Obvious Ophthalmology: Corneal Ulceration*

Corneal Ulceration

Corneal ulcers can range from a simple superficial corneal abrasion after mild trauma, that will heal by itself in a few days, to a deep crater reaching far into the stroma, which may result in a corneal perforation and loss of the eye. The key to managing this diversity of ocular surface lesions is to ask first what is causing the corneal ulceration: Is there infection, an irritating factor such as a foreign body, an aberrant lid hair, or dry eye preventing ulcer healing? Or maybe the problem is a defect in the corneal basement membrane itself? Secondly, the depth of the ulcer must be defined by close assessment of simple features such as the reflection of light at the edge of the ulcer and the degree of stromal haze apparent at the centre of the ulcer. Thirdly, the degree to which healing is taking place must be assessed. With answers to these questions, a treatment plan can be devised either with simple topical antibiotic and tear replacement, or with protection of the corneal surface using application of a polymerised hyaluronic acid gel to facilitate healing, or in specific cases, with surgery such as grid keratotomy, diamond burr debridement or a conjunctival flap.