What Is a Corneal Ulcer?

The cornea is a transparent film in the front of the eyeball. It is often exposed to the air and has a high chance of coming into contact with germs. Corneal ulcers often occur due to foreign body trauma, traumatic injury after removal of corneal foreign body, trachoma and its complications, inversion of the cornea due to cataracts, bacteria, virus or fungus. In addition, corneal ulcers can be caused by allergic reactions caused by tuberculosis, vitamin A deficiency, facial paralysis, and poor lid closure due to eyelid scars.

Corneal ulcer symptoms

In the early stage of illness, the eyes have obvious irritation symptoms, and they are afraid of light, tears, eye pain, and small gray or white infiltration on the cornea; in severe cases

The above symptoms are more obvious, the eyes cannot be opened, the eye pain is intolerable, and the vision is reduced. The bulbar conjunctiva is purple-red and congested, and the closer it is to the cornea, the more severe the gray-white necrotic tissue on the corneal surface is, and an ulcer is formed. If the bacteria is highly toxic, combined with chronic dacryocystitis or reduced systemic resistance, the ulcer spreads around or deep, forming an anterior chamber empyema, and even causing corneal perforation, causing severe damage to vision. Pseudomonas aeruginosa corneal ulcers often cause corneal perforations within 1-2 days with severe consequences. On the other hand, fungal corneal ulcers have mild onset symptoms, irregular ulcers, grayish white, and often have pus in the anterior chamber.

If corneal ulcers are treated in time, the ulcers can be gradually repaired and healed, but often become scarred and cloudy. The turbidity is thin and thick, and the thinnest is like the thin cloud in the sky, called Yun Zhi; after the deeper ulcer is cured, a layer of frosted glass-like gray and white spots is called ; The iris prolapses due to the perforation of the ulcer, and it is called corneal adhesion white spot on the cornea. The impact of corneal scars on vision is related to the site of occurrence, such as when the scar covers the pupil in the central part, even if it is very thin, it also seriously affects vision.

Corneal ulcers must be treated in time to prevent scar formation and affect vision. First of all, it should be treated according to the cause, and dacryocystitis, trachoma, inverted cataract, corneal foreign body, etc. should be completely treated. Eye drops of antibiotic eye drops, once every 1-2 hours, apply eye ointment at night to reduce the friction of corneal ulcers and promote early healing of ulcers. If the ulcer is severe, it is necessary to inject the penicillin, streptomycin or other antibiotics under the bulbar conjunctiva. In severe cases, use sulfa or antibiotics throughout the body. For large and deep ulcers, 1% atropine solution can be dripped once a day to bandage the eyes and reduce friction, which is beneficial to the growth of corneal epithelium and can reduce pain. Cortisone eye drops are forbidden during ulcer progression or viral corneal ulcers.

Corneal ulcer diagnosis

Bacterial corneal ulcers are more common and are severe purulent corneal ulcers. Lame corneal ulcers and Pseudomonas aeruginosa are common. The former is often accompanied by anterior chamber empyema, also known as anterior chamber purulent corneal ulcer. More common in elderly, frail, malnourished, chronic dacryocystitis patients. It is often caused by infection with Streptococcus pneumoniae, Morax-Axenfeld, Staphylococcus infection after corneal trauma. Its clinical features are acute onset, the lesion starts in the center of the cornea, has yellowish white infiltration, quickly forms ulcers and progresses to the surrounding and deep, often followed by iridocyclitis, fibrous exudation in the anterior chamber, and An anterior chamber pus is formed. The empyema is sterile before corneal perforation. A corneal perforation can eventually be formed. Perforation in most cases is a contributing factor to recovery. However, in severe cases, perforations can cause infections in the eye, forming endophthalmitis or panophthalmitis. If dacryocystitis should be removed as soon as possible. Local and systemic treatment with sulfa or penicillin and streptomycin. Pseudomonas aeruginosa corneal ulcer is a kind of severe purulent keratitis. When a corneal trauma or corneal foreign body is removed, Pseudomonas aeruginosa attaches to the foreign body or contaminates the eye drops and becomes infected. With the promotion of contact lenses, it is more common for people with lenses or lens disinfectants to be contaminated with germs and infected. It is characterized by a short incubation period, rapid onset, severe pain, and sharp decline in vision, accompanied by a large amount of yellow-green viscous secretions. The corneal lesions are gray-yellow infiltration, slightly raised, and the surrounding edema quickly forms a round, circular corneal ulcer with anterior chamber pus, which can expand to the full cornea and perforate in 2 to 3 days. Endophthalmitis or corneal edema (ie, partial or full corneal swelling) results in blindness. If the disease is suspected, polymyxin or gentamicin should be used immediately, eye drops every half hour and systemic medication until the condition is stable. In addition, carbenicillin and streptomycin also have a certain effect. Bedside isolation should be done at the same time as treatment.

Common cases of viral corneal ulcers such as herpes simplex infection. Before the onset, there is often a history of fever such as upper respiratory infections. Due to the widespread use of corticosteroids, viral infections are on the rise. At the beginning of the onset, punctate vesicles appear in the corneal epithelium, which are arranged in a linear pattern. Later, the vesicles rupture and gradually connect into dendritic forms. The fluorescein staining showed a green dendrite in the center, with a pale green band next to it. The corneal sensation in the diseased area was reduced or disappeared. It could be cured after treatment, leaving a cloudiness. Keratitis), often associated with iridocyclitis, but without anterior chamber pus, if the anterior chamber pus appears, it may indicate a secondary infection. After the ulcer has healed, it can leave variegated spots or white spots with new blood vessels.

Fungal corneal ulcers are caused by fungi that directly invade the cornea, and are more common in busy agricultural high-temperature seasons. Common pathogenic bacteria are Fusarium, Aspergillus, Candida albicans, etc. Its onset is slow and its symptoms are milder than clinical manifestations. The lesions are characterized by ulcers that are grayish in color, dry on the surface, and slightly swollen. Pseudofoot or small five-star foci can be formed around the lesions, often accompanied by pus in the anterior chamber. The course is slow and often perforates in the end. The diagnosis of this disease depends on corneal scrapings to detect fungal mycelia. Antifungal drugs are currently commonly used with aurein or amphotericin. Prohibit hormones or antibiotics.

Corneal ulcer manifestations

With the exception of paralytic keratitis, most patients with keratitis have symptoms of intense inflammation such as pain, shame, tearing, and eyelid spasms. This is because the trigeminal nerve endings in the cornea are stimulated by inflammation, causing contraction of the reflex orbicularis muscle and excessive secretion of tears. The cornea is a non-vascular tissue, but the adjacent area is rich in blood vessels (vessels of the limbus and iris ciliary body). When inflammation affects adjacent tissues, there is hyperemia and inflammatory exudation. Therefore, patients with keratitis not only have ciliary congestion but also iris congestion. The latter is manifested by discoloration of the iris and dilation of the pupil.

Exudates came from the same source. Severe patients may develop edema in the conjunctiva or even the eyelids. The infiltration of the cornea occurs because leukocytes move to the corneal lesion due to the hyperemia of the corneal sclera. When the corneal inflammation reaches the degenerative phase, clinical irritation symptoms are greatly reduced.

Corneal inflammation will inevitably affect vision to a greater or lesser extent, especially if the inflammation invades the pupil area. The corneal scar formed after the ulcer heals not only prevents light from entering the eye, but also changes the curvature and refractive power of the corneal surface, making it impossible for the object to focus on the retina to form a clear object image, and thus reduces vision. The degree of vision involvement depends entirely on the location of the scar. If it is located in the middle of the cornea, even though the scar is small, it affects vision greatly.

Causes of corneal ulcer

The etiology of corneal inflammation is complicated. Trauma and infection are the most common causes of keratitis; systemic diseases such as tuberculosis, rheumatism, syphilis, and malnutrition are an intrinsic factor; the effects of diseases of adjacent corneal tissues such as Acute conjunctivitis, scleritis, and uveitis.

The symptoms of corneal disease include: patients are afraid of light, tears, pain, and severe cases have eyelid spasm and other irritation symptoms. Exfoliation of the corneal epithelium can cause severe eye pain. Depending on the degree and location of the corneal lesions, there may be varying degrees of visual impairment. Except for purulent corneal infections, there are generally few or no secretions. The signs of corneal disease can be bulbar conjunctival edema, ciliary congestion, corneal opacity, and corneal neovascularization.

Keratopathy is the category of ocular surface diseases that is most harmful to visual function. If it becomes worse, it can cause vision loss and even blindness, that is, corneal blindness. Corneal blindness ranks second in blinding and low vision, second only to cataracts.

Corneal ulcer signs

White, yellow-white, or gray-white ulcers often accompanied by pustules in the front, the development of which is relatively chronic compared with the course of the disease.

Comparison of eye irritation and ulcer size is relatively mild.

Corneal ulcer type

1. Claudication corneal ulcer:

It is an acute purulent corneal ulcer. It is more common in the elderly who are frail or with chronic dacryocystitis. It usually occurs within 1-2 days after corneal trauma. Eye pain, light flow, tears, vision loss, ciliary congestion, or mixed congestion. Yellow dense infiltrates blur the boundary quickly and quickly form ulcers and ulcers. The base is contaminated with necrotic tissue. The edges of the ulcers spread latently to the surroundings and deep. Positive fluorescein staining is often accompanied by a large amount of cellulose-like exudates in the anterior chamber of iris ciliary body inflammation. Those with severe pus and small pupils with adhesions may easily perforate the cornea or even develop into endophthalmitis scraping or culture. Pathogens such as pneumococcus hemolytic streptococcus aureus and so on can be found.

2. Pseudomonas aeruginosa corneal ulcer:

Severe purulent keratitis caused by Pseudomonas aeruginosa infection often occurs rapidly after several hours or 1-2 days after removal of trauma corneal foreign bodies or the use of instruments contaminated with water (such as fluorescein) contaminated by Pseudomonas aeruginosa. Severe pain in the eyes, decreased vision, swelling of the eyelids, conjunctival congestion, edema, yellowish-white necrotic lesions on the cornea, a slight bulge on the surface, rapid expansion, a thick ring infiltrating the anterior chamber, a large amount of pus, corneal necrotic tissue, shedding, forming a large area of ulcer, and producing a large amount of yellow-green viscous secretion If the material cannot be controlled quickly, all the perforated scrapers will be dissolved within 1-2 days for bacteriological examination. Gram-negative bacteria can be found to culture Pseudomonas aeruginosa and the diagnosis can be more clearly diagnosed.

3. Fungal corneal ulcer:

There are often agricultural corneal trauma. The high incidence of high temperature seasons is characterized by a slow onset and a long course of irritation. Compared with the previous two, it is a severe ulcer. The color is whiter. The surface is dry and rough. It has a dry and hard feeling like "tongue coating" or "toothpaste". It is easy to scrape around the central lesion. Sometimes "pseudofoot" or "satellite stove" can be seen. There is a sheet of gelatinous deposits on the posterior wall of the cornea. There is a thick pus scrape in the anterior chamber. You can find the diagnosis of mycelia and establish the culture. Visible pathogenicity Fungi such as Fusarium Aspergillus penicillium candida albicans yeast and so on.

There are several different types of corneal ulcers in the clinic, so patients must be careful when treating them. Ophthalmologists say corneal ulcers are a highly infectious eye disease, and the cornea is the outermost film of our eyes.

Corneal ulcer examination

Take the ulcerated necrotic tissue for smear examination. If fungal hyphae can be found, or necrotic tissue can be taken for cultivation, and fungal growth is the most reliable diagnostic basis. The specimen method is to first drop a surface anesthetic, and then use a pointed blade to scrape a small piece of necrotic tissue with a diameter of 0.5 mm in the infiltrated and dense place as a specimen. Generally, first do the potassium hydroxide and nitrogen oxide smear examination, if there is still a specimen, it can be used for fungal culture at the same time. Sometimes, the cornea of the pupil area is damaged too much by a rabbit at one time. Do not take specimens deep in the ulcer to prevent ulcer perforation.

When scraping specimens, sometimes preliminary identification can be made between fungal and bacterial. Generally speaking, the necrotic tissue on the fungal ulcer surface is "moss scale" or "toothpaste", with loose texture and lack of stickiness; while the necrotic tissue on the bacterial ulcer surface is "gelatinous" and rich in viscosity.

Corneal ulcer fungal smear

Take a small piece of necrotic tissue on the ulcer surface and place it on a glass slide, drop a small drop of 5% potassium hydroxide solution on it, cover it with a cover glass, and press slightly. Fungal hyphae can be detected with a high power microscope. Many people are often full of vision, but a small amount of mycelium needs to be carefully examined to find. A positive smear will usually confirm the diagnosis. Specimens need to be checked at the time and cannot be saved.

Corneal ulcer fungal culture

Take a small piece of necrotic tissue and place it on a slant of solid potatoes or Shaw's medium. If it can be inoculated on several media at the same time, it will help increase the positive rate of culture. Place in a 37 ° C incubator and observe daily. Fungal organisms are possible from the day after inoculation. If no growth is seen after one week, it is positive. The culture method can observe the morphology and color of fungal colonies, check mycelia and spores under a microscope to identify bacteria, preserve strains, and perform drug sensitivity tests. The positive rate of culture is generally low for smears.

Corneal ulcer treatment

Common treatments for corneal ulcers

Eliminate incentives, deal with and treat eye diseases in a timely manner; control infections against pathogenic microorganisms; mydriasis; hot compress; application of corticosteroids;

Corneal ulcer refractory therapy

(1) Corneal burning method.

(2) Freezing method. After surface anesthesia, determine the freezing range by fluorescent staining.

(3) Application of collagenase inhibitors.

(4) Surgery: conjunctival flap occlusion; therapeutic corneal transplantation; application of medical adhesives.

Treatment of corneal ulcer scars

Use medication to promote scar absorption and surgery. According to the location, scope, thickness and degree of corneal scarring, the surgery can be performed by laser iridectomy, optical iridectomy or corneal transplantation. For secondary glaucoma caused by adhesion leukoplakia, anti-glaucoma surgery can be performed.

Keratopathy is the second roughly blind eye disease. There are about 4 million blind people with corneal disease in China. Most of these patients can be cured by corneal transplantation.

Corneal transplantation mainly includes various difficult surgical methods such as penetrating corneal transplantation, lamellar and full lamellar corneal transplantation, total corneal transplantation and corneal transplantation combined with cataract extraction and artificial lens implantation. The cornea is very transparent, without blood vessels, and the rejection is relatively light in immunology. Therefore, corneal transplantation has the highest success rate in organ transplantation. Our hospital has successfully carried out a large number of corneal transplantation operations, so that the majority of patients can eliminate pain and see the light again.

Corneal ulcer lamellar transplantation

It is a partial thickness corneal transplant. During the operation, the diseased tissue in front of the cornea is removed, leaving the underlying tissue as a transplant bed. Grafts are usually thin, leaving only the posterior elastic and endothelial layers. Therefore, lamellar corneal transplantation can be performed where corneal lesions do not invade the deep or posterior elastic layer of the corneal stroma, and the physiological function of the endothelium is healthy or recoverable. It is often used clinically for middle and superficial corneal creases or corneal dystrophy, progressive keratitis or ulcers, corneal fistula, corneal tumors, and some eyeballs that cannot be used for penetrating corneal transplantation in poor conditions. It is first used to improve corneal conditions Layer transplantation.

Corneal ulcer penetrating transplantation

This method is to replace the full-thickness cornea with a full-thickness transparent cornea. Indications can be divided into optical, therapeutic, forming, and cosmetic aspects according to the purpose of the operation.

Corneal ulcer prevention

In corneal ulcers, the exposed corneal stroma contains a large amount of collagen, and the biogel can crosslink and bond with collagen-rich tissues. At the same time, the fibronectin in biogel can stimulate the proliferation of fibroblasts and can be effective Stimulates ulcer healing and promotes epithelial regeneration.

According to clinical studies, biogum is closer to the physiological healing process, with fewer new blood vessels, which can effectively close the cornea, effectively making up for the defect that the amniotic membrane cannot be closed.

Corneal ulcer drugs

[Approval number] National Medicine Standard H20043423

[Chinese name] Norfloxacin eye drops

[Product English name] Norfloxacin Eye Drops

[Manufacturer] Nanjing Hengsheng Pharmaceutical Factory

[Indications] For external eye infections caused by sensitive bacteria, such as conjunctivitis, keratitis, and corneal ulcers.

[Chemical composition] The main ingredients of this product are: Norfloxacin. Its chemical name is: 1-ethyl-6-fluoro-1,4-dihydro-4-oxo-7- (1-piperazinyl) -3-quinolinecarboxylic acid.

Molecular formula: C16H18FN3O3

Molecular weight: 319.24

[Pharmacological action] This product is a fluoroquinolone antibacterial drug, which has a broad spectrum antibacterial effect, especially high antibacterial activity against aerobic gram-negative bacilli, and has good antibacterial effects on the following bacteria in vitro: most bacteria in the family Enterobacteriaceae Enterobacter genus, such as Enterobacter cloacae, Enterobacter cloacae, Enterobacter aerogenes, Escherichia coli, Klebsiella, Proteus, Salmonella, Shigella, Vibrio, Yersinia Bacteria. Norfloxacin also has antibacterial activity against multi-drug resistant bacteria in vitro. Penicillin-resistant Neisseria gonorrhoeae, Haemophilus influenzae, and Moraxella catarrhalis also have good antibacterial effects. Norfloxacin is a bactericide that acts on the A subunit of bacterial DNA helicase to inhibit DNA synthesis and replication and cause bacterial death.

[Drug interaction] is not clear.

[Adverse reactions] Slight transient local irritation, such as tingling, itching, foreign body sensation, etc.

[Contraindications] It is contraindicated in patients with allergies to this product and fluoroquinolones.

[Product Specifications] 8ml: 24mg

[Usage and Dosage] Drop into the eyelid, 1 to 2 drops at a time, 3 to 6 times a day.

[Storage method] shading and sealed.

[Precautions] Use with caution in patients with severe renal insufficiency.

Corneal ulcer prevention

The vast majority of patients are farmers. Although they can occur throughout the year, they are mainly concentrated in agricultural summer and autumn harvest seasons.

1. Develop good hygiene habits, wash your hands frequently, and often cut your nails;

2. Do not wear contact lenses for a long time; be careful when replacing contact lenses.

3. Same as the prevention of acute conjunctivitis, mainly cutting off the source of infection and paying attention to eye and hand hygiene.

4. Patients are prohibited from bathing and swimming in public places.

5. The treatment is mainly based on topical medication. Oral medication and acupuncture also have a certain effect.

6. Eat more foods and fruits with cold and heat-clearing and fire-reducing effects, such as loquat white, winter melon, bitter gourd, fresh loquat, sugarcane, banana, watermelon and so on.

Corneal ulcer recommendations

Surgery is only a part of corneal transplantation. Postoperative management and self-care are also important aspects of corneal transplantation.

1. Regular review.

2. The corneal suture removal time is determined by the doctor. If the patient's vision is good when the suture is present and the corneal topography is regular, consider retaining the suture for a long time.

3. Pay attention to rejection. Rejection usually occurs within 6 months after surgery. If the patient feels red, painful, and sudden vision loss, the corneal graft becomes cloudy, he should go to the hospital immediately.

4. Safe and effective eye drops. Be careful not to touch the corneal graft with the dropper tip; use two or more eye drops alternately, every few minutes to ensure the concentration of the drug in the eye.

5. Reasonable diet. Appropriate nutrition supplements and increased resistance; eat more fruits and vegetables to keep your stools open; eat less spicy and greasy foods.

6. Pay attention to activities and rest. Pay attention to eye hygiene, do not rub your eyes; wear protective glasses when going out to avoid touching the eye. For patients with herpes simplex virus, care should be taken to prevent colds, upper respiratory tract inflammation, and overwork after surgery. Do not smoke to prevent recurrence of keratitis.