Internal Medicine

0521779407-C03 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 20:54

Corneal Ulcer 405

■No eye patch for corneal ulcers

■Eye shield may be used if significant corneal thinning

■Topical cycloplegics (scopolamine^1 / 4 %) for comfort

specific therapy

Indications

■Suspicion of bacterial corneal ulcer requires prompt treatment

pending culture results

Treatment Options

■Corneal ulcers treated as bacterial unless high suspicion of other

cause

■Initial treatment depends on size, location, severity of ulceration:

➣Small, peripheral, & nonvision-threatening infiltrates: topical

quinolones – ofloxacin 0.3%, ciprofloxacin 0.3%, or levofloxacin

0.5% 2 drops q 15 min for 2 hours, then q 1 hour around the

clock

➣Large, central, & vision-threatening infiltrates: fortified topical

antibiotics (must be compounded by pharmacy) – cefazolin &

tobramycin; consider subconjunctival injection of antibiotics

in addition to topicals in most severe infections, when fortified

topical antibiotics not available in short time, or pt compliance

concerns

■Subsequent treatment adjusted by culture & sensitivity results

■Corneal ulcers dues to nonbacterial causes (fungal, herpes simplex

virus, or acanthamoeba) as indicted by stains or cultures require

specific treatment directed at organism

Side Effects & Contraindications

■Side effects: pain/stinging on drop instillation, toxicity to corneal

epithelium, conjunctival sloughing may occur after subconjunctival

injection

■Contraindications:

➣Allergy to above antibiotics:

Cefazolin allergy: vancomycin

Tobramycin allergy: ceftazidime

follow-up

During Treatment

■Initially, daily; assess improvement in infiltrate size & density, size of

epithelial defect, follow for corneal thinning