A red and sore eye? You may have a corneal ulcer, an abrasive lesion on the surface of the eye caused by trauma or infection. It is better to consult an ophthalmologist quickly because this condition, usually benign, can cause complications and cause irreversible loss of visual acuity, or even blindness in the most serious cases.

Definition

Eye ulcers are corneal ulcers, or corneal ulcers. They result from a lesion with loss of substance, or ulceration, which hollows more or less deeply this thin transparent membrane covering the pupil and the iris. The underlying inflammation can be very painful.

Causes

A corneal ulcer can appear following an eye trauma (a simple scratch, a cat scratch, a branch in the eye…) or an infection.  

Different microbial agents can cause ulcerations of varying severity. Viruses such as the herpes virus are rather implicated in chronic ulcers. Inflammation of the cornea (keratitis) can also be caused by bacteria (Pseudomonas, Staphylococcus aureus, Chlamydia trachomatis, or a streptococcus, a pneumococcus …), a fungus or an amoeba.

The presence of a foreign body in the eye, the rubbing of an ingrown eyelash (trichiasis) or the projection of chemicals are also likely to cause ulceration.

In developing countries, ulcers caused by vitamin A deficiency are a major cause of blindness.

The people concerned

Corneal ulcers are common pathologies at any age. 

Trachoma, an eye infection with bacteria, Chlamydia trachomatis, is a real public health problem in developing countries. Repeated infections indeed cause corneal ulcers with serious consequences. According to the WHO, trachoma is responsible for blindness and visual impairment, which affected around 1,9 million people in 2016.

Risk factors

Wearing contact lenses increases the risk of infection, especially when the rules of use and hygiene are not respected: prolonged wear beyond the prescribed time, insufficient disinfection … Contamination by amoeba in swimming pools can be the cause. cause of ulcers.

Irritations due to dry eyes or failure to close the eyelid (especially in the event of turning the eyelid towards the eye, or entropion) can also progress to a corneal ulcer.

Activities which expose to projections of corrosive products or particles, or even welding, are other risk factors.

Diagnostic

The diagnosis is based on examinations carried out by the ophthalmologist. The reference examination is performed using a biomicroscope, or slit lamp. In order to assess the damage to the cornea, it is carried out in blue light, after instillation of an eye drop containing a dye, fluorescein, which binds to the ulcerations and makes them appear green.

Samples should be taken to identify the microbial agent involved in infectious ulcers.

The deeper the ulcer becomes the more severe the symptoms. The ulcerated eye is red and sore, and the lesion also makes it feel like there is a foreign body in the eye. 

Other symptoms are frequently associated:

• excessive sensitivity to light, or photophobia,
• tears
• impaired vision with reduced visual acuity,
• in more severe forms, an accumulation of pus behind the cornea (hypopion).

Evolution

It is often favorable when the ulceration is superficial, but the eye may remain partly cloudy following scarring. An opaque stain, or pillowcase, does not cause visual discomfort if it is small and peripheral. When it is larger and more central, it causes a decrease in visual acuity. 

A possible complication is the spread of infection to the depths. In the most severe cases, the cornea punctures and the eye tissue is destroyed. An untreated corneal ulcer can thus lead to blindness.

Treatment of an acute corneal ulcer should be started as soon as possible. Depending on its severity, the ophthalomogue will judge whether hospitalization is necessary.

Eye drops

As an attack treatment, antiseptic eye drops should be instilled into the eye very frequently, sometimes every hour for the first 24 hours.

Broad-spectrum antibiotic eye drops can be administered as the first line, as long as the causative organism has not been identified. Then, the ophthalmologist will prescribe more specific antibiotic, antiviral or antifungal eye drops.

Eye drops like atropine or scopolamine, which dilate the pupil, can help relieve pain.

You will usually need to continue to administer drops to the eye as a maintenance treatment until the ulcer has healed completely.

Grafts

In more serious cases, a cornea transplant may be necessary, especially when the cornea is perforated. An amniotic membrane transplant (which covers the placenta and the fetus in pregnant women) is sometimes indicated, this membrane being very rich in healing substances.

A few simple precautions could prevent many ulcers! On a daily basis, it is above all a question of respecting the instructions for maintaining lenses, protecting the eyes from aggressions (sun, smoke, dust, air conditioning, wind, etc.) liable to weaken them, possibly using artificial tears, etc.

Wearing glasses or even a protective mask must be respected for activities exposing the eye to projections or radiation.