TREATMENT OF NON-HEALING CORNEAL ULCER

Non-healing corneal ulcers, also known as chronic or recalcitrant corneal ulcers, refer to corneal ulcers that do not respond to standard treatment or that take longer than expected to heal. These types of ulcers can cause significant damage to the cornea and lead to severe vision loss if not treated promptly and effectively.

Treatment Overview

The treatment of non-healing corneal ulcers typically involves a combination of methods, including the use of antibiotics or antifungal medications, bandage contact lenses, oral antibiotics and systemic medications, and surgery.

Topical Antibiotics and Antifungal Medications

  • Topical antibiotics are the primary treatment for bacterial corneal ulcers. The most commonly used antibiotics include:
    • Drops or ointments containing antibiotics such as amikacin, ciprofloxacin, gatifloxacin, levofloxacin, ofloxacin, and vancomycin.
    • Polymyxin B/trimethoprim and fortified antibiotics (such as vancomycin, ceftazidime, or gentamicin) are commonly used when the corneal ulcer is caused by antibiotic-resistant bacteria.
  • Topical antifungal medications are used to treat fungal corneal ulcers. The most commonly used antifungal agents include:
    • Natamycin (Natacyn) is the first-line therapy for fungal corneal ulcers.
    • Nystatin, amphotericin B, and fluconazole can also be used as alternative medications.

Bandage Contact Lenses

  • A bandage contact lens is a special type of contact lens that is placed on the eye to protect the cornea, promote healing, and aid in administering the medication. The bandage contact lens helps to relieve pain and discomfort, and it also helps to keep the medication in contact with the ulcer for a longer period of time.
  • The contact lens is typically worn during the day, and it is removed at night to allow the eye to "breathe" and to apply drops or ointment as required.

Oral Antibiotics and Systemic Medications

  • In cases of more severe or resistant corneal ulcers, oral antibiotics or systemic medications may be added to the treatment regimen.
  • Oral antibiotics such as doxycycline, minocycline, and erythromycin can be used to treat resistant bacterial infections,
  • Systemic medications such as steroids and immunosuppressants may be used to reduce inflammation and prevent the formation of scar tissue in the cornea.

Surgery

  • In cases of severe or progressive non-healing corneal ulcers, surgery may be required to repair the damage and restore vision.
  • Penetrating keratoplasty (PK) is a surgical procedure in which the affected cornea is removed and replaced with a healthy donor cornea.
  • Tectonic keratoplasty is similar to PK, but it is typically used in cases where the perforation is small or the integrity of the eye needs to be maintained.
  • Therapeutic keratoplasty is a procedure in which a button-shaped section of the affected cornea is removed and replaced with a healthy donor cornea.
  • Amniotic membrane transplant

 

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