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By ULY CLINIC

 

Corneal Ulcer

Introduction

This is a painful red eye condition resulting from a raw discontinuity to the corneal epithelium. It may be caused by infection (bacterial, viral e.g Herpes simplex virus and measles, fungal, trauma (physical or chemical) and nutritional (Vitamin A deficiency). 

Diagnostic Criteria

  • Painful and red eye of acute onset 

  • Excessive tearing

  • Severe photophobia 

  • Poor vision

  • Gray/white spot on the cornea staining with fluorocein 

  • Hypopyon (Pus or white cells in anterior chamber)

 Investigations

  • In specialized eye unit, the following should be done:

  • Examination of the eye with Slit Lamp Microscope 

  • Fluorescein sodium drops or a drop of local anesthetic on a fluorescein strip to assess the pattern of the ulcer and measure the size of corneal defect

  • Corneal scrapping for Gram Stain and Potassium Hydroxide staining if bacterial and fungal organisms are suspected  

 

Pharmacological Treatment

While waiting for laboratory results, give:

  • Ciprofloxacin 0.3%, ophthalmic drops, instil 1–2 drops 1–2 hourly for 3 days then reduce to 3–4 hourly.

OR

  • Ofloxacin 0.3%, ophthalmic drops, instil 1 drop 1–2 hourly for 3 days then reduce to 3–4 hourly   Give antifungal, if fungal infection is suspected or confirmed 

  • Natamycin 5%, ophthalmic drops, instil 1 drop 1–2 hourly for 3–4 days (specialist use only).

Then reduce to 1 drop 3–4 hourly. Continue for 14–21 days until resolution of infection

OR

  • Econazole 2%, ophthalmic drops, instil 1 drop 1–2 hourly for 3–4 days (specialist use only).         

Then reduce to 1 drop 3–4 hourly. Continue for 14–21 days until resolution of infection

OR

  • Chlorhexidine 0.2%, ophthalmic drops, instil 1 drop 1–2 hourly for 3–4 days (specialist use only). Then reduce to 1 drop 3–4 hourly. Continue for 14–21 days until resolution of infection 

 

Give antiviral if viral causes is suspected after the examination of the eye 

  • Acyclovir 3% eye ointment 5 hourly a day until there is no corneal stain, then continue with treatment 8 hourly a day for a maximum of 10–14 days 

 

Note: Treatment may be changed depending on corneal scrapping results

 

Referral

  • Refer to the next level of care where there is an eye specialist when there is hypopyon (white cells in anterior chamber)

Updated on, 2.11.2020

References

1. STG 

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