Concept: Local necrosis of the corneal tissue due to an invasion by bacteria, fungi, viruses oracanthamoeba.
Corneal ulcers are mainly caused by staphylococcus, pseudomonas, and streptococcuspneumonea. The invasion of the bacteria with frequency is caused by sleeping with thecontacts lens, the inadequate sterilization, corneal trauma and foreign objects. It can also occuras a complication of queratitis by herpes, neurotrofic queratitis and gonorrea. It can also be theresult of a disorder of the corneal nutrition secondary to a deficiency of vitamin A or proteicdeficiency. Other causes are due to disorders of the eyelids for example the incomplete closureof the eyelid, bell
paralysis and trauma of the eyelid.
Signs and symptoms:
Pain and the sensation of foreign object, photophobia, tears, however these can be minimum.The corneal ulcer starts with a dull and grey superficial opacity, and then it turns necrotic anddischarges leaving an excavated ulcer. The epithelial alteration turns green, when dyed withfluorescein. Peri-corneal intense redness if very frequent and in prolong cases the blood vesselscan go into the cornea through the limbo. The ulcer can cover the whole cornea and can godeeper in some occasion pus can be found in the anterior chamber.There could be ulceration without significant infiltration in the queratitis by herpes. The ulcerscaused by fungi have a more chronic course than the ones caused by bacteria; they show amore dense infiltration sometimes small dispersed lesions on the borders of the cornea. Theulcers caused by acanthamoeba are extremely painful, they can also present transitoryepithelial defects and multiple stromal infiltration.
The mooren ulcer is a very rare disease probably caused by an autoimmune response toantigens of the corneal estroma.
according to the clinical signs, the finding with fluorescein and the response tothe treatment we can identify 3 types.1.
Unilateral ulcer affects mainly elderly women of white skin complexion.