
• Fluoroscein drops - ulcer stains green in blue light
• Red eye maximal around corneal edge
• Hypopyon (white ‘fluid level’ visible against inferior iris)
• Dendritic ulcer (branching linear pattern) indicates Herpes simplex

Management:

• If Herpes simplex dendritic ulcer - Ganciclovir ointment 5 times daily , review Ophthalmology within 72h
• All other corneal ulcers - treat as bacterial keratitis:
  1. Conjunctival swab for C&S
  2. Corneal swab from ulcer for C&S
  3. Admit to NTC Ophthalmology, side room
  4. Ofloxacin drops hourly day and night
  5. Cyclopentolate 1% drops three times a day
  6. Arrange for follow up with Ophthalmology that day or, if out of hours, the following day.