Corneal ulcer (keratitis) is an open sore on the cornea. Cancer is an extremely rare cause.
Common Causes
- Infectious (Most Common):
- Bacterial: Pseudomonas (contact lens), Staph, Strep, Moraxella.
- Viral: HSV-1 (dendritic ulcer), VZV, adenovirus.
- Fungal: Fusarium, Aspergillus (trauma, vegetation, steroid use).
- Acanthamoeba: Contact lens + water exposure.
- Non-Infectious:
- Neurotrophic (V1 trigeminal damage — diabetes, herpes, surgery).
- Exposure (lagophthalmos, facial nerve palsy).
- Autoimmune (Mooren's, rheumatoid, GPA).
- Chemical/thermal burn.
- Contact lens overwear/hypoxia.
Symptoms
- Severe eye pain, photophobia, tearing, blurred vision, redness, foreign body sensation, discharge, hypopyon (pus in anterior chamber).
Emergency Signs
- Rapid progression, large infiltrate, hypopyon, corneal thinning/perforation risk.
Diagnosis
Slit-lamp exam + fluorescein staining (uptake at ulcer margins). Corneal scrape for Gram stain, culture, PCR, confocal microscopy.
Treatment
- Infectious: Fortified topical antibiotics (cefazolin + tobramycin/fluoroquinolone), antivirals (trifluridine, ganciclovir, oral valacyclovir), antifungals (natamycin, voriconazole), anti-amoebic (PHMB, brolene). No steroids until pathogen identified/controlled.
- Non-Infectious: Lubrication, bandage contact lens, tarsorrhaphy, autologous serum, amniotic membrane, treat underlying cause.
Cancer Context
Primary corneal malignancy (SCC, melanoma) is rare. Metastatic deposits rarer. Conjunctival/corneal intraepithelial neoplasia (CIN) can mimic ulcer. Biopsy if atypical.
Urgent ophthalmology referral is mandatory for any suspected corneal ulcer.
