CORNEAL ULCERS BY DR. ZACK BURKHART

Because infectious corneal ulcers are a serious problem regularly encountered at Focal Point Vision, a review of their prevention and treatment is useful.

Background

Most of the corneal ulcers seen in our practice are related to contact lens wear, and can be prevented by following a few guidelines. The most important of these is that contact lenses should always be removed from the eyes before sleeping, even if only for an hour or two. This applies to extended-wear contacts as well those marketed for “day and night” wear.  Contacts can cause microscopic abrasions of the cornea during sleep, which open a pathway for bacteria to enter the cornea and cause an ulcer, which is highly painful as well as potentially vision threatening.

Daily disposable contacts cause the fewest infections, and are preferable. If extended-wear contacts are used, they should be replaced routinely every 2-4 weeks. These lenses should be cleaned daily with preservative-free liquid cleaner and hydrogen peroxide disinfectant solution. Never clean contact lenses with tap water, and avoid swimming in contacts, especially in rivers or lakes – these activities raise the risk of a severe parasitic infection, called acanthamoeba keratitis. Fungal infections of the cornea can be caused by traumatic abrasions, especially with branches and leaves of trees and plants. For this reason safety glasses should always be worn when doing yard work and gardening.

Treatment

An infection or ulcer of the cornea usually causes pain, irritation, blurred vision, light sensitivity, tearing, and redness of the eye. If a person starts to experience  some of these symptoms, they should promptly remove their contact lenses. Eye drops, especially anti-inflammatory or steroid drops, should not be used until an experienced eye physician has closely examined the affected eye. Focal Point Vision doctors are equipped with all of the necessary tools for diagnosing infections of the eye including a confocal microscope, which can take detailed photos of each layer of the cornea in order to visualize more unusual parasitic or fungal infections.  We routinely work with local compounding pharmacies to make the strongest and most effective infection-fighting medications for our patients.

Pink Eye

Adenoviral conjunctivitis, more commonly known as “pink eye,” is a frequently encountered problem at Focal Point Vision. Adenovirus is present in the environment in over 40 subtypes, and can cause a variety of health problems including respiratory and gastrointestinal infections.

When adenovirus infects the eye, the patient notices redness, tearing, itching, irritation, crusting, and sometimes eyelid swelling. Typically the infection starts in one eye, then spreads to affect the other eye within a few days. Patients may also notice a tender lymph node in front of the ear on one or both sides. Often there is a history of recently having had an upper respiratory infection or of having a friend or family member with a red eye.

The examining ophthalmologist typically notices a “lumpy bumpy” appearance of the conjunctiva called “follicular conjunctivitis” and sometimes sees swollen conjunctiva (“chemosis”) or red patches caused by broken blood vessels (“subconjunctival hemorrhage”).

Certain subtypes of adenoviral conjunctivitis are particularly severe, causing additional symptoms and termed epidemic keratoconjunctivitis, or EKC. Patients with EKC are often light sensitive and have blurred vision because of a strong reaction by the immune system in the cornea. They can also have yellowish “pseudomembranes” that form on the insides of the eyelids.

Adenovirus is highly contagious and is spread by contact with the tears, so patients should wash their hands frequently and refrain from shaking hands with other people during the infection. Like the common cold, there is no treatment that reliably shortens the course of an adenoviral infection. Treatment is geared toward relieving symptoms, and usually consists of cool compresses and cold artificial tears. In more severe cases of EKC, topical and even oral steroids are sometimes necessary to reduce inflammation. If you have any questions on Pink Eye, or any eye issues contact Focal Point Vision today: 210-614-3600