Corneal Ulcer Symptoms and Contact Lens Infections

Corneal ulcer symptoms include eye pain that keeps getting worse, a red and irritated eye, light sensitivity, sudden blurry vision, and unusual tearing or discharge. A corneal ulcer is an open sore in the outer layer of the cornea, the clear front of the eye. It is usually caused by an infection, and it can develop very quickly. Contact lens wearers need to watch most closely, because lens-related infections are the most common cause of keratitis, or inflammation of the cornea. If you have these symptoms, take your lenses out and get seen the same day, at an emergency room if we're closed.

Key takeaways

A corneal ulcer, an open sore on the clear front of the eye, can cause worsening pain, redness, light sensitivity, sudden blur, and unusual tearing or discharge.
Take your lenses out, skip leftover eye drops, and call your eye doctor right away, or go to an emergency room when the office is closed.
Sleeping in contact lenses raises the risk of a lens-related eye infection six to eight times, and daily-wear lenses are not safe to sleep in.
A white spot on the clear part of the eye always needs a same-day visit, or an emergency room when the office is closed.

What does a corneal ulcer feel like?

The CDC lists these signs of a contact lens-related eye infection:

A red, irritated eye
Pain in or around the eye that keeps getting worse, even after you take the lens out
Light sensitivity
Sudden blurry vision
Unusually watery eyes or discharge

Sometimes the ulcer itself is visible. In one of six cases the CDC reported in people who slept in their lenses, the eye showed a dense white ulcer in the center of the cornea. In our office, a white spot on the clear part of the eye is always a same-day visit, or an emergency room when we're closed.

You can't tell how serious a lens-related problem is on your own. The FDA advises getting an eye care professional to find out what is wrong.

What causes a corneal ulcer?

Most ulcers start with an infection. Bacteria, viruses, fungi and parasites can all infect the cornea.

You don't have to wear contacts to get one. The herpes simplex virus can infect the cornea in people with or without lenses, and people who have had that infection are at risk of it coming back. Fungal keratitis also affects both groups, and the CDC recommends protective eyewear for tasks such as farm work that can injure the eye with plant material.

Other risks the CDC lists for bacterial keratitis include a recent eye injury, eye disease, a weakened immune system, and problems with the eyelids or tearing. Even a slight scratch can lead to a serious infection, which is why we check a corneal abrasion the same day (an emergency room when we're closed).

How do you get an eye infection from contacts?

Contact lenses sit right on top of the cornea. Used the wrong way, they can lead to serious problems, including corneal ulcers and infections.

What happens if you sleep with contacts in?

Sleeping in contact lenses raises the risk of a lens-related eye infection six to eight times, and about one third of wearers say they sleep or nap in their lenses. Daily-wear lenses are not safe to sleep in. Extended-wear lenses are made for overnight wear, but they may also make a serious infection more likely.

Water on your lenses or case

Water, even the tap water you drink, has germs that can harm your eyes. Take your lenses out before you shower, swim, or get in a bath or hot tub. The CDC notes that swimming or showering in lenses increases the risk of infection.

Tap and distilled water have been associated with Acanthamoeba keratitis, a corneal infection the FDA describes as resistant to treatment and cure. It is rare and most common in contact lens wearers, and it can cause permanent vision loss.

Case and solution habits

Use fresh solution every time instead of topping off what's in the case, and replace your lens case at least once every 3 months, or sooner if your eye doctor tells you to. Skipping case cleaning and storing or rinsing lenses in water are both on the CDC's list of risks for bacterial keratitis. Our contact lens exams go over these habits with you.

Is a corneal ulcer an emergency?

Yes. Left untreated, bacterial keratitis can lead to vision loss or even blindness. A CDC report on six people who slept in their lenses found these infections can require surgery and can leave corneal damage and permanent vision loss.

What to do right now

Take your lenses out and don't put them back in.
Keep the lenses in their case and bring them with you. Your eye doctor may use them to find the cause.
Skip leftover eye drops. Steroid drops can make some eye infections worse.
Call your eye doctor right away, or go to an emergency room when the office is closed.

Same day, or the emergency room?

During our office hours (Monday 10am to 5pm, Tuesday to Friday 8am to 5pm), call 310-828-2010 for a same-day urgent eye care visit. Outside those hours, including weekends, don't wait for us to open: go to an emergency room for intense or worsening eye pain, blurry vision or any other change in vision, a very red, watery eye, or a white spot on the cornea. The National Eye Institute lists intense eye pain, a change in vision, blurry vision and very red, watery eyes as reasons to go to the eye doctor or the emergency room right away.

For sudden loss of vision in one or both eyes, call 911 at any hour, even if your sight comes back: sudden trouble seeing can be a sign of stroke.

How is a corneal ulcer treated?

Treatment depends on the cause, so the first job is finding it. Your eye doctor examines the cornea under magnification and may put a stain on the eye to see how far the inflammation reaches. A culture or biopsy may be needed to identify the germ.

Infections are treated with eye drops matched to the cause: antibiotic, antiviral or antifungal. Advanced infections may also need medicine by mouth. Use the drops exactly as prescribed and keep every follow-up visit.

Some infections take months to treat. Fungal keratitis is treated with prescription antifungal medicine for several months. If the damage to the cornea can't be repaired, a corneal transplant replaces the damaged part with healthy tissue from a donor.

How we treat corneal ulcers at Cohenmehr Optometry

Corneal infections and contact lens-related infections are among the problems we evaluate and manage at same-day urgent visits. Our eye doctors in Los Angeles examine the cornea and the front of the eye at the slit lamp and check your eye pressure.

Infectious keratitis is treated urgently with targeted drops. Your lenses stay out until the cornea is quiet, and we recheck until it is. When a surgeon is needed, we coordinate the referral with an ophthalmologist and your records go over the same day.

If an ulcer heals with a scar that leaves the cornea irregular, a scleral lens for corneal scarring can give light a smooth surface to enter through. During office hours, call 310-828-2010 before you come in; calling ahead gets you triaged fastest. When we're closed, go to an emergency room.

Questions patients ask

Is a corneal abrasion the same as a corneal ulcer?

No. A corneal abrasion is a scratch on the cornea. Small scratches usually heal on their own, deeper ones can cause scarring and vision problems, and eye doctors use a dye called fluorescein to make an abrasion easier to see. A corneal ulcer is an open sore in the outer layer of the cornea, usually caused by an infection. Even a slight scratch can lead to a serious infection, so we still see a scratched cornea the same day (an emergency room when we're closed).

What are antibiotic eye drops used for?

Antibiotic eye drops treat eye infections caused by bacteria. Some are FDA-approved for bacterial corneal ulcers as well as bacterial conjunctivitis; ofloxacin drops (Ocuflox) are one example. On that label, the most frequently reported side effect is brief burning or discomfort, and long use can let germs the drug doesn't kill, including fungi, overgrow. Use them only for the eye and the length of time your doctor prescribes.

What should I do if I slept with my contacts in?

Take the lenses out, and try not to sleep in them again. Then pay attention to how that eye feels. If it turns red or irritated, hurts more and more even after the lenses are out, becomes sensitive to light, blurs suddenly, or waters or makes discharge, keep the lenses out and call your eye doctor right away, or go to an emergency room when the office is closed.

Can wearing contacts cause dry eye?

It can make dry eye more likely. The National Eye Institute lists wearing contact lenses among the things that raise your chance of dry eye, which can cause a scratchy feeling, stinging or burning, red eyes, light sensitivity and blurry vision. If severe dry eye isn't treated, it can sometimes damage the cornea. Our contact lens discomfort page explains how we treat dryness in lens wearers.

Sources

Written by

Dr. Kevin Cohenmehr, OD

Medical eye care: glaucoma, diabetic eye exams, macular degeneration and eye infections, plus vision therapy for children. A graduate of UCLA and SUNY College of Optometry.

About Dr. Kevin →

Corneal Ulcer Symptoms: What They Feel Like and What to Do Today