There’s a lot of benefits to wearing contacts. There’s also a fair amount of risks. Near the top of the list is a bacterial corneal ulcer. The cornea is the front, clear, curved part of the eye where the contact lens sits. A bacterial ulcer of the cornea is when a bacterial infection results in an “eating away” of the of the cornea. It’s very similar to an abscess. Within this abscess or ulcer, the bacteria can cause significant tissue damage and even result in scarring and permanent vision loss.
What are the symptoms of a corneal ulcer?
An early corneal ulcer may cause mild discomfort or irritation. As the infection progresses, symptoms may include increasing pain, blurring vision, light sensitivity, tearing, mucous discharge, redness, and swelling. But, don’t wait for the whole of list of symptoms before you self-diagnose a corneal ulcer. If you wear contact lenses and have any of these symptoms, an immediate call to your eye doctor is a must.
What should you do?
I cannot stress enough that the first step should be a call or visit to your eye doctor at the first experience of symptoms. Some of the most damaging vision loss I’ve seen in my practice has occurred with a corneal ulcer that went 5 to 7 days before the patient called me. As patients, sometimes we either think things are not a big deal or assume it will just go away on its own. If you report pain to your eye doctor and you wear contact lenses, they will want to see you that day. It’s important to diagnose and treat early.
The next step after calling your eye doctor is to remove the contact lens. At this point, the contact lens is doing more harm than good—plus its harboring bacteria that are going unchecked. This is why its important for ALL contact lens wearers to have an updated pair of glasses as backup. The next thing is to be prepared to have an honest conversation with your doctor. Be sure to share any information in full detail: how old are the lenses, cleaning solutions and practices, nights slept in contact lenses, recent activities such as swimming, current medications and/or eye drops, other pertinent history. This is all important in helping the doctor make the correct diagnosis.
What to expect at the eye doctor
The eye doctor will thoroughly examine the front surface of the eye to assess the extent of the damage and make a diagnosis. There are different types of corneal ulcers, as well as many other conditions with similar symptoms. This is why I cannot stress enough that a symptomatic contact lens wearer visit an eye doctor and not their family doctor or urgent care. While those providers are invaluable, they lack the clinical experience or diagnostic tools to make a definitive diagnosis. I’ve seen a fungal infection misdiagnosed as a bacterial corneal ulcer, the wrong treatment given, and the patient go blind. Don’t call your eye doctor if you are having chest pains, but definitely call the him or her if you are having eye symptoms.
If the diagnosis is a bacterial corneal ulcer, the key is to start an antibiotic eye drop immediately. A class of antibiotic drops, called fluoroquinolones, are the standard of care and they may be prescribed to be used once an hour initially. Your eye doctor may also dilate your pupils to reduce eye pain. Staying out of contact lenses during the course of treatment will also be advised. And, regular (perhaps, daily) follow-ups will be necessary. The follow-up visits are just as important as the initial visit. Your eye doctor will need to assess the corneal ulcer’s response to treatment and adjust the treatment accordingly. The goal is to get complete resolution without permanent vision loss, and following a proper course of treatment is critical. Depending on the severity of the corneal ulcer, it could take 1-2 weeks for complete resolution.
Even with proper treatment and resolution, it’s still possible to have permanent vision reduction due to scarring of the cornea. This really depends on the severity and location of the scar. If it’s a dense scar in the center of the cornea, vision will be affected. That’s why it’s very important for contact lens wearers to clean and replace contact lenses properly. Handwashing and storage case replacement is also important. And, it’s always worth mentioning, daily disposable contact lenses greatly reduce the risk for bacteria corneal ulcers and other contact lens related complications. They are definitely worth the extra investment.
As always, I’d love to hear from you. Feel free to shoot some feedback or questions my way.