Keratitis (Corneal Ulcer) - Causes, Treatment & When to See a Doctor

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What is Keratitis (Corneal Ulcer)?

Keratitis, also known as a corneal ulcer, is a serious eye condition that involves inflammation or an open sore on the cornea—the clear, dome-shaped surface covering your iris and pupil. This condition can severely impact vision and even lead to blindness if left untreated. Keratitis can be caused by infections (bacterial, viral, fungal, or parasitic) or non-infectious factors like trauma or autoimmune diseases. The cornea’s outer layers are vulnerable to damage, and a corneal ulcer often develops when these layers become compromised.

According to the Mayo Clinic, keratitis is considered a medical emergency because it can rapidly deteriorate vision. Symptoms and treatment depend on the underlying cause, but prompt medical attention is critical to prevent complications such as scarring or vision loss.

Common Causes

Keratitis can arise from various causes. Below is a list of the most common conditions associated with this symptom:

• Bacterial infections: Often linked to poor hygiene or improper contact lens use, bacterial keratitis is frequently caused by Staphylococcus or Pseudomonas bacteria. CDC warns that contacts worn overnight or with improper cleaning solutions significantly raise this risk.
• Fungal infections: Fungi like Aspergillus or Candida typically affect individuals with severely weakened immune systems or contact lens wearers in dry, dusty environments. NIH notes that fungal keratitis is uncommon but severe.
• Viral infections: Herpes simplex virus (HSV) or varicella-zoster virus (chickenpox/shingles) can cause viral keratitis. Cleveland Clinic states that recurrent HSV is a leading cause of corneal scarring.
• Parasitic infections: Rare but possible, infections like Acantocheilonema (a worm) in trachoma patients can lead to keratitis. WHO links this to poor sanitation and lack of eye protection.
• Trauma or injury: Chemicals (e.g., industrial cleaners), foreign objects, or physical scratches can breach the cornea, leading to ulceration.
• Dry eye syndrome: Prolonged dryness can damage the cornea’s protective layer, increasing vulnerability to infection.
• Autoimmune conditions: Diseases like Stevens-Johnson syndrome or herpes zoster (shingles) may trigger keratitis through systemic inflammation.
• Acanthamoeba keratitis: Caused by a microorganism in contaminated water or dust, this is a rare but sight-threatening condition. International Eye Foundation highlights that contact lens wearers are at higher risk.
• Exposure to UV radiation: Prolonged sun exposure without protection can contribute to non-infectious keratitis.

Associated Symptoms

Keratitis often presents with the following symptoms, which may worsen over time:

• Severe eye pain: A persistent, aching discomfort that may feel like pressure on the eye.
• Redness and swelling: The affected eye may appear unusually red and inflamed.
• Sensitivity to light (photophobia): Intense discomfort when exposed to bright lights.
• Blurred or distorted vision: Vision may become hazy or tunnel-like.
• Excessive tearing or discharge: Watery eyes or pus-like secretion from the affected eye.
• Foreign body sensation: A constant feeling of a gritty object in the eye.
• Swelling or cloudiness: The cornea might appear cloudy or swollen.

Mayo Clinic emphasizes that symptoms can vary depending on the cause, but any sudden change in vision or eye discomfort warrants immediate medical evaluation.

When to See a Doctor

Seek urgent medical care if you experience:

• Sudden vision loss or significant blurring in one eye.
• Severe or unrelenting eye pain that doesn’t improve with home care.
• Intense redness, swelling, or a sensation of something being in the eye.
• Recent contact lens use or eye injury (e.g., chemical exposure).
• No improvement after 24 hours of OTC treatments like artificial tears.

As noted by the National Eye Institute, keratitis can progress rapidly, and delays in treatment may result in irreversible corneal damage.

Diagnosis

Diagnosing keratitis involves a thorough eye examination by an ophthalmologist. Key steps include:

• Slit-lamp examination: A specialized microscope to visualize the cornea’s surface and depth of the ulcer.
• Culture tests: Swabs of the cornea or discharge are analyzed to identify bacteria, fungi, or viruses. Mayo Clinic recommends culturing to target treatment effectively.
• Fluorescein staining: A dye applied to the eye to highlight areas of damage or scratches on the cornea.
• Imaging: In rare cases, ultrasound or CT scans may be used to assess deeper corneal involvement.

The Cleveland Clinic stresses that prompt diagnosis is crucial to distinguish between infectious and non-infectious causes, as treatments differ significantly.

Treatment Options

Treatment depends on the underlying cause but typically involves professional medical intervention:

• Antibiotics: For bacterial keratitis, topical or oral antibiotics (e.g., ciprofloxacin, tobramycin) are prescribed. CDC advises stopping contact lens use during treatment.
• Antifungal medications: If fungal, drugs like fluconazole or amphotericin B may be used. NIH notes that invasive treatment (e.g., corneal transplants) might be necessary for severe cases.
• Antiviral drugs: Acyclovir or ganciclovir are used for herpes-related keratitis to reduce viral replication. Cleveland Clinic emphasizes early antiviral use to prevent complications.
• Steroids: In non-infectious keratitis, corticosteroids may reduce inflammation but are avoided in infections to prevent worsening.
• Surgical options: Corneal transplants or debridement (removing dead tissue) may be required if the ulcer doesn’t heal.

At home, avoid rubbing the eye, use prescribed medications as directed, and keep the eye clean. Mayo Clinic warns against self-medication, as incorrect treatment can delay healing.

Prevention Tips

Preventing keratitis involves proactive measures to protect corneal health:

• Practice hygiene: Clean and disinfect contact lenses as directed. Never wear contacts while sleeping or reuse solution. CDC notes that improper contact lens use is a major risk factor.
• Wear eye protection: Use goggles during activities like swimming, gardening, or using chemicals. WHO recommends UV-protective sunglasses outdoors.
• Treat dry eye promptly: Use artificial tears or discuss medical options with a doctor to maintain lubrication.
• Avoid contaminated water: Do not use tap water to clean contacts or rinse eyes while swimming. International Eye Foundation links Acanthamoeba keratitis to this behavior.
• Address systemic conditions: Manage autoimmune diseases or diabetes to reduce inflammation in the eyes.
• Remove foreign objects: Flush the eye with clean water if a particle enters, but avoid rubbing.

The National Eye Institute advises regular eye checkups, especially for individuals with a history of keratitis or contact lens use.

Emergency Warning Signs

Always consult a healthcare professional for accurate diagnosis and treatment. Resources like the Mayo Clinic and CDC provide detailed guidance on eye health.

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