Corneal Ulcer (Keratitis) Treatment in Delhi, India

A corneal ulcer, also known as keratitis, is an open sore on the cornea—the transparent layer that covers the front of the eye. It typically occurs due to infections, injuries, or underlying eye conditions, leading to redness, pain, and vision problems. If untreated, a corneal ulcer can result in severe complications, including vision loss. Early diagnosis and treatment are crucial for preventing permanent damage.

Infectious Corneal Ulcers

These ulcers are caused by infections, including bacteria, viruses, fungi, or parasites, and are the most common type. They often develop due to trauma or conditions like improper contact lens use. Causes include:

• Bacterial Infection: Often linked to trauma or poor contact lens hygiene, bacterial ulcers can result from common pathogens such as Staphylococcus or Pseudomonas.
• Viral Infection: The herpes simplex virus (HSV), which can cause cold sores, is a major cause of viral corneal ulcers. These ulcers may recur.
• Fungal Infection: Fungi, particularly in cases involving eye injuries with plant matter or soil, can lead to fungal ulcers.
• Parasitic Infection: Acanthamoeba is a parasite that can infect the cornea, especially in individuals with contact lens-related issues.
• Improper Contact Lens Use: Wearing contact lenses for too long, not cleaning them properly, or wearing them while swimming can increase the risk of infection leading to corneal ulcers.

Non-Infectious Corneal Ulcers

These ulcers are not caused by infections but can result from other factors that affect the cornea. Causes include:

• Trauma or Injury: Any injury, like a scratch to the cornea, can result in an ulcer due to damage to the protective surface.
• Corneal Dryness or Inflammation: Conditions like dry eye syndrome or inflammation can lead to non-infectious ulcers.
• Foreign Body in the Eye: Any foreign object that irritates the cornea can cause an ulcer if it remains lodged in the eye.
• Ultraviolet (UV) Light Exposure: Excessive exposure to UV rays, such as from the sun or welding, can damage the cornea and lead to ulcers.
• Allergic Reactions: Allergies, particularly those affecting the eyes, can cause inflammation and lead to ulcer formation.
• Improper Contact Lens Use: As with infectious ulcers, poor contact lens hygiene or wearing lenses too long can also lead to non-infectious ulcers.

Certain factors increase the likelihood of developing a corneal ulcer. These include:

• Contact Lens Use: Wearing lenses for extended periods, especially overnight, raises the risk of infection.
• Eye Trauma: Injuries caused by foreign objects, scratches, or chemical exposure can lead to ulcers.
• Compromised Immunity: Conditions like diabetes or use of immunosuppressive medications can increase susceptibility.
• Previous Eye Infections: A history of herpes simplex virus or fungal infections may predispose an individual.
• Dry Eye Syndrome: Reduced tear production can weaken the cornea, making it prone to ulcers.
• Exposure to Contaminated Water: Swimming or washing your face with unclean water can introduce harmful microorganisms.

A corneal ulcer often presents with noticeable and uncomfortable symptoms, including:

Eye Redness

Persistent redness in the eye is often an early sign of a corneal ulcer. This redness occurs when the blood vessels in the eye become dilated due to inflammation or infection.

Severe Eye Pain

Sharp or intense pain, especially when moving the eye, can signal a corneal ulcer. This discomfort tends to worsen over time and may become debilitating.

Blurred Vision

As the ulcer damages the cornea, it may lead to blurry or cloudy vision, affecting clarity and visual function.

Light Sensitivity

Known as photophobia, increased sensitivity to bright lights occurs when the cornea becomes inflamed or injured, making it painful to look at light sources.

Watery Eyes or Discharge

Excessive tearing or a yellowish discharge is commonly seen with eye infections, including corneal ulcers, and is a way the eye attempts to flush out harmful substances.

Foreign Body Sensation

A feeling as though something is stuck in the eye, even if no visible foreign object is present, can indicate an ulcer or corneal abrasion.

Swollen Eyelids

Swelling around the eye area may occur as a response to infection or irritation from the ulcer, leading to puffiness or inflammation in the surrounding tissues.

White or Grey Spot on the Cornea

Visible spots on the cornea, typically white or grey, can signal the presence of an ulcer. These spots can obstruct vision and indicate infection or tissue damage.

If you experience any of these symptoms, seek immediate medical attention to prevent further complications.

Diagnosing a corneal ulcer involves a thorough eye examination and diagnostic tests to determine the underlying cause. The process typically includes:

Patient History

The doctor may begin by asking detailed questions about symptoms, recent eye injuries, and habits such as contact lens usage. It's also important to discuss any exposure to contaminated water, as this can provide key clues to the potential cause of the corneal ulcer.

Slit-Lamp Examination

A slit-lamp examination involves the use of a specialized microscope to inspect the cornea in detail. This allows the doctor to observe the damage or presence of ulcers and assess the severity of the condition.

Fluorescein Staining

To make any corneal damage visible, a special dye is applied. Under blue light, the dye highlights the ulcer, enabling a clearer diagnosis and determining the extent of injury.

Corneal Scrapings

In cases where an infection is suspected, the doctor may take a sample from the ulcer. This is sent for laboratory analysis to identify the specific type of infection, whether bacterial, viral, fungal, or parasitic.

Visual Acuity Test

A visual acuity test measures how the ulcer affects vision. By checking the clarity and sharpness of vision at different distances, the doctor can evaluate the impact of the ulcer on daily activities.

Treatment for a corneal ulcer depends largely on its cause and severity. The goal is to heal the ulcer, reduce symptoms, and prevent complications that could impair vision. Here’s an overview of treatment options we offer at Max Hospitals for both infectious and noninfectious corneal ulcers:

Noninfectious Corneal Ulcer Treatment

For noninfectious corneal ulcers, treatment generally focuses on relieving symptoms and promoting healing. The approach will depend on the cause and severity of the ulcer.

• Mild Cases (e.g., Corneal Scratches):
  For minor injuries, such as a superficial corneal scratch, treatment may be as simple as using artificial tears to soothe dryness and irritation. These lubricating drops help keep the cornea moist and aid in the healing process.
• Moderate to Severe Cases:
  If the ulcer is more severe, with significant pain, tearing, or inflammation, stronger treatments are necessary. Topical medications, including steroid or anti-inflammatory eye drops, may be prescribed to reduce swelling and alleviate discomfort. In some cases, an eye patch or bandage contact lens may also be used to promote healing.

Infectious Corneal Ulcer Treatment

Treatment for infectious corneal ulcers depends on the type of infection responsible for the ulcer. The most common causes are bacterial, viral, fungal, and parasitic infections.

• Bacterial Corneal Ulcer:
  The first line of treatment for bacterial keratitis is antibiotic eye drops. The frequency of the drops may vary, often starting with frequent application (every 30 minutes to 1 hour) to rapidly combat the infection. Depending on the severity, oral antibiotics may also be prescribed as a supplement. In cases of severe bacterial infection, hospitalization may be required for more intensive treatment.
• Fungal Corneal Ulcer:
  Fungal infections typically require antifungal treatment. This may involve antifungal eye drops and, in more severe cases, oral antifungal medication. Fungal keratitis can take longer to treat than bacterial infections, and sometimes, surgical intervention is necessary if the infection doesn’t respond to medication.
• Viral Corneal Ulcer:
  If the corneal ulcer is caused by a viral infection (such as the herpes simplex virus), antiviral medications, both topical and oral, are commonly used. These medications help to suppress the virus and reduce symptoms. In some cases, only supportive care, such as artificial tears to alleviate dryness and discomfort, may be needed for minor viral infections.
• Acanthamoeba Corneal Ulcer:
  Acanthamoeba keratitis, caused by a parasitic infection, can be particularly challenging to treat. Antiparasitic eye drops are used, but some strains of Acanthamoeba are resistant to treatment, requiring prolonged therapy that may last for months. In the most severe cases, corneal transplant surgery may be required if the infection does not respond to medication.

For any type of corneal ulcer, general management includes rest for the eyes, avoiding further irritation, and sometimes the use of a patch or bandage contact lens. Keeping the eyes hydrated with lubricating drops or ointments is often a key part of treatment. Depending on the severity and cause, regular follow-up visits with an eye specialist are important to monitor the progress and make adjustments to the treatment plan if necessary.

Advanced Surgical Interventions

In cases where medical management alone is insufficient, our surgeons may recommend:

• Debridement: A meticulous procedure to remove infected or damaged tissue, facilitating the healing process.
• Corneal Transplant (Keratoplasty): For severe cases where significant corneal damage has occurred, a corneal transplant may be necessary to restore vision. Our team excels in performing this delicate surgery, utilising the latest techniques and advanced technologies.

If left untreated or improperly managed, a corneal ulcer can lead to severe complications, including:

• Corneal Scarring: Permanent scars on the cornea can impair vision and may require surgical intervention, such as a corneal transplant.
• Vision Loss: Severe ulcers can cause partial or complete loss of vision in the affected eye.
• Corneal Perforation: The ulcer may penetrate deeper into the cornea, causing a rupture that could lead to infection or fluid leakage.
• Infection Spread: If the infection extends to other parts of the eye (endophthalmitis), it can result in significant damage or even the loss of the eye.
• Glaucoma: Increased intraocular pressure due to inflammation can lead to secondary glaucoma.
• Iris Inflammation (Iritis): Infections causing ulcers may lead to swelling of the iris, the coloured part of the eye.

To avoid these complications, early detection, accurate diagnosis, and prompt treatment are essential. Regular follow-ups with an ophthalmologist are also critical for monitoring recovery.

Preventing corneal ulcers involves maintaining good eye health and taking precautions to minimise risk factors. Key preventive measures include:

• Proper contact lens care is essential. One should follow hygiene practices when handling lenses, ensuring they are cleaned and disinfected regularly with recommended solutions. Contact lenses should not be worn while sleeping unless specifically advised by a doctor.
• Protecting the eyes during high-risk activities is crucial. Patients are advised to wear protective eyewear to shield their eyes from injuries, chemical exposure, or debris. Avoiding swimming in contaminated water, particularly while wearing contact lenses, can further minimise the risk of infections.
• Maintaining good eye hygiene helps prevent infections. Rubbing the eyes, especially with unclean hands, should be avoided as it can introduce harmful microorganisms. For dryness, artificial tears can be used to ensure the eyes remain well-lubricated.
• Prompt care for eye injuries is vital. Even minor injuries can lead to complications if untreated. Patients experiencing redness, pain, or unusual symptoms in the eyes should seek immediate consultation with an eye specialist.
• Managing underlying conditions, such as dry eyes or eyelid disorders, reduces the risk of corneal ulcers. Patients with a history of eye infections or other risk factors should address these issues through proper medical guidance and regular eye check-ups.

By adhering to these preventive strategies, one can significantly lower their chances of developing a corneal ulcer and ensure their eyes remain healthy.

Can corneal ulcers recur after treatment?

Yes, corneal ulcers can recur, particularly if the underlying cause, such as herpes simplex virus or improper contact lens use, is not managed effectively. Following your doctor’s recommendations and maintaining good eye hygiene can help prevent recurrence.

How long does it take to recover from a corneal ulcer?

The recovery time depends on the severity of the ulcer and the effectiveness of the treatment. Mild cases may heal within a week or two, while severe cases may take several weeks or even months. Regular follow-ups are crucial during recovery.

What are the signs that a corneal ulcer is healing?

Healing signs include reduced redness and pain, clearer vision, and the absence of discharge. However, your ophthalmologist can confirm healing through a detailed eye examination.

Can wearing glasses prevent corneal ulcers?

Glasses provide a protective barrier for the eyes and can reduce the risk of injury or exposure to irritants. While they don’t directly prevent corneal ulcers, they can minimise certain risk factors.

How does a corneal ulcer affect daily activities like driving or reading?

Corneal ulcers can cause blurred vision, light sensitivity, and discomfort, making activities like driving or reading challenging. It is best to limit these activities until your vision improves and your doctor clears you.

Is a corneal ulcer considered an emergency?

Yes, a corneal ulcer is an eye emergency that requires immediate medical attention. Delays in treatment can lead to serious complications, including vision loss.

Can children develop corneal ulcers?

Yes, children can develop corneal ulcers, often due to eye injuries, infections, or improper hygiene. Parents should encourage children to avoid rubbing their eyes and consult an eye specialist if symptoms occur.

Are corneal ulcers contagious?

While the ulcer itself isn’t contagious, the underlying infections, such as viral or bacterial infections, can spread. Proper hygiene and avoiding sharing personal items like towels can reduce the risk of transmission.

Can I use over-the-counter eye drops for a corneal ulcer?

Over-the-counter eye drops are not recommended for treating a corneal ulcer, as they may not address the underlying cause. Always consult an ophthalmologist for a proper diagnosis and prescription.

Does diet play a role in preventing corneal ulcers?

A balanced diet rich in vitamins A and C, omega-3 fatty acids, and antioxidants can support overall eye health, but it won’t directly prevent corneal ulcers. Maintaining good hygiene and addressing risk factors are more effective preventive measures.

Can corneal ulcers lead to permanent vision loss?

Yes, if left untreated, corneal ulcers can cause permanent scarring or damage to the cornea, resulting in partial or complete vision loss. Prompt treatment is essential to avoid such outcomes.

What should I do if I suspect a corneal ulcer?

If you suspect a corneal ulcer, avoid touching or rubbing your eye, remove contact lenses (if applicable), and seek immediate medical attention from an eye specialist.

Are there lifestyle changes I should make after recovering from a corneal ulcer?

Post-recovery, you should adopt good hygiene practices, avoid sleeping in contact lenses, and protect your eyes from injury. Regular eye check-ups are also recommended to monitor your eye health.

Can allergies cause corneal ulcers?

While allergies themselves do not directly cause corneal ulcers, excessive rubbing of the eyes due to allergic irritation can lead to corneal injuries, increasing the risk of infection and ulcers.

Is it safe to wear contact lenses after recovering from a corneal ulcer?

In most cases, you can resume wearing contact lenses after full recovery, but only with your doctor’s approval. Ensure you follow proper hygiene practices to avoid future complications.

What is the role of corneal transplantation in treating ulcers?

Corneal transplantation is considered when a severe ulcer causes significant damage or scarring to the cornea, impairing vision. It involves replacing the damaged cornea with a healthy donor cornea.

Can stress contribute to corneal ulcers?

Stress doesn’t directly cause corneal ulcers, but it can weaken the immune system, potentially making the body more susceptible to infections that may lead to ulcers.

How often should I visit an eye specialist if I am prone to corneal ulcers?

If you are prone to corneal ulcers, regular eye check-ups every 3–6 months or as advised by your ophthalmologist are essential for early detection and prevention.

Can I use makeup or beauty products during treatment for a corneal ulcer?

It’s best to avoid using makeup or beauty products around the eyes during treatment, as they may introduce irritants or bacteria that could worsen the condition.

Reviewed By Dr. Vivek Garg, Senior Consultant, Eye Care / Ophthalmology, on 27 March 2025.