Corneal ulcers, or keratitis, can form due to trauma to the cornea, eyelid disease, severe dry eye, Infections of the cornea and in patients who wear contact lenses.

Most corneal ulcers are caused from infections including:

Bacterial infections

These are common in contact lens wearers, especially in people using extended-wear lenses.

Viral infections

The virus that causes cold sores (the herpes simplex virus) may cause recurring attacks that are triggered by stress, an impaired immune system, or exposure to sunlight. Also, the virus that causes chicken pox and shingles (the varicella virus) can cause corneal ulcers.

Fungal infections

Improper use of contact lenses or steroid eyedrops can lead to fungal infections, which in turn can cause corneal ulcers. Also, a corneal injury that results in plant material getting into the eye can lead to fungal keratitis.

Parasitic (Acanthamoeba) infections

Acanthamoeba are microscopic, single-celled amoeba that can cause human infection. They are the most common amoebae in fresh water and soil. When Acanthamoeba enters the eye it can cause severe infection, particularly for contact lens users.

Poor contact lens hygiene, sleeping in contact lenses, or overwear can lead to an infection resulting in a corneal ulcer. If left untreated, corneal ulcers can cause severe damage or even corneal perforation.

The symptoms of corneal ulcers may include:

• pain
• redness
• blurred vision
• tearing
• discharge
• sensitivity to light

Treatment for corneal ulcers depends on the cause. Infectious corneal ulcers are treated with antibiotics, antifungal or antiviral eyedrops are the mainstay of treatment. Sometimes antifungal tablets will be prescribed, or an injection of medication is given near the eye for treatment. Once any infection has diminished or is gone, then steroid or anti-inflammatory eyedrops may be used to reduce swelling and help prevent scarring. The use of steroid eyedrops is controversial and should only be used under close supervision by your ophthalmology. It is possible that steroid eyedrops may worsen an infection. In rare cases when the cornea is severely damaged, a corneal transplant may be necessary to improve vision.

Fuchs’ dystrophy is a progressive disease that affects the cornea, the clear dome that covers the iris (the colored part of the eye) and helps focus light as it enters the eye.

With this disease, cells in the cornea’s inner layer, called the endothelium, are reduced in number. This causes the remaining cells to swell or thicken. The loss of endothelial cells can also allow abnormal dewdrop-shaped growths called guttata to form.

These cell changes may cause the cornea to become cloudy and swollen. Because Fuchs’ dystrophy is a progressive disease, the changes to the cornea can interfere with vision over time. Fuchs’ dystrophy usually occurs in people after age 40. Studies show that it is an inherited condition.

Symptoms of Fuchs’ dystrophy include hazy or cloudy vision that develops in stages. In the first stage, as the cornea swells, vision in the morning may be hazy, but it clears up during the day. Once the disease has progressed to a more advanced stage, vision no longer clears, and instead, you may experience pain and sensitivity to light.

It can take up to 20 years or longer for Fuchs’ dystrophy to progress from its earliest stage to a stage that is visually or physically significant. To diagnose and monitor this condition, an ophthalmologist (Eye M.D.) checks for adequate endothelial cell number and function, obtains an endothelial cell count, and may measure the thickness of the cornea.

In its early stage, Fuchs’ dystrophy is treated with saline eyedrops to pull excess fluid from the cornea or by using a hairdryer to help dry the surface of the cornea. As Fuchs’ dystrophy advances, you may be given a therapeutic bandage contact lens to lessen your discomfort.

If vision loss begins to interfere with your life in the latter stages of the disease, a new corneal transplant procedure, Descemet’s Stripping Endothelial Keratoplasty may be performed. This procedure has an excellent success rate.

Keratoconus is an uncommon condition in which the dome-shaped cornea (the clear front window of the eye) becomes thin and develops a cone-like bulge. As the condition progresses, the shape of the cornea is altered, distorting your vision. Usually, keratoconus affects both eyes, although symptoms and progression in each eye may differ.

Early symptoms include mild blurring of vision, increased sensitivity to light and glare, and mild eye irritation. The rate of progression varies. Keratoconus usually begins in the teenage years. It may progress slowly for 10 to 20 years and then suddenly stop. As it progresses, the most common symptoms are increased blurring, increased nearsightedness or astigmatism, inability to wear contact lenses, and frequent eyeglass prescription changes.

The causes of keratoconus are not known. Since an estimated 10% of people with keratoconus have a family member with the condition, some researchers believe genetics may play a role.

Keratoconus is usually corrected with eyeglasses. However, as the condition progresses, rigid contact lenses may be needed so that vision is improved. If vision is greatly affected, a corneal transplant may be recommended. While this procedure will relieve the symptoms of keratoconus, it will not cure it completely. Nonetheless, corneal transplants offer the best prognosis for clear vision.

A new technique recently has been evaluated to treat progressive keratoconus. This technique involves placing crescent-shaped acrylic inserts in the midperiphery of the cornea. This has been shown to be effective in some patients. You should discuss this technology with your ophthalmologist (Eye M.D.).

Southwestern Pennsylvania Eye Center offers DSEK (Descemet’s Stripping Endothelial Keratoplasty) transplantation, a leading surgical method that uses only a thin portion of the cornea for transplant. Recognized as a superior procedure to conventional PK (Penetrating Keratoplasty) by The American Acamdemy of Ophthalmology, DSEK reportedly offers better visual acuity and stability with fewer risk factors. As one of the most successful organ transplant surgeries, cornea transplants are an effective solution for restoring vision in those suffering from a clouded, scarred or thinning cornea. The success of the procedure is contingent on the type and severity of damage the eye has sustained from disease or injury and patients with additional eye problems may still need glasses or contact lenses to achieve optimal vision.