Some twenty years ago, when vanity got the better of me, I decided to give contact lenses another whirl. I had never had much luck with them in the past as my eye fault is a strong astigmatism, which requires the lenses sit tightly on the cornea less they twist. I had suffered from corneal ulcers when I had previously worn contacts so I was familiar with the symptoms. Sure enough I developed the ulcers again, and so I took myself off to Denpasar to have them properly diagnosed and treated. Well after telling the eye specialist what I had (for he did not have a clue!) he prescribed me some eye drops which contained steroids. As usual I thought I should cross check this with my trusty medical manual and sure enough there it was in big black italic letters “STEROID DROPS ARE ABSOLUTLY CONTRAINDICATED WHERE LESIONS OR ULCERS OF THE CORNEA ARE SUSPECTED. Steroid drops may cause the ulcer to deepen and eventually perforate the eye”.
Sadly I know of at least one person here who indeed did lose their vision because of this.
This morning (on the 5th January 2009) I received a call from a man who had been playing with his young daughter when her fingernail brushed his eye causing a corneal lesion (scratch). He sought medical attention at a popular “tourist” clinic in Legian and the doctor promptly prescribed steroid drops. So I am sorry guys, in twenty odd years the “Eye guys” here have learned absolutely nothing!
What is a corneal ulcer?
A corneal ulcer is an open sore on the cornea, the thin clear structure overlying the iris, which is the colored part of your eye.
Causes
- Most corneal ulcers are caused by infections and are common in people who wear contact lenses (your risk of corneal ulcerations increases 10-fold when using extended-wear soft contact lenses)
- Tiny tears to the cornea may also cause corneal ulcers. These tears can come from direct trauma; scratches; or particles, such as sand, glass, or small pieces of steel. (Very common in those who ride motor bikes without eye protection) Such injuries damage the cornea and make it easier for bacteria to invade and cause a serious ulcer.
- Disorders that cause dry eyes can leave your eye without the germ-fighting protection of tears and cause ulcers.
- Disorders that affect the eyelid and prevent your eye from closing completely, such as a stroke, can dry your cornea and make it more vulnerable to ulcers.
- Chemical burns or other caustic (damaging) solution splashes can injure the cornea.
Symptoms
- Red eye
- Severe pain especially when looking at bright lights
- Feeling that something is in your eye
- Tears and /or pus or thick discharge draining from your eye
- Blurry vision
- Swollen eyelids
- A white round spot on the cornea that is visible with the naked eye if the ulcer is very large
When to Seek Medical Care
- Change in vision
- Severe pain
- Feeling that there is something in your eye
- Obvious discharge draining from your eye
- History of scratches to the eye or exposure to chemicals or flying particles
Corneal Ulcer Treatment - Self-Care at Home
- If you wear contact lenses, remove them immediately.
- Apply cool compresses to the affected eye.
- Do not touch or rub your eye with your fingers.
- Limit spread of infection by washing your hands often and drying them with a clean towel.
- Take over-the-counter pain medications, such as Panadol or Ibuprofen.
Medical Treatment
- Your ophthalmologist will remove your contact lensesif you are wearing them.
- Your ophthalmologist will generally not place a patch over your eye if he or she suspects that you have a bacterial infection. Patching creates a warm dark environment that allows bacterial growth.
- Hospitalization may be required if the ulcer is severe.
Medications
- Because infection is a common occurrence in corneal ulcers, your ophthalmologist will prescribe antibiotic eye drops. If the infection appears very large, you may need to use these drops as often as 1 drop an hour.
- Note that many antibiotic eye drops have steroids added so read the label before use. Steroids are “dexamethasone”, “prednisone/prednisolone”, “flucortisone”, “hydrocortisone”, “betamethasone” or generally any medication that ends with “…sone”
- Oral pain medications will be prescribed to control the pain. Pain can also be controlled with special eye drops that keep your pupil dilated.
Prevention
Seek medical attention from your ophthalmologist immediately for any eye symptoms. Even seemingly minor injuries to your cornea can lead to an ulcer and have devastating consequences.
- Wear eye protection when exposed to small particles that can enter your eye (especially when riding motor bikes or even push bikes).
- If you have dry eyes or if your eyelids do not close completely, use artificial teardrops to keep your eyes lubricated.
- If you wear contact lenses, be extremely careful about the way you clean and wear your lenses.
A corneal ulcer is a true emergency. Without treatment, the ulcer can spread to the rest of your eyeball, and you can become partially or completely blind in a very short period of time, but with the proper treatment, corneal ulcers should improve within 2-3 weeks.
Kim Patra is a qualified registered nurse and midwife who has been living and working in Bali for almost 20 years. She now runs her own private practice and medical referral service from her Kuta office. Kim is happy to discuss any health concerns with you and she may be contacted via e-mail at info@chcbali.com or Hp. 081 2366 0000.
