What is that White Spot on my Eye?

If you wear contact lenses and you ever wake up with a painful red eye with discharge or blurred vision, you should always consider the possibility of a corneal infection.   A corneal ulcer, or infectious keratitis, occurs when there is a breakdown in the cornea and microbes create an infection of the eye.  The cornea is the transparent window into the eye, and it is critical for this segment to remain healthy and intact so that you can see everything clearly.

What Causes a Corneal Ulcer?

A corneal ulcer is most commonly caused by bacteria.  It can occur in anyone after sustaining a direct injury to the eye.  The trauma creates an entry point for bacteria or other microorganisms to invade and establish an infection.

Contact lens wearers have a significantly higher risk of developing a corneal ulcer. This is especially true for individuals who wear extended duration contact lenses as they are ten times more likely to develop an infection.  Contact lens wearers are susceptible to microtrauma that can occur from the lens itself.  With extended wear, contact lenses can develop small scratches at the edge or deposits that can lead to this microtrauma.  In addition, these contact lenses can harbor bacteria on the surface over time. Lastly, these contact lenses can obstruct oxygen availability and thus make the cornea more susceptible to infection.  Overnight wear of contact lenses is also associated with a higher risk of infection.

Ulcers can also occur due to other microorganisms. The herpes virus, commonly associated with cold sores, can lead to recurrent corneal ulcers.   Contact lens wearers are at higher risk for a fungal or parasitic infection.  Acanthamoeba, a parasite found in tap water, swimming pools, hot tubs, and lakes, can lead to a severe corneal ulcer in contact lens wearers.

Contact lens wearers must maintain good hygiene to reduce their risk of an infection.  This includes washing hands regularly before handling contact lenses, disinfecting and disposing of lenses in a timely fashion, and frequent cleaning of contact lens cases.  Individuals should also avoid wearing contact lenses during swimming or showering.  Patients with severe dry eyes, eyelid abnormalities leading to exposure of the cornea, and autoimmune disorders, such as rheumatoid arthritis, are especially prone to infection and should be aware of this possibility.

What are the Symptoms of a Corneal Ulcer?

Any individual experiencing symptoms of eye pain or foreign body sensation, blurred vision, discharge, or light sensitivity should seek urgent care from an eye care provider.  Delay in attention and treatment can lead to vision loss and sometimes even blindness or loss of the eye.   Contact lens wearers should immediately stop using their lenses.

Corneal Ulcer Treatment

Your ophthalmologist or optometrist will obtain a detailed history and examine the extent and location of the corneal ulcer.  He or she will initiate the frequent use of topical antibiotics, and in certain severe or unusual circumstances, obtain cultures to determine the specific bacteria causing the infection.  You will be asked to return for a reassessment of the ulcer and its response to antibiotics every 1 to 3 days.

Most patients respond well to topical antibiotics with good visual prognosis.  In severe cases where the central cornea is affected, treatment may be required for a duration of several weeks to months.  Patients can also develop cataracts or glaucoma concurrently.  Permanent vision loss may occur despite aggressive treatment due to irreversible scarring of the cornea.  In these rare cases, a corneal transplant procedure followed by long visual rehabilitation may be necessary to restore the patient’s vision.

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