Emergent Care / Stabilization:
Bacterial corneal ulcers require urgent recognition and treatment to prevent scarring, corneal thinning, permanent vision loss, and even loss of the eye. Treatment involves topical antibiotic eye drops, with antibiotic selection and frequency of application dependent on ulcer size and severity.

Diagnosis Overview:
A bacterial corneal ulcer, or bacterial keratitis, is an infection of the corneal stroma that causes rapid visual loss and pain. Infectious corneal ulcers need to be treated as soon as possible to preserve vision. If left untreated, a bacterial infection can lead to perforation of the cornea, loss of vision, and even loss of the eye.

Risk factors that can lead to bacterial keratitis include contact lens wear (particularly contact lens overuse, misuse, sleeping in lenses, inadequate hygiene), eye trauma, previous ocular surgery, dry eye or eyelid inflammation, immunosuppression, and any other diseases that cause ocular surface abnormalities.

Patients with bacterial corneal ulcers may experience eye pain, light sensitivity, tearing, discharge, red eye, and reduced vision. The rapidity of the onset and progression of symptoms depends on the pathogen.

While patient symptoms and clinical findings are largely indistinguishable regardless of the causative bacteria, bacterial keratitis in a contact lens wearer is frequently caused by gram-negative organisms, such as Pseudomonas aeruginosa, whereas ulcers in patients with blepharitis are more commonly due to gram-positive organisms, such as Staphylococcus aureus.