The cornea, this fine transparent membrane covering the pupil and iris, is fragile. His injuries, whether they are superficial (keratitis) or more deep (ulcers), pose an infectious risk (corneal abscess) or poor healing, engaging Visual prognosis.
Related to the projection of liquid or solid particles in the eye, favored by dry eye and contact lenses, the keratitis, ulcers and corneal abscess are extremely common and can occur at any age. The Pr Christophe Baudouin *, ophthalmologist, returns on the warning signs and taking care of these pathologies.
A red and painful eye sign the ulcer of the cornea
Corneal ulcer, also called ulcerative keratitis, is an infringement of the surface of the eye, at the level of the essential vision transparent layers. It is an intermediate injury between the relatively superficial keratitis and corneal perforation. If there is infection, one speaks of abscess of cornea.
The Pr Christophe Baudouin Note: “the cornea is rich in nerve endings. In case of injury, it is often the pain that serves as a sign of appeal. In general, there is also a watery, intolerance to light, as well as Visual discomfort when the central part of the cornea is concerned.”
Visually, the eye is red. The white of the eye blood vessels are more apparent and a sometimes very visible circle on the periphery of the cornea. Its presence allows to distinguish between diseases of the cornea (keratitis, ulcers…), simple conjunctivitis.
Corneal ulcer, obvious or more insidious causes
The diagnosis of the keratitis and corneal ulcers based on symptoms and the context of appearance. Sometimes, the cause of the trauma is evident: projection of sand, tree branch, scratch, splashing of detergent, UV radiation… In fact, fortunately, these injuries are rare, as explained in the Pr Baudouin: “the cornea is fragile but well protected. In the event of aggression, eyelid close reflex way. The tear film also enables to evacuate the foreign body and repair minor damage”.
In some people, however, this tear film, rich in protective and antimicrobial agents, is of poor quality or too little now. The cornea becomes sensitive to any dust that creates a repetitive strain injury to its surface. The eyes are irritated, bite or itch. “The ‘ dry syndrome ‘ is responsible for the majority of the keratitis and corneal ulcers, continued the specialist.”It is 15% of the population and is favoured by certain factors (age, medications, autoimmune diseases…)”.
Contact lenses favour also, repetitive strain injury and concentrated infectious agents. With many thousands of cases each year, contact lenses are the first cause of corneal infections, note the Pr Baudouin. Relatively, it is reported to the three million people who wear, but still too large given risks associated with these diseases.”
Herpes and shingles virus can also infect the cornea and recur, in the form of keratitis or ulcers, in certain circumstances (fatigue, fever, UV radiation…).
The aftermath of corneal ulcers may be disabling
Infringement on the outskirts can win the center of the cornea and a shallow dig in ulcer, or perforate the cornea. However, most injury extends, most healing is difficult, says Pr Baudouin. “Even cured, the injury may be responsible for keratitis repeatedly, the scar not resistant to the aggressions of the environment. This disease, called recurrent keratalgie, is particularly painful and disabling. Some people have several attacks per month lasting several days each time. Only artificial tears and sometimes a laser (peeling effect) treatment can alleviate these patients.”
Scarring can also lead to the formation of a whitish veil (corneal pillowcase). Beyond its unsightly appearance that scar directly threatens the Visual prognosis when it touches the center of the cornea. The opacity tends to regress over the month but this is not systematic and sometimes consider a corneal transplant. “Contact pillowcases are responsible for hundreds of transplants each year. This may seem insignificant but these interventions remain particularly distressing for those undergoing”, warns the doctor.”
Consult an ophthalmologist urgently
If contact lenses are at the origin of most of the contact, any other infections trauma opens a breccia which facilitates the penetration of pathogenic agents. “Superficial keratitis can heal quickly, alone and without sequelae.” But if intense pain and red eye symptoms persist more than 24 hours without lenses, it is imperative to quickly consult an ophthalmologist, even go to emergency, insists the Pr Baudouin.
General practitioners and pharmacists do not have instruments to assess the severity of the lesions. The eye drops and ointments anti-inflammatory cortisone are absolutely deprecated before being sure of the diagnosis.
During the consultation, the ophthalmologist examines the cornea under the microscope and carries out samples to check for possible infectious agents. If the wound does not test of gravity, he prescribed an antiseptic drops (antibiotic infection) and analgesic treatment if necessary. A consultation of control is usually set for the day after tomorrow to verify their effectiveness.
If it is a deep ulcer infected, specialist demand hospitalization. The first days, it is sometimes necessary to instill eye drops every hour (including night!). However, the most severe injuries remain related to projections of chemicals that literally dissolve eye tissue. They need to be made urgently.