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Corneal Ulcer (Keratitis)

Keratitis is an erosion or open sore on the cornea, the thin clear structure of the eye that refracts light. An ulcer may form if the cornea becomes inflamed as a result of infection or injury.


Symptoms of Corneal Ulcer (Keratitis)

  • Redness
  • Pain
  • Watering
  • Gritty sensation
  • Blurry vision
  • Discharge
  • Burning
  • Itching
  • Light sensitivity


Causes of Corneal Ulcer (Keratitis)

  • Contaminated solution, poor hygiene, excessive use, sleeping with contact lenses on, swimming with contact lenses on Wearing contact lenses for long periods of time reduces the supply of oxygen to the cornea, making it susceptible to infections.
  • Trauma can be caused by a chemical injury, a thermal burn, a bee sting, an animal tail, makeup, or vegetative matter such as a tree branch or sugarcane.
  • Post-surgery – delayed healing, loose sutures
  • Lid deformities include inward or outward turning of the eyelid, misdirected eyelashes that constantly rub against the cornea, and incomplete eye closure.
  • Diabetics and patients with Bell’s palsy have decreased nerve supply to the cornea.
  • Allergic conjunctivitis
  • Vitamin A deficiency
  • Prolonged use of eye drops – corticosteroids
  • Diabetes mellitus, thyroid disorder, vitamin A deficiency, rheumatoid arthritis, Sjogren syndrome, Stevens-Johnson syndrome, and other medical conditions can cause severe dry eyes.


Risk factors of corneal ulcer (keratitis)

  • Injury or chemical burns
  • Eyelid disorders that prevent proper functioning of the eyelid
  • Dry eyes
  • Contact lens wearers
  • people who have or have had cold sores, chicken pox or shingles
  • Abuse of steroid eye drops
  • Diabetics


Prevention of Corneal Ulcers (Keratitis)

  • Do not sleep with contact lenses on
  • Do not overuse contact lenses
  • Wash your hands before putting the lenses
  • Advised to use daily disposable lenses
  • Do not use tap water as lens solution
  • While riding a bike, wear eye protection or visor to prevent foreign bodies from entering the eye.
  • Do not rub your eye
  • Proper instillation of eyedrops. The nozzle of the eye drop bottle should not touch the eye or the finger
  • Use artificial tears in case of dry eyes
  • Wear protective eyewear when working with wood or metals, especially when using a grinding wheel, hammering on metal, or welding.
  • Do not use over-the-counter eye drops


Types of corneal ulcer (keratitis)

  • Bacterial – untreated fingernail scratches or abrasions, paper cuts, and makeup brushes over the cornea can lead to an ulcer. Extensive wear contact lens wearers are prone to this condition.
  • Fungal – injury to the cornea from any vegetative matter or improper use of steroid eye drops
  • Viral – the virus that causes chickenpox and shingles can cause ulcers too
  • Parasitic – infection caused by fresh water, soil, or long-term contact lens use


Diagnosis of keratitis of the cornea

Slit lamp microscopy is used to examine the ulcer for size, shape, margins, sensation, depth, inflammatory reaction, hypopyon, and the presence of any foreign body. To enhance the features of the ulcera and check for any leaks, a fluorescein dye is used to stain it.

Debridement of the ulcer is required for microbiological evaluation in order to identify the causative organism. After inserting an anesthetic drop into the eye, the margins and base of the ulcer are scraped with a sterile disposable blade or needle. These samples are stained and cultured in order to identify and isolate the organism. Scraping the ulcer also aids in the absorption of the eyedrops.

If the patient wears contact lenses, the lenses will be microbiologically evaluated. Blood sugar levels will be tested at random. If the sugars are not under control, a diabetologist is consulted because this affects corneal wound healing. A gentle ultrasonography of the affected eye is performed to look for any posterior segment pathology.


Treatment for Corneal Ulcer (Keratitis):

Treatment will begin based on the laboratory results. Depending on the causative agent, antibiotics, antifungals, or antivirals are first administered as tablets or eye drops. In cases of large or severe corneal ulcers (keratitis), fortified eye drops made from injectable preparations are used. This is accompanied by pain relievers, cycloplegic eye drops, anti-glaucoma eye drops, and artificial tears. The frequency varies according to the size of the ulcer. In cases of fungal corneal ulcer, corticosteroids are strictly prohibited (keratitis). However, in other types of ulcers, they can be considered at a later stage with extreme caution and supervision.

In the case of a small perforation, tissue adhesive glue is applied over the perforation under sterile conditions, followed by a bandage contact lens to seal the perforation. Bandage contact lenses are also used to improve healing in cases of recurring epithelial erosions. Patients with deformed eyelids that cause ulcers require corrective surgery. If the corneal ulcer (keratitis) is caused by an inward-growing eyelash, the offending lash and its root should be removed. If it grows back abnormally, the root may have to be destroyed with a low-voltage electrical current. In cases of improper or incomplete lid closure, a surgical fusion of the upper and lower lids is performed. Patch grafts are also used to treat small perforations, which involve anchoring a full thickness or partial thickness graft from the donor cornea over the perforated site.

Surgical intervention is required for ulcers that do not heal. Under sterile conditions, an amniotic membrane graft is placed on the cornea to build thickness and establish healing. In the case of a larger perforation or severe scarring, corneal transplant surgery is performed, which involves surgically removing the diseased corneal tissue and replacing it with healthy donor tissue.

If you;

  • Notice decrease in vision
  • Redness and foreign body sensation
  • Discharge
  • White spot forming in front of the eye, Kindly

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We're an eye specialist hospital dedicated to providing the best care for you and your eyes. At Accra Specialist Eye Hospital, we are committed to delivering accessible and comprehensive eye care, to the highest possible standards. Our Expertise & Services Offered are Laser Eye Surgeries, Micro Incision Cataract, Surgery (Phaco), Retina Surgeries, Phaco (Cataract), Gluacoma Surgeries, Cornea Surgeru - Transplant , Oculoplastic Surgery and Child Eye Care Services. We're located at Tantra Hill - Accra.