A 24 year old female with no past medical history presents for right eye pain. She does not wear glasses or contacts. About 1 week ago, she was at a beach when she felt like she got sand into her right eye. She has been rubbing that eye often and has been developing worsening pain with gradual loss of vision. Her vital signs are within normal limits. Visual acuity is 20/400 OD and 20/20 OS. Exam demonstrates a 3 x 3 mm pale grey lesion with irregular borders over the right cornea. Fluorescein stain results are shown below. Intraocular pressure is normal. What’s the diagnosis?
Answer: Corneal ulcer
- Corneal ulcers are a vision-threatening emergency that develops due to a disruption in the corneal epithelial barrier that evolves into more extensive involvement.
- The ulcer typically develops days after the initial injury which is an important distinguishing history from a corneal abrasion which has instantaneous symptoms after injury. A corneal abrasion may develop into an ulcer.
- Worrisome complications of corneal ulcers include permanent loss of vision, globe perforation, or endophthalmitis which is an infection of the posterior chamber of the eye.
- Management includes ophthalmology consult for a corneal ulcer wound culture and antibiotic eyedrops. Contact lens wearers should receive coverage for Pseudomonas. Do not patch the eye due to possibility of worsening infection. Other etiologies include Staphylococcus, Herpes, Gonococcal, and less commonly Aspergillus. Eyedrops should be administered every hour and close outpatient follow up with ophthalmology in 24-48 hours should be arranged.
References:
Ahmed F, House RJ, Feldman BH. Corneal Abrasions and Corneal Foreign Bodies. Prim Care. 2015;42(3):363-375. doi:10.1016/j.pop.2015.05.004
Walker RA, Adhikari S. Eye Emergencies. In: Tintinalli JE, Ma O, Yealy DM, Meckler GD, Stapczynski J, Cline DM, Thomas SH. eds. Tintinalli’s Emergency Medicine: A Comprehensive Study Guide, 9e. McGraw Hill; 2020.
