Synopsis
Recognise corneal inflammation and ulceration promptly, distinguish important infectious mechanisms, and coordinate urgent specialist treatment that protects vision while microbiology and response guide therapy.
- Keratitis means corneal inflammation; a corneal ulcer involves epithelial breakdown with underlying tissue involvement and may be infectious or non-infectious.
- Pain, watering, photophobia and reduced vision are common, but reduced corneal sensation can make dangerous disease less painful.
- A corneal infiltrate or ulcer is not uncomplicated conjunctivitis, even when there is associated discharge.
Key red flags
A focal corneal infiltrate with an epithelial defect, especially near the visual axis, requires emergency ophthalmic assessment.
Investigation priorities
Measure visual impact and map the corneal lesion.
Management branches
Symptoms or examination suggest a microbial ulcer, significant epithelial lesion or rapidly worsening keratitis.
- Record visual function and relevant lens, water, trauma and medication exposure, and contact the same-day emergency ophthalmic service.
- Remove contact lenses and avoid patching, empirical steroid preparations or unsupervised take-home topical anaesthetic drops.
Key medicines
Ciprofloxacin 0.3% eye drops, CiloxanWhen selected for a corneal ulcer, the licensed regimen is two drops into the affected eye every 15 minutes for the first six hours of day one, then every 30 minutes for the rest of that day; on day two give two drops hourly, and on days three to fourteen give two drops every four hours. These schedules include the night. Continuing beyond day fourteen requires physician direction; the SmPC gives a maximum recommended duration of 21 days.