Corneal Ulcer (Keratitis)

A corneal ulcer is an open sore on the cornea, the clear front surface of the eye, most often caused by infection. It is a serious eye condition that can threaten vision if not treated promptly.

• Eye pain, often significant
• Redness of the eye
• Sensitivity to light (photophobia)
• Blurred vision
• Discharge from the eye
• A visible white or grey spot on the cornea may be seen with careful examination

• Most commonly caused by bacterial, viral, or fungal infection of the cornea.
• Risk is significantly increased by contact lens wear, particularly with poor hygiene or overnight wear, and by prior eye injury or trauma, especially involving plant material for fungal infection.
• Dry eye and other conditions affecting the eye's surface can also increase susceptibility.

• Diagnosed through eye examination, ideally with magnification, looking for the characteristic ulcer and associated inflammation.
• A sample of the ulcer material may be taken for laboratory testing, where available, to identify the specific causative organism, particularly for more severe or non-improving cases.
• Contact lens wearers or anyone with a red, painful eye and reduced vision should be assessed urgently.

A corneal ulcer is an eye emergency requiring urgent referral to a facility with eye care capability, as delayed treatment risks permanent scarring and vision loss.

Treatment depends on the underlying cause — intensive antibiotic eye drops for bacterial infection, antiviral treatment for viral causes, or antifungal treatment for fungal infection — often started frequently, sometimes hourly initially for bacterial ulcers.

Contact lens wear should be stopped immediately if a corneal ulcer is suspected.

Close follow-up is needed to monitor healing and adjust treatment, as corneal ulcers can worsen quickly and some causes require prolonged treatment courses.

• Practise strict contact lens hygiene, including proper cleaning, storage, and avoiding overnight wear unless specifically approved for that use.
• Never wear contact lenses while swimming or in water without appropriate protection.
• Seek prompt eye protection when working with plant material, soil, or in environments with risk of eye injury.
• Seek urgent medical assessment for any painful, red eye with reduced vision or light sensitivity, rather than treating it as a minor irritation.