A red and painful eye signs the corneal ulcer


The cornea, this thin transparent membrane that covers the pupil and the iris, is fragile. Its wounds, whether superficial (keratitis) or deeper (ulcers), pose an infectious risk (corneal abscesses) and / or poor healing, engaging the visual prognosis.
Corneal ulcer, obvious or more insidious causes

Related to the projection of liquids or solid particles in the eye, favored by dry eye and contact lenses, keratitis, ulcers and corneal abscess are extremely common and can occur at any age. Prof. Christophe Baudouin *, an ophthalmologist, reviews the warning signs and the management of these pathologies.

The sequelae of corneal ulcers can be disabling

Corneal ulcer, also called ulcerative keratitis, is an affection of the surface of the eye, at the level of the transparent layers indispensable to the vision. This is an intermediate wound between the relatively superficial keratitis and the perforation of the cornea. If there is an infection, it is called corneal abscess.

Consult an emergency ophthalmologist

Professor Christophe Baudouin remarked: "The cornea is rich in nerve endings, and in the case of an injury, it is often pain that serves as a sign of appeal, in general there is a lacrimation, an intolerance to light, and Visual disturbance when the central part of the cornea is concerned. "

Visually, the eye is red. The blood vessels of the white of the eye are more apparent and form a circle sometimes very visible at the periphery of the cornea. Its presence makes it possible to differentiate the pathologies of the cornea (keratitis, ulcers ...), simple conjunctivitis.

The diagnosis of keratitis and corneal ulcers is based on the symptoms and the context of onset. Sometimes the cause of the trauma is obvious: sand blasting, tree branch, scratching, detergent splash, UV radiation ... Fortunately, these injuries are rare, as Professor Baudouin explains: Cornea is fragile but well protected, and in the event of an attack, the eyelids close reflexively, and the tear film also allows foreign bodies to be evacuated and mildly damaged. "
In some people, however, this lacrimal film, rich in protective and antimicrobial agents, is of poor quality or too little present. The cornea becomes sensitive to the slightest dust that creates microtrauma on its surface. Eyes are irritated, stinging or itching. "This" dry syndrome "is responsible for the majority of keratitis and corneal ulcers, continues the specialist, it concerns 15% of the population and is favored by certain factors (age, drugs, autoimmune diseases ...).

Contact lenses also promote micro trauma and concentrate infectious agents. "With several thousand annual cases, contact lenses are the leading cause of corneal infections," notes Professor Baudouin. "It is relatively small, compared to the three million people who wear it, but always too important considering the risks Associated with these pathologies. "Herpes and zoster viruses can also infect the cornea and re-infect, in the form of keratitis or ulcers, under certain circumstances (fatigue, fever, UV radiation ...)

An involvement in the periphery can reach the center of the cornea and a superficial involvement widen into an ulcer, or even perforate the cornea. However, the more the lesion spreads, the more difficult it is to cicatrize, explains Professor Baudouin. "Even when cured, the wound can be responsible for repeated keratitis, and the scar is not resistant to environmental stresses, which is known as recurrent keratalgia and is particularly painful and disabling. Several days, only artificial tears and sometimes a laser treatment (peeling effect) can relieve these patients. "

Wound healing may also lead to the formation of a whitish veil (corneal sheath). Beyond its unsightly aspect, this scar directly threatens the visual prognosis when it touches the center of the cornea. The opacity tends to regress over the months but it is not systematic and it is sometimes necessary to consider a corneal transplant. "The corneal pillows are responsible for several hundred transplants every year, which may seem negligible, but these interventions remain particularly distressing for those who suffer from them."

If contact lenses are the cause of most corneal infections, any other trauma opens a gap that facilitates the penetration of pathogens. "Superficial keratitis can heal rapidly, alone and without sequelae, but if the symptoms of red eye and intense pain persist for more than 24 hours without lenses, it is imperative to consult an ophthalmologist very quickly, even if you go to the emergency room, Insists Professor Baudouin.

General practitioners and pharmacists do not have the tools to judge the severity of the lesions. Anti-inflammatory corticosteroids and ointments are absolutely not recommended before being sure of the diagnosis.

During the consultation, the ophthalmologist examines the cornea under a microscope and takes samples to look for possible infectious agents. If the wound does not have a severity criterion, it prescribes antiseptic eye drops (antibiotics in case of infection) and an analgesic treatment if necessary. A check-up is usually set for the day after tomorrow to check their effectiveness.

If it is an infected deep ulcer, the specialist requests a hospitalization. The first few days, it is sometimes necessary to instill an eye drops every hour (including the night!). However, the most severe injuries remain related to the projections of chemicals that literally dissolve ocular tissue. They need to be operated urgently.

How to protect the cornea

Some precautions may be enough to avoid the accident. The most obvious is to wear protective glasses to block the way to splashes, be it droplets of corrosive products (caustic soda to unclog sinks, bleach, acids, varnish ...) or particles Solids (earth, vegetable debris, glass chips or metallic ...). Goggles also protect against UV radiation. They are indispensable to winter sports, the risk of burning increases with the altitude and the reverberation of the sun on the snow. Some professional activities also expose them to UV radiation (welding, disinfection, etc.) and need to wear a mask. Cat scratches or baby nails are another cause of corneal injury. Better to observe a certain safety distance. Attention also to the mascara brushes. Make-up in public transport, which can stop suddenly, is a risky practice .; Infections are favored by contact lenses. The instructions for their maintenance and renewal should be observed: daily to change daily, monthly to rinse with a suitable solution - tap water is far from being sterile! - then to be stored in a clean container. Lastly, it is necessary to limit the factors which can dry eyes, especially tobacco, air conditioning, dry air, prolonged work on screen (especially if the latter is badly positioned), The prolonged reading sessions, the wind, the sun ... Artificial tears, provided you observe irreproachable hygiene, can help protect the cornea.

Sources

- Interview with Prof. Christophe Baudouin, ophthalmologist, head of department at the National Hospital of Ophthalmology (CHNO) des Quinze-Vingts (Paris), Secretary General of the French Society of Ophthalmology (SFO) , The major risk of wearing contact lenses, L'Hopit @ lien, n ° 3, September 2009.

- The hospital of Quinze-Vingts for the pages Ophthalmologic grafts and Ocular surface. - Abscess of cornea, the major risk of the wearing of contact lenses, L'Hopit @ lien, n ° 3, September 2009. Newsletter of the CHU Of Montpellier intended for health professionals, accessible to the general public.