Corneal ulcer – main causes and best treatments. Corneal ulcer Creeping corneal ulcer

Due to infection or under the influence of other factors, an ulcer of the cornea of the eye occurs in humans. The disease is accompanied by pain, involuntary blinking, photophobia, and the appearance of pus. There are several types of pathology, which has dangerous consequences in the form of the formation of a cataract, glaucoma, optic nerve atrophy, and the spread of infection to other organs. It is recommended to promptly consult a doctor who will diagnose and prescribe effective treatment.

Why does pathology occur?

Poor nutrition leads to a lack of microelements and vitamins, which negatively affects the cornea.

An ulcer on the cornea occurs as a result of destructive processes in which a defect in the form of a crater is formed on Bowman's membrane. There are several types of pathology, but the most severe is considered to be a marginal creeping corneal ulcer. It is characterized by a deepening in one of its borders and capture of the iris tissue. The disease is provoked by the following factors:

burns and eye injuries;
infection with pathogenic microorganisms (streptococci, staphylococci, Pseudomonas aeruginosa, herpes viruses, gibi, acanthamoeba);
incorrect use of contact lenses and improper care of them;
uncontrolled use of medications;
development of dry eye syndrome;
unnatural direction of eyelash growth;
chronic ENT diseases;
infectious diseases of the organs of vision (conjunctivitis, keratitis, trachoma);
diabetes mellitus;
arthritis;
decreased immunity;
use of non-sterile equipment for ophthalmic or aesthetic manipulations in beauty salons.

Symptoms: how does the disease manifest itself?

The growth of a bacterial infection provokes the appearance of purulent discharge.

Most often, a purulent corneal ulcer appears at stage 2 of keratitis due to tissue death. The disease is accompanied by the following symptoms:

photophobia;
pain and stinging in the eye;
foreign body sensation;
lacrimation;
involuntary blinking of the eyelids;
swelling of the eyelids and conjunctiva;
formation of infiltrate from particles of cells, lymph and blood;
the appearance of purulent discharge;
clouding of the cornea;
blurred vision;
redness of the sclera.

Diagnostic measures

Laboratory diagnostics will help determine the nature of the lesion.

Keratitis and corneal ulcers are identified and treated by an ophthalmologist. The doctor performs the following diagnostic procedures:

examination of the cornea with a slit lamp;
instillation test using fluorescein solution;
gonioscopy to visualize the anterior chamber;
measurement of intraocular pressure;
diaphanoscopy;
ophthalmoscopy;
ultrasound examination of ocular structures;
bacterial culture of purulent discharge from the eyes;
microscopy;
biochemical blood test.

How is the treatment carried out?

Drug therapy

Medicines must be prescribed by a doctor; self-medication is dangerous. Comprehensive treatment of creeping corneal ulcers includes drops and ointments shown in the table:

Changes in the structures lead to the formation of scars, so treatment of corneal ulcers includes physiotherapeutic methods, such as:

magnetic therapy;
electrophoresis;
UHF therapy;
diadynamic therapy;
exposure to ultrasound;
ultraviolet irradiation;
diathermocoagulation.

The initial stage of an eye ulcer is successfully treated, since the methods have the following effect:

relieve pain and inflammation;
promote tissue regeneration;
normalizes blood circulation;
eliminates the consequences of the inflammatory process;
stops vision loss.

An eye ulcer in humans (ulcerative keratitis) is a severe lesion, one of the most complex in modern ophthalmology. The disease is difficult to treat, especially with deep lesions, can lead to disability, and significantly reduces the quality of life.

What is a corneal ulcer and why is it dangerous? Without treatment, the disease leads to blindness and the formation of scarring. A corneal ulcer is an ulcerative process that is accompanied by the formation of a crater-shaped defect.

Species

Depending on the depth of the lesion, deep and superficial, acute and chronic corneal ulcers are distinguished. According to the width and depth of distribution of the ulcerative defect, they are corrosive and creeping. The specific type of disease can only be determined by an ophthalmologist, using the results of the examination and diagnostic data.

A separate group includes persistent corneal ulcers, which often appear in patients with diabetes. Defects of this type do not heal well and often recur, quickly leading to blindness.

Creeping corneal ulcer

A creeping corneal ulcer is characterized by the involvement of deep layers, including the iris, in the ulcerative infectious process. The disease is characterized by a severe course. The main cause of creeping corneal ulcers is infection with Pseudomonas aeruginosa and pneumococci. The causative agents of the disease enter the eye from the outside, through microdamages and injuries.

Causes

Ulcerative eye damage occurs due to the action of infectious and non-infectious factors. Bacterial and purulent ulcers of the cornea appear against the background of contact with the mucous membrane of staphylococci, streptococci, Pseudomonas aeruginosa, and pneumococci.

Additional causes of the disease:

improper use of contact lenses, when no attention is paid to infection safety;
long-term use of corticosteroids and antibiotics;
use of contaminated instruments during diagnosis or treatment of eye diseases;
vitamin A deficiency;
pathological dryness of the cornea;
foreign bodies getting into the eyes, mechanical, chemical, thermal injuries;
poor-quality ophthalmological operations;
chronic eye diseases, including;
decreased local immunity;
hormonal disorders, diseases of the endocrine glands, including diabetes;
autoimmune diseases.

Having established the causes of the disease, the ophthalmologist can not only select treatment, but also develop an individual plan for the prevention of relapses and the development of complications.

Immunodeficiency states and hormonal changes contribute to the development of the disease. It is necessary to monitor blood glucose levels in those patients who suffer from persistent corneal ulcers. Also, the ophthalmologist must exclude the presence of vitamin deficiency through laboratory diagnostics.

Symptoms

An ulcerative defect in the cornea is most often unilateral. Before its appearance, pain occurs in the eye, which only intensifies every day.

Additional symptoms of a corneal ulcer in humans:

lacrimation;
swelling of the eyelids;
cutting pain;
discharge of pus from the eyes;
decreased quality of vision;
clouding of the cornea with further scarring of the ulcerative defect.

When symptoms of a corneal ulcer appear in a person, treatment should begin as early as possible to avoid adverse health effects and vision loss in the future.

Diagnostics

Ulcerative eye defects are diagnosed during biomicroscopy. The examination method makes it possible to detect even minor changes of a degenerative and inflammatory nature, as well as areas with clouding. Biomicroscopy is carried out using a special slit lamp. It is a binocular microscope with a modern lighting system.

Additional diagnostic methods:

ophthalmoscopy;
Ultrasound of the eye;
measurement of intraocular pressure;
diaphanoscopy;
cytological examination of conjunctival smears.

Treatment

Treatment is carried out by an ophthalmologist. To prevent the expansion of the ulcerative defect, it is extinguished using tincture of iodine or brilliant green. It is also possible to use laser coagulation.

Depending on the type of pathogen, antibacterial therapy is used. An ophthalmologist can prescribe antifungal and antiviral agents, taking into account the diagnostic results. To relieve inflammation, swelling and redness, anti-inflammatory and antihistamine drugs are prescribed. Correction of local immunity requires the use of immunomodulatory agents.

Medicines can be used in the form of ointments, instillations, subconjunctival injections. Physiotherapy includes electrophoresis and magnetic therapy. These methods prevent the formation of rough scar tissue and accelerate the processes of regeneration and restoration of mucous tissues.

With timely initiation of treatment, it is possible to clean the damaged surface and fill the formed crater with new tissue.

It is not always possible to avoid cloudiness, but the growth of a peptic ulcer can only be prevented with the help of qualified and timely assistance from an ophthalmologist.

Complications

The most common complications are infectious ulcers accompanied by a purulent process. But the prognosis of the disease largely depends on the stage at which the patient seeks ophthalmological help. Any pain in the eye is a reason to visit a doctor.

Common complications of a purulent corneal ulcer are:

excessive expansion, deepening of the ulcerative defect;
the formation of a hernia-like protrusion;
perforation of the cornea;
formation of rough scars;
development and blindness;
optic nerve atrophy;
phlegmon of the orbit;
brain abscess;
blood poisoning.

If the course is unfavorable, a purulent infection can spread to the vitreous body, provoke the development of brain abscess, meningitis and blood poisoning. The outcome of the disease is clouding of the stratum corneum. This complication is accompanied by a decrease in visual acuity and occupies a leading place among all causes of blindness. To prevent the formation of a cataract, it is necessary to promptly treat injuries that patients often receive at home and during the performance of professional duties.

The causative agent of creeping corneal ulcers is considered to be pneumococcal infection. Much less commonly - diplobacillus Morax-Axenfeld, streptococcus, staphylococcus.

A creeping ulcer occurs only after microtraumas of the cornea, which are sometimes so insignificant that patients, and often medical workers, do not attach much importance to them. Damage to the corneal epithelium is caused by small foreign bodies (at work and at home), scratches from tree branches, dry leaves, straw, hay, etc.

For a creeping ulcer to occur, in addition to superficial trauma, infections must also penetrate into the corneal wound. The causative agent of infections rarely penetrates the wound with the damaging foreign body itself. In most cases (50%), the source of infection is the conjunctiva and lacrimal ducts, especially in the presence of purulent inflammation of the lacrimal sac (dacryocystitis).

The disease begins acutely with the appearance of a characteristic corneal syndrome. A grayish-yellow infiltrate appears on the cornea, most often in the center, which soon disintegrates and turns into a crescent-shaped or disc-shaped ulcer with a purulent-infiltrated bottom and a characteristic appearance of the edges: one edge of the ulcer (regressive edge) is cleared, becomes smooth and covered with epithelium, and the opposite edge (progressive) is sharply infiltrated, raised by a roller, hangs over the ulcer and is undermined in the form of a pocket. The cornea around this edge is infiltrated and diffusely cloudy. The progressive edge quickly spreads, creeps along the surface of the cornea and within 3-5 days the entire cornea becomes infiltrated and molten.

Often the ulcer spreads not only on the surface, but also deep, reaching the posterior limiting membrane (Descemet's membrane). This membrane is resistant to the lytic action of infection and does not melt. But under the influence of pressure inside the eye, it stretches and a black bubble (descemetocelle) appears in the area of the destroyed stroma. There is a threat of perforation, which can occur with the slightest pressure on the eyeball, straining, sneezing, blowing the nose, etc.

Vascularization of the cornea with a creeping ulcer is absent or very weakly expressed. Usually, already in the first days of the disease, the iris and ciliary body are involved in the process as a result of the action of toxins penetrating deep into the eye through the cornea. Pain in the eye sharply increases, the color of the iris changes, the pupil narrows and its reactions disappear, and when the pupil dilates with mydriatics, its irregular shape (scalloped) is revealed due to the formation of posterior synechiae.

As a consequence of the development of purulent inflammation of the ciliary body (purulent cyclitis), purulent exudate appears at the bottom of the anterior chamber (hypopyon), consisting of fibrin and leukocytes. But it remains sterile until the ulcer perforates. Initially, the hypopyon looks like a yellow stripe (in the form of a horizontal level) at the bottom of the chamber. Being liquid, the pus moves when the position of the patient's head changes. Subsequently, sometimes very quickly, the amount of exudate increases; due to the coagulation of fibrin, the pus becomes viscous and turns into a film fused to the posterior surface of the cornea.

Sometimes perforation of the ulcer quickly occurs due to the lytic effect of the hypopyon on the epithelium and Descemet's membrane. After perforation of the ulcer, it usually clears and recovers, but with the formation of a corneal cataract (leukoma) fused to the iris or flattening of the cornea, or the formation of staphyloma. Secondary glaucoma often develops, which leads to excruciating pain, as a result of which it is necessary to resort to surgical treatment, and if ineffective, to enucleation (removal of the eyeball).

In some cases, after the ulcer perforates, the infection penetrates into the eye and causes endophthalmitis (purulent inflammation of the vitreous body), panophthalmitis - purulent inflammation of all the membranes of the eye. In this case, there is a need for eviceration (removal of all contents) of the eyeball. Or the process ends with eye atrophy.

Treatment of patients with a creeping corneal ulcer should be carried out in a hospital. To

treatment, it is necessary to conduct a bacteriological study of scrapings from a corneal ulcer and determine sensitivity to antibiotics. However, without waiting for the result of the study, broad-spectrum antibiotics are prescribed, according to the principles of treatment of keratitis: penicillin, streptomycin, gentamicin, cyclosporins or others, affecting staphylococci, Pseudomonas aeruginosa and other pyogenic flora (neomycin 0.1 per 1 kg of weight 6 times a day, polymyxin 250,000 units 4 times a day, monomycin 250,000 units 4-6 times a day, morphocycline, etc.). At the same time, tetracycline drugs and chloramphenicol are also prescribed orally. Locally:-6 times a day instillation of a 30% solution of albucid, a solution of penicillin (10,000 units per 1 ml), application of 1-2.5% syntomycin emulsion, 30% albucid ointment. You can use nitrofuran preparations: a solution of furazolin 1:3000, which often has an even stronger therapeutic effect than albucid - 6 times a day; at the same time furazolidone 0.1 is also prescribed orally 4 times a day. It is recommended to prescribe antifungal drugs locally: a solution of nystatin 100,000 units in 1 ml, amphotericin 3-5 mg in 1 ml dist. water, etc.

Currently, physical methods of treating ulcers are also used.

cornea (diathermocoagulation of the ulcer, scarification of its bottom followed by cauterization of 5% alcohol tincture of iodine, cryotherapy and cryocoagulation of the ulcer, laser coagulation).

Now there are possibilities for conservative cleansing of ulcers using

enzymes. Ribonuclease obtained from the pancreas of cattle has a particularly good effect. This enzyme is capable of breaking down polypeptides of necrotic tissues, sputum, fibrinous deposits, mucus and, thereby, liquefying them, which helps cleanse the ulcer. In addition, RNase also has an anti-inflammatory effect. RNase powder is applied to the ulcer once a day. Other types of treatment are used at the same time.

Another proteolytic enzyme is also used - collagenase (1

An ampoule of the dry preparation is dissolved in 3-5 ml of saline. solution). Collagenase not only helps cleanse corneal ulcers and reduce the inflammatory reaction, but also prevents the formation of intense corneal cataracts, as it delays collagen formation in the area of inflammation. Collagenase has a highly specific ability to digest collagen. The treatment method consists of instilling solutions of various concentrations (1 ampoule of dry preparation per 3-5 ml of physic solution, 4-5 times a day). After 1-3 days, a noticeable cleansing of the ulcer and a decrease in inflammation are observed.

Antibiotics and enzymes can be administered using electrophoresis. Good

the effect is provided by lidase in the form of an ointment (32 units of lidase per 20.0 tetracycline or other ophthalmic ointment).

For concomitant iridocyclitis, mydriatics are prescribed; for dacryocystitis, surgical treatment is prescribed.

Application of a bandage is contraindicated. Instead, a curtain or mesh is recommended.

If the hypopyon occupies a significant part of the anterior chamber and does not resolve under the influence of treatment, then they resort to opening the anterior chamber and washing it with physical fluid. solution with penicillin.

In some cases, when conservative treatment is ineffective and the ulcer quickly

progresses both on the surface and in depth, they resort to therapeutic layered keratoplasty.

Prevention. The most important measure to prevent creeping corneal ulcers

is: 1) prevention of eye injuries in production and agriculture; 2) urgent medical care for the slightest damage to the cornea (albucid, antibiotic ointments); 3) timely treatment of conjunctivitis and dacryocystitis.

If improvement from outpatient treatment does not occur within 1-2 days, it is necessary to

refer for inpatient treatment.

Corneal ulcer is one of the most dangerous ophthalmological diseases, which leads to serious vision problems. Most often, the anomaly progresses against the background of erosion. In the absence of proper treatment and ignoring a visit to the clinic, a mild deviation develops into a serious illness. Treatment of the disease is carried out in a hospital.

The main purpose of the element is to protect the internal structures of the visual apparatus from infection and mechanical injuries to the eye. The cornea is a thin transparent film, which consists of five layers:

Anterior epithelium. Located on the surface of the eye;
Bowman's membrane. This is a thin cellular layer that acts as a “barrier” between the epithelium and stroma;
Endothelium. Separates the cornea from the internal elements of the visual apparatus;
Descement membrane. A thin, but very dense shell that holds the cornea and acts as a supporting element for the remaining layers;
Stroma. The cells are arranged in a certain order, thanks to which a beam of light penetrates freely through them.

If the top layer (epithelium) is damaged, doctors diagnose corneal erosion. However, when pathological processes penetrate the stroma, an ulcer develops. Treatment of the anomaly is carried out exclusively in a hospital. Even small sizes of the formation after healing leave scars that resemble a thorn in appearance.

The greatest danger lies in ulcers located in the central part of the eye and penetrating deep into its structures.

Types and forms of corneal ulcers

Pathology has many different classifications: according to the type of course it is divided into acute and chronic forms, according to quality into perforated and non-perforated. An eye ulcer in a person can be located on the surface or in the deep layers. Based on its location, the disease is divided into central, peripheral (located near the temples) and paracentral (closer to the middle of the eye).

Based on the nature of its course, the disease is divided into two types:

Creeping. They spread throughout the stroma, but only in one direction. At the same time, scarring of the edge is observed on the opposite side. Most often, creeping ulcers are infected;
Corrosive. These are several foci that unite with each other and resemble a crescent in appearance. The reason for the development of this form has not yet been established.

In practice, ophthalmologists most often use two definitions: infectious, which are provoked by pathogenic microorganisms, and non-infectious, the reason for their development is severe dry eye.

Causes of the disease

A purulent corneal ulcer occurs under the influence of the following factors:

Burn of the organ of vision. Occurs as a result of exposure to high temperatures or contact with chemicals;
Mechanical damage to the eye, for example, penetration of a foreign body;
Infection of the eye with pathogenic bacteria and fungi;
Dry eye syndrome;
Failure to comply with the rules for the use and storage of contact lenses.

Vitamin deficiency and improper use of eye drops, which leads to a failure of metabolism in the cornea, can also lead to the formation of ulcers.

Symptoms

Pathology always affects only one eye. The exception is an extensive burn or mechanical injury to both the left and right eyes. The first symptom of the disease is severe pain. It may appear immediately or twelve hours after injury. If the cause of the development of the disease lies in harmful bacteria, then the first symptom makes itself felt even later.

Almost immediately after the onset of pain, patients note the occurrence of increased lacrimation and intolerance to bright light. Also characteristic signs of an ulcer are:

Redness of the conjunctiva;
Swelling of the eyelid in the area of the damaged eye;
A feeling that a foreign object has entered the eye;
Deterioration of visual acuity;
In some cases, there is pain when trying to open the eye.

A severe form of the disease in the absence of proper therapy is accompanied by the formation of scars (cataracts) that cannot be removed.

Diagnostic methods

If an ulcer is suspected, the doctor will first examine the patient using a slit lamp. To make an accurate diagnosis, the eyeball is stained with fluorescent; it gives the damaged areas a rich green tint.

Based on the intensity of the color and the size of the spot, the doctor makes a conclusion about the depth of the lesion. The procedure allows you to identify microscopic lesions that cannot be seen during normal visual examination. Diagnostics also includes a number of activities:

Ultrasound examination of the eyeball;
Ophthalmoscopy;
Tonometry (measurement of intraocular pressure);
Diaphanoscopy.

The difference between ulcerative lesions of the eye organ and erosion

The initial symptoms of the pathologies are almost identical. But if erosion can be easily and quickly gotten rid of, it goes away without consequences for health, then with an ulcer everything is much more complicated. The anomaly is difficult to treat; it affects the deep layers of the organ of vision. In addition, the ulcer causes problems with visual acuity and can lead to blindness.

Since the signs of the diseases are very similar, it is imperative to consult a doctor before starting treatment.

After watching the video, you will finally understand how erosion differs from an ulcer.

Possible complications

The main consequence of the pathology is the formation of a scar (cataract), which negatively affects visual function even if it is small in size. If during the development of the disease the deep layers are affected, the risk of damage to the ciliary body and iris increases. As a result, the patient may develop iridocyclitis.

Also, if left untreated, an ulcer can lead to a number of serious complications:

Proliferation of the vascular system of the cornea;
Formation of the descemetote body, leading to protrusion of the membrane;
A perforated ulcer often causes pinching of the iris, resulting in the formation of synechiae. In most cases, this leads to secondary glaucoma and optic nerve atrophy;
If the infection gets into the deeper layers, panophthalmitis develops.

General treatment

If a pathology is detected, a mandatory therapeutic course is prescribed, which includes taking certain medications:

Antihistamines (help get rid of swelling and inflammation);
Keratoprotectors (moisturize damaged elements);
Metabolites (normalize nutrition of affected tissues);
Immunostimulants (accelerate the regeneration process);
Antihypertensives (reduce the severity of swelling and redness).

Treatment of the disease involves the administration of drugs intravenously and intramuscularly. To achieve maximum effect, doctors use all therapeutic measures: the use of eye drops, ointment, parabulbar vaccination.

After acute symptoms have been relieved, at the stage of scar tissue formation, physiotherapy (for example, electrophoresis) is prescribed. It activates regeneration in the cornea and prevents the formation of rough cataracts.

To improve the nutrition of damaged structures, it is recommended to use Taufon or Korneragel. The purulent form of the ulcer is treated exclusively through surgery; the patient undergoes keratoplasty (donor tissue transplantation). It can be end-to-end or layer-by-layer. During the operation, the damaged area is excised, and a healthy membrane obtained from a donor is placed in its place.

To get rid of a scar, you will need to perform an expensive operation using an excimer laser.

A purulent corneal ulcer is an eye disease that is caused by extensive destruction of the corneal tissue of the eye with the release of pus. It is a crater-shaped ulcerative defect, accompanied by decreased vision and clouding of the membrane. In ophthalmology, a corneal ulcer is a severe eye lesion that is difficult to treat. In this case, visual function is significantly impaired.

Reasons

A corneal ulcer in humans can be caused by various factors:

eye burns, which include damage caused by exposure to caustic chemicals and high temperatures;
mechanical injury to the eyes (for example, foreign body penetration);
viruses, pathogenic bacteria, fungal infections, herpes virus - all this can cause inflammation of the layers of the cornea of the eyes; Initially, keratitis often develops, leading to serious tissue destruction;
syndrome when tear production is disrupted;
neurological disorders;
inability to close eyelids;
vitamin deficiency (especially vitamins A and B);
uncontrolled use of eye drops (anti-inflammatory and painkillers), leading to disruption of metabolic processes in the cornea and its destruction;
improper processing and violation of the use of contact lenses, which can cause mechanical damage to the corneal tissue and provoke a severe inflammatory process;
A favorable background for the formation of corneal ulcer is the presence of disorders of the auxiliary functioning of the organ of vision (trachoma, conjunctivitis, blepharitis, trichiasis, dacryocystitis, entropion of the eyelids, damage to the trigeminal and oculomotor cranial nerves).

In the development of corneal ulcers, an important role is played by general disorders and diseases of the body: atopic dermatitis, diabetes mellitus, autoimmune diseases (rheumatoid arthritis, Sjogren's syndrome), vitamin deficiency and exhaustion.

Symptoms

Immediately after the onset, the patient experiences pain in the eye. This is due to the fact that irritation of the nerve fibers of the cornea occurs. The pain is accompanied by profuse lacrimation. At the same time, patients note:

photophobia;
redness of the eye, which is manifested by the reaction of local vessels to irritation of nerve endings;
When the cornea is located in the central zone, there may be a significant decrease in vision due to tissue swelling and clouding.

With an ulcer, the corneal stroma is often deformed and when it is restored, a scar is formed, which can be invisible or very pronounced (until the formation of a cataract).

Often, with extensive and deep ulcers and the simultaneous manifestation of the infectious process, intraocular structures are affected - the ciliary body and the iris. Ulcerative keratitis develops, which leads to loss of vision.

Classification

According to the depth and course of corneal ulcers, they are divided into:

chronic;
spicy;
superficial;
deep;
perforated;
unperforated.

According to the position of ulcerative defects there are:

peripheral (marginal);
paracentral;
central ulcers.

According to the area of distribution of the defect in depth or width, ulcers are distinguished:

creeping, which spreads towards one edge, and on the other edge the defect epithelializes; such an ulcer develops against the background of infected microtraumas of the organ with diplobacillus, pneumococcus, Pseudomonas aeruginosa;
corrosive, the etiology of which has not been established; This type of corneal ulcer is characterized by the formation of several peripheral ulcers, which subsequently merge into one crescentic defect, which then scars;
purulent, arising due to the development of pneumococcal infection, which penetrates the site of corneal erosion; the main symptom is the appearance of a white infiltrate in the central part, which then turns into an ulcer with yellowish pus discharged;
herpetic - this type of ulcer is characterized by a long and sluggish course; the ulcerative lesion is clean, completely devoid of any discharge component; pain may not bother you.

Diagnostics

A corneal ulcer is identified by an ophthalmologist when examining a patient using a slit lamp, which is a special microscope. In order not to miss small ulcers, the cornea is additionally stained with a dye (fluorescein solution). Upon further examination, even minor areas of damage, their depth and extent, are revealed.

Also used as diagnostic methods for determining corneal ulcers are:

Ultrasound of the ocular cavity;
diaphanoscopy;
gonioscopy;
ophthalmoscopy;
tonometry, etc.

To determine what causes the formation of ulcers on the cornea, a smear is taken from the membrane for cytology and a microbiological examination is carried out.

Treatment of corneal ulcers

Treatment of corneal ulcers is carried out exclusively in a hospital setting. If the infectious process develops, the patient is prescribed maximum anti-inflammatory therapy:

if there is a deficiency of tear production, medications are used to moisturize the surface of the eyes;
vitamin therapy is carried out;
to relieve inflammation, the patient is prescribed hormonal and steroid drugs;
the use of broad-spectrum antibiotics (these can be topical preparations in ointments, for example, Tetracycline, Erythromycin, Detetracycline, etc.); in case of severe corneal ulcers, the drugs Gentamicin, Netromycin, Neomycin, Monomycin are administered under the conjunctiva, which are prescribed by a doctor;
prescription of internal antibiotics Streptomycin sulfate, Oletetrin, Benzylpenicillin sodium acid, Tetracycline, etc.
As an addition to the main treatment, agents are used that restore the cornea and strengthen it.

In case of an active inflammatory process, especially if there is a threat of perforation of the cornea, the patient is indicated for surgical operation - layer-by-layer or. With this intervention, the affected area of the cornea is removed and replaced with a donor one of the same size.

Physiotherapy is actively prescribed for corneal ulcers, the most popular methods being ultrasound, electrophoresis and x-ray therapy. This effect prevents the formation of a rough scar.

To avoid deepening and widening the area of localization of the corneal ulcer, the ophthalmologist smudges it with an alcohol solution of brilliant green or iodine. If the disease is caused by dacryocystitis, then the nasolacrimal canal is washed. When the ulcerative lesion is healing, the patient, if necessary, undergoes excimer laser removal of corneal scars that are on the surface.

Complications of the disease

If treatment for a corneal ulcer is not started, serious complications may subsequently arise, such as:

development of secondary glaucoma;
the occurrence of a vitreous abscess;
protrusion in the form of a hernia of the corneal membrane;
collection of pus in the anterior chamber of the eye;
the occurrence of iritis or iridocyclitis;
optic nerve atrophy.

The greatest danger is a creeping corneal ulcer. If help is not provided, it leads to purulent inflammation of the entire eye, which can be complicated by thrombosis of the cavernous sinus, meningitis, and sepsis.

Forecast and prevention of corneal ulcers

To prevent the development of the disease in question, it is necessary to avoid injury to the eyes, follow the rules for storing and using contact lenses, and treat all emerging eye diseases at an early stage.