Corneal ulcer. Complications of purulent keratitis (corneal ulcer)

Among the dangerous ophthalmic diseases, leading to a significant impairment of the quality of vision, there is a corneal ulcer. Often, this disease arises from a safer one - erosion, and with untimely seeking medical help or with poor-quality treatment, it flows into a more complex pathology.

Treatment of this disease always depends on the cause of its occurrence and takes place in a hospital.

The cornea of the eye is designed to protect the internal structures of the eye from infection and mechanical damage, this thin transparent structure consists of five layers:

Anterior epithelium, a multicellular layer on the surface of the eye, it is formed from several layers of cells;
Bowman's membrane is a thin network of cells that separates the epithelium and the substance of the stroma, supports it;
The cornea itself is the stroma. This is the most voluminous layer, its cells are arranged in a strict order, they allow a beam of light to pass unhindered;
Descement membrane, a very thin and dense membrane that holds the cornea and serves as a support for other layers;
Endothelium, a thin layer of cells (it is only one) that separates the cornea from the internal structures of the eye.

If the integrity of the upper epithelium is violated, corneal erosion is diagnosed, but if the destruction penetrates through the Bowman's membrane into the stroma, then a corneal ulcer develops.

A corneal ulcer is always treated in a hospital. With a small size, after its healing, a scar appears. The presence of a small scar significantly impairs the quality of vision, as the transparency of the cornea is disturbed, and, consequently, the movement of the beam to the retina slows down or is distorted.

The formation of a large scar can cause blindness. More dangerous will be those ulcers that are in the center of the eye and deeply penetrating.

Causes and symptoms of eye ulcers

Among the factors that cause corneal ulcers, erosion is often called untreated in time.

Ulcers are characterized by most of the causes that provoke the occurrence of erosion:

eye injury;
burns;
ophthalmic diseases causing dry eyes;
the influence of pathogens;
dry eye syndrome.

Among the most common are the misuse of contact lenses, eye injury from foreign objects and excessive dryness of the eyes.

A corneal ulcer in humans causes several characteristic symptoms.

Feeling of sand, pain, severe pain in the eye, which appear during corneal erosion and only increase with time.
Gradually, intolerance to light joins the pain, which is associated with the exposure of nerve endings.
Redness of the cornea, its swelling, and over time, its clouding.
Decreased visual acuity due to clouding of the cornea, its swelling and redness.

All symptoms are pronounced, as the spread of ulcerative processes only increase.

Types and forms of corneal ulcers

Ulcers are divided according to many parameters: acute and chronic - by the course, non-perforated and perforated - by quality, deep and superficial. According to the location on the cornea, peripheral (located closer to the eyelids), paracentral (closer to the center) and central are distinguished.

The nature of the course of the disease is recognized as follows.

Creeping, which spread along the stroma in one direction, while scarring of the edge occurs on the other side. Very often creeping are infected ulcers.
Corrosives appear as several separate foci, which then merge together in the shape of a crescent. The reason for their occurrence has not yet been established.

Most often, ophthalmologists use two terms. Infectious, caused by pathogens and non-infectious - they are provoked by excessive dryness of the eyes.

The most dangerous pathologies will be central creeping and perforated. They lead to permanent loss of vision.

Any type of ulcer, after healing, forms a scar that impairs the quality of vision.

Treatment of corneal ulcer

The diagnosis is made in the ophthalmologist's office after examination using a special device - a slit lamp. In the presence of small sores that are poorly visible, a special dye fluoriscein can be used.

After the diagnosis is made, the doctor may prescribe additional tests (cytology, conjunctival smear culture) to clarify the nature of the infection that provoked the infectious form of the ulcer.

A number of diagnostics are used to assess a deep lesion:

diaphanoscopy,
eye ultrasound,
gonoscopy,
ophthalmoscopy.

If lacrimation disorders are suspected, special tests are used: the Schirmer test, the color nasal tear test, the Norn test.

Studies of blood serum and lacrimal fluid for immunoglobulins may be prescribed.

Treatment of a corneal ulcer is always carried out in an ophthalmological hospital and requires certain skills in carrying out specific procedures.

For an infectious ulcer

At the beginning of the treatment, the defect is extinguished with iodine or brilliant green. The procedure is complex and requires special skills of an ophthalmologist. Its modern analogues are laser and diathermocoagulation.

For non-infectious ulcer

If the appearance of an ulcer is due to a violation of the outflow of tears and the formation of pus in the lacrimal canal, then the lacrimal canal is washed, the purulent focus is surgically removed.

General treatment

Comprehensive treatment is required, which includes the appointment of:

antiallergic drugs (to relieve inflammation and swelling);
keratoprotectors (to moisturize the affected structures);
metabolites (to improve the nutrition of the affected structures);
immunostimulants (to improve recovery processes);
antihypertensive drugs (to reduce swelling and redness).

Treatment of a corneal ulcer in humans involves the systemic administration of drugs intravenously and intramuscularly.

The whole complex of measures is applied locally: instillation of drops, laying ointments, parabulbar and subconjunctival injections.

After removing the exacerbation, at the stage of scarring, physiotherapy is indicated: ultraphonophoresis, electrophoresis. These procedures well stimulate reparative (restorative processes) in the cornea and prevent the formation of a rough scar.

To improve nutrition (trophism) of the affected area, Taufon, Korneragel, etc. are prescribed.

If there is a danger of perforation of the cornea, with purulent forms of corneal ulcers, keratoplasty (corneal transplantation) is used.

Keratoplasty can be through or layered, but in any case it is a complex operation. In its course, the affected area is excised, and a healthy cornea from a donor is transplanted in its place.

To remove a rough scar, excimer laser scar removal is used, the operation is expensive.

Possible complications after an ulcer

A healed corneal ulcer forms a scar, which in any case affects the quality of vision. With extensive ulcers, a thorn (clouding of the cornea) is formed, it leads to complete or partial blindness.

Other complications include proliferation of corneal vessels and the occurrence of corneal vascularization, which also forms a thorn.

A corneal ulcer, when reaching deep structures, forms a descemetotele, a protrusion of the descement membrane.

With its perforation and the formation of a perforated ulcer of the cornea, the iris is infringed into its opening, which provokes the formation of anterior and posterior synechiae. Over time, this leads to optic nerve atrophy and secondary glaucoma.

When the infection penetrates into the deep structures of the eye (vitreous body), endophthalmitis and panophthalmitis occur, which lead to complete loss of vision and the eyeball.

Disease prevention

Treatment of a corneal ulcer is very long and takes from 1.5 to 5 months. In most cases, it is not possible to completely restore vision, and if complications occur, it is completely impossible.

In the prevention of corneal ulcers, safety measures during various work that are potentially hazardous to health, as well as timely treatment of ophthalmic diseases, come to the fore. Often, the appearance of ulcerative processes can be prevented if corneal erosion is treated in time.

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General information

The cornea of the eye has a five-layer structure and includes the epithelial layer, Bowman's membrane, stroma, Descemet's membrane and the lower layer of the endothelium. When the epithelium is damaged, corneal erosion occurs. A corneal ulcer is said to be when the destruction of the corneal tissue extends deeper than the Bowman's membrane. Ulcerative lesions of the cornea are among the severe eye lesions in clinical ophthalmology, which are difficult to treat and often lead to significant impairment of visual function, up to blindness.

The outcome of a corneal ulcer in all cases is the formation of a corneal scar (thorn). An ulcerative defect can be localized in any part of the cornea, but the central zone is most severely affected: it is more difficult to treat, and scarring of this area is always accompanied by loss of vision.

The reasons

For the development of a corneal ulcer, a combination of a number of conditions is necessary: damage to the corneal epithelium, a decrease in local resistance, colonization of the defect with infectious agents. Corneal ulcers can have infectious and non-infectious etiologies:

Exogenous factors contributing to the development of corneal ulcers include:

prolonged wearing of contact lenses (including the use of contaminated solutions and containers for their storage);
irrational topical pharmacotherapy with corticosteroids, anesthetics, antibiotics;
the use of contaminated eye preparations and instruments during medical ophthalmic procedures.
getting into the eyes of foreign bodies, photophthalmia, mechanical damage to the eyes,
previous surgical interventions on the cornea, etc.

In addition to local factors, an important role in the pathogenesis of corneal ulcers belongs to general diseases and disorders: diabetes mellitus, atopic dermatitis, autoimmune diseases (Sjogren's syndrome, rheumatoid arthritis, polyarthritis nodosa, etc.), malnutrition and beriberi, immunosuppression.

Classification

According to the course and depth of the lesion, corneal ulcers are classified into acute and chronic, deep and superficial, non-perforated and perforated. According to the location of the ulcer, there are peripheral (marginal), paracentral and central corneal ulcers. Depending on the tendency to spread the ulcer in width or depth, there are:

Creeping ulcer of the cornea. It spreads towards one of its edges, while the defect is epithelialized from the other edge; in this case, the ulcer deepens with the involvement of the deep layers of the cornea and iris, the formation of a hypopyon. It usually develops against the background of infection of microtraumas of the cornea with pneumococcus, diplobacillus, Pseudomonas aeruginosa.
Corrosive ulcer of the cornea. Etiology unknown; pathology is characterized by the formation of several peripheral ulcers, which then merge into a single crescentic defect, followed by scarring.

Among the main, most common clinical forms, corneal ulcers are distinguished:

Corneal ulcer, as a rule, has one-sided localization. The earliest sign signaling the danger of developing a corneal ulcer is pain in the eye, which occurs even at the stage of erosion and intensifies as the ulcer progresses. At the same time, a pronounced corneal syndrome develops, accompanied by profuse lacrimation, photophobia, eyelid edema and blepharospasm, mixed injection of the eye vessels.

When the corneal ulcer is located in the central zone, there is a significant decrease in vision due to clouding of the cornea and subsequent scarring of the defect. A scar on the cornea, as an outcome of the ulcerative process, can be expressed in varying degrees - from a gentle scar to a rough walleye.

The clinic of a creeping corneal ulcer is characterized by severe pain of a cutting nature, lacrimation, suppuration from the eye, blepharospasm, chemosis, mixed injection of the eyeball. On the cornea, a yellowish-gray infiltrate is determined, which, breaking up, forms a crater-shaped ulcer with regressive and progressive edges. Due to the progressive edge, the ulcer quickly "spreads" along the cornea in width and depth. With the involvement of intraocular structures, it is possible to attach iritis, iridocyclitis, panuveitis, endophthalmitis, panophthalmitis.

With a tuberculous corneal ulcer in the body, there is always a primary focus of tuberculosis infection (pulmonary tuberculosis, genital tuberculosis, kidney tuberculosis). In this case, infiltrates with phlyctenous rims are found on the cornea, which further progress into rounded ulcers. The course of a tuberculous corneal ulcer is long, recurrent, accompanied by the formation of rough corneal scars.

Herpetic ulcers are formed at the site of tree-like infiltrates of the cornea and have an irregular, branched shape. Corneal ulceration due to vitamin A deficiency (keratomalacia) develops against the background of milky-white clouding of the cornea and is not accompanied by pain. The formation of dry xerotic plaques on the conjunctiva is characteristic. With hypovitaminosis B2, epithelial dystrophy, corneal neovascularization, and ulcerative defects develop.

Complications

With timely therapeutic measures taken, it is possible to achieve regression of the corneal ulcer: cleansing its surface, organizing the edges, filling the defect with fibrinous tissue, followed by the formation of cicatricial opacities - walleye.

The rapid progression of a corneal ulcer can lead to a deepening of the defect, the formation of a descemetocele (hernial protrusion of the Descemet's membrane), perforation of the cornea with infringement of the iris in the resulting hole. Scarring of a perforated corneal ulcer is accompanied by the formation of anterior synechiae and goniosinechia, which prevent the outflow of intraocular fluid. Over time, this can lead to the development of secondary glaucoma and optic nerve atrophy.

In the event that the perforation in the cornea is not plugged with the iris, the purulent infection freely penetrates the vitreous body, leading to endophthalmitis or panophthalmitis. In the most unfavorable cases, the development of phlegmon of the orbit, thrombosis of the cavernous sinus, brain abscess, meningitis, sepsis is possible.

Diagnostics

To detect a corneal ulcer, instrumental diagnostics, special ophthalmological tests and laboratory tests are used. Main methods:

Eye examination. The initial examination is performed using a slit lamp (biomicroscopy). The reaction of the deep structures of the eye and their involvement in the inflammatory process is assessed using diaphanoscopy, gonioscopy, ophthalmoscopy, and ultrasound of the eye.
Study of the function of the lacrimal apparatus. When conducting a fluorescein instillation, a sign of the presence of a corneal ulcer is the staining of the defect with a bright green color. In this case, the examination allows you to identify even minor corneal ulcers, assess the number, extent and depth of corneal damage.
Laboratory research. To identify the etiological factors that caused the corneal ulcer, a cytological and bacteriological examination of a smear from the conjunctiva, the determination of immunoglobulins in the blood serum and lacrimal fluid, and microscopy of scrapings from the surface and edges of the corneal ulcer are necessary.

Corneal ulcer treatment

With a corneal ulcer, it is necessary to provide specialized inpatient care under the supervision of an ophthalmologist. Treatment includes topical therapy, systemic drug therapy, physiotherapy, and, if necessary, surgical methods.

In order to prevent corneal ulcers, it is necessary to avoid eye microtraumas, follow the necessary rules when using and storing contact lenses, carry out preventive antibiotic therapy in case of a threat of infection of the cornea, and treat general and eye diseases in the early stages.

A disease characterized by significant destruction of the corneal tissue, usually of a purulent nature, is called.

The cornea of the human eye is a five-layer tissue. If you look from the outside in depth, it consists of: corneal epithelium, Bowman's membrane, stroma, Descemet's membrane, corneal endothelium.

Any damage is an ulcer if the area of its distribution extends deeper than Bowman's membrane of the cornea.

Causes

A corneal ulcer can be caused by completely different reasons:

Mechanical injuries (including falling under foreign bodies);
Exposure to caustic chemicals;
Exposure to high temperatures;
Bacteria and viruses;
Fungal infections;
Dry eyes (dry eye syndrome, neurological disorders, with the inability to close the eyelids, deficiency of vitamins A, B);

At the same time, very often the development of a corneal ulcer is caused by a violation of operation - an incorrect mode of wearing and care. In most cases, it is contact lenses that become the "culprits" of mechanical damage to the corneal tissue, provoking the occurrence of severe inflammatory phenomena - which give rise to the development of an ulcer.

Symptoms of the disease

The main symptom of a corneal ulcer is pain in the eye that occurs immediately after the onset of the disease. Such pain is a consequence of damage to the epithelium, with irritation of the nerve endings, while the pain syndrome increases with the development of the ulceration process.

Pain syndrome occurs simultaneously with abundant, which is caused by pain, as well as irritation of nerve endings.

In addition, the process of ulceration is accompanied by a condition.

The reaction of adjacent vessels to irritation of nerve endings - the environment, which, however, can also serve as a manifestation of inflammation accompanying an ulcer.

If the pathological process is localized in the central zone, it can proceed against the background of a noticeable decrease in vision, due to tissue edema and a decrease in the transparency of the cornea.

Complications

Peptic ulcer also damages the stroma of the cornea, which, when restored, can form a hard scar. In this case, depending on the size of the damage, the scar is either barely pronounced or very noticeable (). The appearance of a walleye provokes massive germination of newly formed vessels into the cornea, this process is called neovascularization.
Often, with extensive deep ulcers, accompanied by infectious inflammation, intraocular structures are involved in the process - the ciliary body. Development begins, which in the first phase is aseptic in nature and is the result of simple irritation. Later, with the development of inflammation, infectious agents penetrate the eye - the second phase of infectious iridocyclitis sets in, which can provoke the occurrence of endophthalmitis and panuveitis, which threatens blindness or loss of the eye.

Such severe complications can be observed with a significant progression of ulceration, complicated by an infectious process with damage to the entire corneal tissue - a perforated ulcer.

Video what a corneal ulcer looks like

Diagnostics

Diagnosis of a corneal ulcer occurs during an ophthalmological examination. Such an examination involves the inspection of the entire surface of the cornea using a special microscope - a slit lamp. A mandatory procedure is also additional staining of the cornea with a medical dye - a fluorescein solution, which helps to detect even minor areas of damage. An ophthalmological examination makes it possible to identify the extent of damage, the reaction of the internal structures of the eye to the inflammatory process, and the complications that have begun.

Corneal ulcer treatment

Persons diagnosed with a corneal ulcer should receive treatment in a specialized hospital. It is here that it is possible to clarify the causes of the disease and establish treatment tactics.

So, the infectious process, as a rule, requires massive anti-infective therapy, anti-inflammatory treatment (both locally and systemically).

Where to treat

A corneal ulcer is a serious ophthalmic disease that threatens with serious consequences. Therefore, the choice of a medical institution should take into account both the cost of treatment and the level of qualification of the clinic's specialists. At the same time, be sure to pay attention to the equipment of the institution with modern equipment and its reputation among patients. Only in this way can you achieve a guaranteed result.

The ulcer got its name for the tendency to spread along the cornea: both on the surface and in depth. The development of an ulcer can be so rapid (especially when infected with Neisseria gonorrhoeae and Pseudomonas aeruginosa) that the ulcer captures the entire cornea within 2-3 days.

The causative factor is pneumococcus (Streptococcus pneumoniae), less often other streptococci, staphylococci, gonococci, Pseudomonas aeruginosa, Moraxella-Axenfeld diplobacilli (Moraxella lacunata, etc.), which penetrate into the thickness of the cornea after a slight injury to it.

The source of infection is often the lacrimal ducts (chronic purulent dacryocystitis), the conjunctival sac, the edge of the eyelids, the nasal cavity, the paranasal sinuses, and the instruments used to remove foreign bodies of the cornea.

Clinical picture

The disease begins acutely with decreased vision, photophobia, lacrimation, closure of the palpebral fissure, and a feeling of severe pain. The conjunctiva is sharply hyperemic, edematous. In the center of the cornea, a rounded grayish-yellow infiltrate appears, which quickly ulcerates. A purulent ulcer is formed with an undermined edge surrounded by a band of purulent infiltrate (progressive edge of the ulcer). The cornea around the ulcer is edematous. Pus appears in the anterior chamber, indicating involvement in the inflammatory process of the iris and ciliary body. Fusions are formed between the inner membranes and structures of the eye.

The progressive edge of the ulcer sometimes spreads so rapidly that within a few days the ulcer can capture most of the cornea. At the same time, the opposite edge of the ulcer begins to epithelialize and the pus gradually resolves. In some cases, the ulcer spreads not only over the area of the cornea, but also in depth, which can lead to necrosis of the entire corneal tissue and infection of the inner membranes of the eye. This causes the development of endophthalmitis and panophthalmitis.

Further, in the case of progression of the process, phlegmon of the orbit, thrombosis of the veins of the orbit and cavernous sinus may occur. If the process stops at the level of ongoing endophthalmitis, atrophy or subatrophy of the eyeball is formed in the outcome.

A creeping ulcer is characterized by a triad of symptoms:

specific type of ulcer - the ulcer has a progressive infiltrated edge, beyond which the inflammatory process spreads and regresses, it is much less infiltrated, where the reverse process of healing takes place. Around the ulcer, the cornea is edematous, thickened, grayish, and folds of the Descemet's membrane (descemetitis) are visible in its thickness.
hypopyon
iridocyclitis - often it is a secondary fibrinous-purulent iridocyclitis with the presence of posterior synechia of the iris.

All 4 stages of the ulcer may be present at the same time. Newly formed vessels may appear in the scarring area.

With a creeping ulcer gonococcal etiology the pathogen very often penetrates through the intact epithelium and within 3-4 days a descemetocele can form and corneal perforation occurs with the insertion of the iris and the formation of anterior synechiae. In this case, the penetration of infection into the internal membranes with the development of endo- and panophthalmitis is possible.
For a creeping ulcer caused by Pseudomonas aeruginosa , characterized by the presence of chemosis, rapid progression of the type of circular abscess, capturing the entire cornea. Often the anterior layers of the cornea peel off and hang down. In all patients, an abundant liquid hypopyon of a grayish color is found. Within 2-3 days, infiltration of the entire cornea occurs, it thickens 3-5 times. In the center of it, a large deep crater-like ulcer is formed, then necrosis quickly develops, extensive perforation, and the eye dies.

After corneal perforation, further development can take place in two directions.

In some cases, after perforation, the ulcer heals with the formation of cataracts stuck together with the iris.
In other cases, the infection penetrates into the eye cavity, where a severe inflammatory process develops - endophthalmitis or panophthalmitis, which leads to the death of the eye.

Treatment

Self-help consists in a timely visit to a doctor about blepharitis, dacryocystitis, improper eyelash growth (trichiasis), washing the eyes if contaminated foreign particles get into them, instilling a solution of sodium sulfacyl. If symptoms of keratitis appear, an urgent visit to the doctor is necessary. A doctor of any specialty should make a preliminary diagnosis of keratitis and urgently hospitalize in an eye hospital.

A preliminary procedure is washing the lacrimal ducts with a weak solution of an antibiotic in order to sanitize and diagnose possible obstruction of the lacrimal canal. If chronic inflammation of the lacrimal sac is detected, urgent dacryocystorhinostomy is indicated. If possible, prior to the use of local antibiotics and sulfonamides, cultures should be made from the conjunctiva of the diseased eye and from the surface of the ulcer to isolate the causative agent of the disease and subsequently conduct etiotropic treatment, taking into account the greatest sensitivity of the flora to a particular chemotherapy drug.

Local treatment of a creeping corneal ulcer consists in instillation of antibiotic solutions into the conjunctival sac: 0.25-0.5-1% solutions of neomycin, monomycin, kanamycin, levomycetin, benzylpenicillin, polymyxin (when sowing Pseudomonas aeruginosa) 6-8 times a day, laying an antibacterial ointment or medicinal films. Sulfonamide solutions are instilled: 20-30% sodium sulfacyl, 10-20% sodium sulfapyridazine. Broad-spectrum antibiotics are injected under the conjunctiva. If necessary, antibiotics are prescribed orally and intramuscularly. Distractions, mustard plasters on the back of the head, hot foot baths, etc. are recommended.

In connection with secondary iridocyclitis, instillations of a 1% solution of atropine sulfate are prescribed, 2 drops 3 times a day. Antibiotics and sulfonamides are prescribed intramuscularly or orally.

Upon receipt of the results of a bacteriological study, an appropriate correction in the treatment is carried out - drugs are prescribed to which the detected microflora is sensitive.

It is also recommended stimulating and restorative treatment. If the hypopyon does not resolve for a long time and the ulcer progresses, corneal paracentesis is performed with washing of the anterior chamber with antibiotics and their introduction into the anterior chamber. If there is a threat of perforation of the ulcer, keratoplasty (tectonic, therapeutic) or biocoating is necessary.

As infiltration decreases, anti-inflammatory therapy decreases, reparative therapy is added and intensified, physiotherapy (magnetotherapy), laser stimulation and resorption therapy are added.

A corneal ulcer is a disease associated with significant destruction of the corneal tissue.

The cornea of the human eye consists of five layers. If listed outside, they are arranged in this order: corneal epithelium, Bowman's membrane, corneal stroma, Descemet's membrane, corneal endothelium. A corneal injury is called an ulcer only if it extends deeper than the Bowman membrane of the eye.

Causes of corneal ulcer.

A corneal ulcer can be caused by various factors:

Mechanical trauma to the eye, for example, a foreign body.
Eye burns - damage to the cornea of \u200b\u200bthe eye when exposed to high temperatures, caustic chemicals.
pathogenic bacteria; viruses, especially the herpes virus; fungal infection can cause inflammation of the cornea of the eye, i.e. keratitis, which in turn can lead to severe destruction of the corneal tissue.
Increased dryness of the eye in violation of the production of tears, such as dry eye syndrome; with neurological disorders and the inability to close the eyelids; with a lack of vitamins in the body, especially vitamins A and B.

Uncontrolled use of eye drops, mainly painkillers and anti-inflammatory drugs, leads to disruption of metabolic processes in the cornea, increasing the risk of its destruction.

Violation of the rules for processing and wearing contact lenses can cause both mechanical damage to the corneal tissue and provoke the development of a severe inflammatory process, that is, keratitis, often turning into an ulcer.

Symptoms of a corneal ulcer.

Pain in the eye occurs immediately after the appearance of corneal erosion, that is, damage to the epithelium, and, as a rule, increases with the progression of the process and the appearance of an ulcer. The pain syndrome is associated with irritation of the nerve endings of the cornea.
Simultaneously with the pain, profuse lacrimation appears due to the pain syndrome and irritation of the nerve endings.
Photophobia is also a manifestation of severe pain in the eye.
Redness of the eye is a manifestation of the response of local vessels to severe irritation of nerve endings or be a sign of an incipient inflammatory process that accompanies an ulcer.

If the corneal ulcer is located in the central zone, then vision will be significantly reduced, as the surrounding corneal tissue swells, resulting in a decrease in its transparency. In addition, since the stroma of the cornea is damaged during an ulcer, a scar is formed while recovering. Depending on the amount of damaged tissue, the scar can be expressed to varying degrees, from barely noticeable to very pronounced, the so-called corneal cataract. Quite often, when a corneal walleye occurs, the germination of newly formed vessels on the cornea occurs, that is, neovascularization of the cornea.
Very often, with deep or extensive ulcers with manifestations of the infectious process, intraocular structures are also involved - the iris and the ciliary body, that is, iridocyclitis develops. At first, iridocyclitis in such a situation is aseptic in nature, that is, it is the result of simple irritation, but then, with the progression of the inflammatory process, the infection can pass into the cavity of the eye with the development of infectious secondary iridocyclitis, and even endophthalmitis and panuveitis, leading to loss of vision and eyes. As a rule, such severe complications are observed with a pronounced progression of the ulcer against the background of an infectious process with the destruction of the entire corneal tissue, that is, the development of a perforated ulcer.

Diagnostics.

A corneal ulcer is detected during an ophthalmological examination. The entire surface of the cornea is examined using a microscope, the so-called slit lamp.

Small ulcers can be missed, so the cornea is additionally stained with a dye, such as a fluorescein solution, thanks to which even the smallest areas of damage can be detected. Examination reveals the extent and depth of damage to the cornea, as well as the reaction of intraocular structures to the inflammatory process and other complications.

Treatment.

Patients with a corneal ulcer should be treated in an ophthalmological hospital. The cause of the disease is clarified, since the tactics of treatment depend on it. In the infectious process, a massive anti-infective and anti-inflammatory treatment is prescribed. With a lack of tears, drugs are prescribed that moisturize the surface of the eye. Vitamin therapy is also carried out, vitamins of groups A and B are especially widely used.
Be sure to supplement the main treatment with drugs that improve the restoration of the cornea and strengthen it. With a pronounced inflammatory process, especially with the threat of perforation of the cornea, it is possible to perform a surgical operation with a therapeutic purpose - penetrating or layered keratoplasty. This is a very complicated operation, in which the altered area of the cornea of the eye is removed, transplanting the corresponding area of the cornea of the donor's eye into its place.