If you’ve ever experienced severe eye pain that won’t go away, extreme light sensitivity, or vision that’s suddenly become blurry and uncomfortable, you might be dealing with something more serious than a minor irritation. A corneal ulcer is an open sore on the clear front surface of your eye, and it requires immediate medical attention to protect your vision.
At Cascade Eye & Skin Centers, our ophthalmology team has extensive experience diagnosing and treating corneal ulcers and other serious corneal conditions. Whether you’re experiencing symptoms for the first time or dealing with recurring issues, we’re here to provide the specialized care you need.
What Is a Corneal Ulcer?
A corneal ulcer, also called keratitis, is an open sore on the cornea, the clear, dome-shaped surface that covers the front of your eye. Your cornea acts like a watch crystal, protecting the inner structures of your eye while focusing light so you can see clearly.
When an ulcer forms, it means the protective outer layer has broken down, creating a wound that penetrates the deeper layers of corneal tissue. This involves loss of the epithelium (the outermost layer) along with damage to the underlying stromal tissue and inflammation throughout the affected area.
Corneal Ulcer Symptoms
The symptoms of a corneal ulcer are usually hard to miss and often appear suddenly:
- Severe eye pain that’s constant and sharp, often worse when you blink or when light hits your eye
- Extreme light sensitivity (photophobia), where even normal indoor lighting feels unbearably bright
- Intense redness that’s typically more pronounced than with common eye infections
- Excessive tearing or watery discharge that may become thick and yellow or green if infection is present
- Blurry or decreased vision, especially if the ulcer is located centrally
- A white or gray spot on the cornea that may be visible when you look in the mirror
- Foreign body sensation, where it feels like something is stuck in your eye
- Crusting or mucus on the eyelids, especially after waking
If you’re experiencing severe pain with light sensitivity and vision changes, see an eye doctor immediately. Corneal ulcers can progress rapidly, sometimes causing significant damage within 24 hours.
What Causes a Corneal Ulcer?
Corneal ulcers occur when something compromises your cornea’s natural defenses, allowing bacteria, viruses, fungi, or parasites to invade.
Bacterial Infections
Bacterial infections are the most common cause, particularly in contact lens wearers. The bacteria include Staphylococcus aureus, Streptococcus pneumoniae, and Pseudomonas aeruginosa, with Pseudomonas being especially aggressive.
Contact lens wearers face a higher risk because sleeping in lenses reduces oxygen to the cornea, using tap water to rinse lenses introduces bacteria, and contaminated lens solution can directly infect the eye.
Viral Infections
The herpes simplex virus that causes cold sores is a common viral cause. Once infected, the virus remains dormant and can reactivate due to stress, illness, fever, or sun exposure. The varicella-zoster virus (chickenpox and shingles) can also cause corneal ulcers.
Each viral infection can damage corneal nerves, reducing sensation and increasing future ulcer risk.
Fungal Infections
Fungal corneal ulcers are less common but challenging to treat. These often occur after eye injuries involving plant material, such as being poked by a tree branch. They can also develop from overusing steroid eye drops or improper contact lens use.
Parasitic Infections (Acanthamoeba)
Acanthamoeba are microscopic organisms found in water and soil. This infection is most common in contact lens wearers who use tap water to rinse lenses or swim while wearing contacts. The pain is often severe and out of proportion to the eye’s appearance, and treatment can take months.
Other Causes
Corneal injury from scratches, foreign objects, chemical burns, severe dry eye, eyelid problems preventing proper closure, and vitamin A deficiency can all lead to ulceration.
How Is a Corneal Ulcer Diagnosed?
Your ophthalmologist will perform a slit lamp examination to view your cornea under high magnification. A special dye called fluorescein glows under blue light and highlights damaged areas. The ulcer appears bright green, allowing assessment of size, depth, and location.
For larger or central ulcers, your doctor may take a culture by gently scraping the ulcer surface.
Corneal Ulcer Treatment Options
Treatment depends on the cause, severity, and location. Starting therapy quickly is critical to prevent progression.
Antibiotic Eye Drops
For bacterial ulcers, antibiotic eye drops are the primary treatment. Fluoroquinolone antibiotics like moxifloxacin work for mild to moderate ulcers. However, severe ulcers may require stronger compounded antibiotic drops.
Treatment often starts with drops every 30 minutes to every hour around the clock, then gradually tapers as the infection improves.
Antifungal Medications
Fungal ulcers require antifungal eye drops like natamycin, sometimes combined with oral antifungal medications. Treatment may continue for weeks or months.
Antiviral Medications
For viral ulcers, treatment includes topical antiviral drops like trifluridine or ganciclovir gel and oral antivirals like acyclovir or valacyclovir. Topical steroids may also be used in addition to help control inflammation.
Anti-inflammatory Medications
Once the infection is controlled, your ophthalmologist may add steroid drops to reduce inflammation and minimize scarring. However, steroids are never used during active infection and are contraindicated for fungal and Acanthamoeba ulcers.
Surgical Interventions
Severe cases may require corneal gluing for small perforations, amniotic membrane transplantation to promote healing, or corneal transplantation for extensive damage.
Recovery and Prognosis
Bacterial infections should begin to improve within 48 hours with appropriate treatment. Complete healing occurs in stages: infection control (days), inflammation resolution (days to weeks), and scar maturation (months).
Small peripheral ulcers often heal with minimal impact on vision. Larger central ulcers can cause permanent scarring that affects vision. The resulting scar may cause irregular astigmatism, sometimes correctable with glasses or specialty contact lenses. Severe scarring may require a corneal transplant.
Preventing Corneal Ulcers
Practice proper contact lens hygiene: Never sleep in contact lenses unless approved by your eye doctor. Wash your hands before handling lenses, use only sterile solution, never use tap water, and replace lenses on schedule.
Protect your eyes: Wear safety glasses when working with tools, chemicals, or in environments where injury is possible.
Treat dry eye promptly: Regular use of artificial tears and addressing underlying causes helps maintain healthy corneal surfaces.
Address infections quickly: See an eye doctor promptly for any symptoms of eye infection rather than waiting.
When to See an Eye Doctor
Seek immediate care for severe eye pain, sudden vision changes, intense light sensitivity, heavy discharge, visible white or gray spots on your eye, or rapidly worsening symptoms.
If you wear contact lenses and develop any eye pain, redness, or vision changes, remove your lenses immediately and see an eye doctor the same day.
Expert Care at Cascade Eye & Skin Centers
A corneal ulcer requires immediate professional care. At Cascade Eye & Skin Centers, our experienced ophthalmology team provides comprehensive diagnosis and treatment for corneal ulcers and urgent eye conditions. If you are experiencing an urgent eye problem, we recommend calling our office directly to discuss appointment availability.
Serving patients throughout the South Sound, including Auburn, Bonney Lake, Gig Harbor, Puyallup, Sunrise, and University Place, we’re committed to protecting your vision.
If you’re experiencing symptoms of a corneal ulcer, don’t wait. Schedule an appointment online with one of our eye doctors today. Early treatment makes all the difference in preserving your vision.
