CORNEA 36 EWAP JUNE 2023 by Liz Hillman EyeWorld (US) Editorial Co-Director An update on corneal ulcer management Contact information Beckman: kenbeckman22@aol.com Majmudar: pamajmudar@yahoo.com When to refer, when to culture, treatment strategies, new treatment options, and more— EyeWorld spoke with Kenneth Beckman, MD, and Parag Majmudar, MD, to get an update on the latest in corneal ulcer management. Corneal ulcers, Dr. Beckman said, typically present as an epithelial defect that develops a deeper infection into the stroma. “They’ll usually present with staining in the area where the epithelium is gone and a white spot in the stroma,” Dr. Beckman said, noting that most patients with these will have a history of an abrasion, foreign body, contact lens wear, or even significant lid margin disease. Causes Dr. Majmudar categorizes corneal infections into four buckets: bacterial, fungal, viral, and other (atypical organisms, parasitic infections). “Many times, the history and clinical presentation will give you some clue as to which category the infection falls into. For example, patients who use and/or abuse contact lenses are most likely going to experience bacterial infections,” he said. “Patients who are immunocompromised or live in tropical climates may have a higher risk of fungal infections. Viral in-fections are fairly ubiquitous, the most common being the herpes virus family, including herpes simplex as well as zoster, although technically zoster is more of an immunologic reaction than an active infectious one. “Atypical organisms like mycobacteria are very rare. There was some increased incidence in post-refractive surgery patients in the late 1990s and early 2000s, but we don’t hear about that as much anymore,” Dr. Majmudar said. “Although parasitic infections are largely relegated to patients who have had exposure outside the U.S., one of the parasitic infections that continues to plague corneal specialists is Acanthamoeba. More often than not, there is a history of exposure to contact lenses and freshwater such as swimming in lakes, although tap water in many communities across the United States has also been shown to harbor Acanthamoeba.” Dr. Beckman said that patients with lid margin disease are more likely to get bacterial infections, like Staph and Strep, but he noted that atypical things are more common in patients who wear contact lenses or those who have had previous ocular surgery or exposures. Fungal infections, for example, are more common if the patient has been exposed to vegetative matter, like tree branches. Anecdotally, Dr. Beckman said there seems to be an increase in fungal infections. “I’m not sure why. It could be they’re just growing more. It This article originally appeared in the April 2023 issue of EyeWorld. It has been slightly modified and appears here with permission from the ASCRS Ophthalmic Services Corp. Severe bacterial ulcer with hypopyon. Source: Kenneth Beckman, MD
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