From the Guidelines
Treatment for a corneal ulcer typically involves antibiotic eye drops to fight the infection, which is the most common cause, with fluoroquinolones like moxifloxacin or ciprofloxacin often prescribed every 1-2 hours initially, then tapered as the condition improves, as recommended by the most recent study 1. The choice of antibiotic depends on the severity and cause of the infection.
- For severe infections, fortified antibiotics such as tobramycin or vancomycin may be needed, as indicated by the study 1.
- Antifungal medications (natamycin 5% or amphotericin B) are used for fungal ulcers, while acyclovir or ganciclovir treats viral causes, as stated in the study 1.
- Pain management with cycloplegic drops like cyclopentolate helps reduce discomfort by relaxing eye muscles.
- Treatment should begin immediately to prevent vision loss, with drops applied day and night initially, as emphasized by the study 1.
- Patients should avoid wearing contact lenses during treatment and follow strict hygiene practices.
- Severe ulcers may require hospitalization for intensive treatment, as noted in the study 1. The cornea's avascular nature makes infection treatment challenging, as medications must penetrate the tissue effectively to reach the infection site, as discussed in the study 1. Most corneal ulcers heal within 2-3 weeks with proper treatment, though severe cases may require corneal transplantation if scarring significantly affects vision, as reported by the study 1. It is essential to note that the use of corticosteroids in the treatment of corneal ulcers is controversial and should be approached with caution, as highlighted by the studies 1. In general, corticosteroids may be considered after 48 hours of antibiotic therapy when the causative organism is identified and/or the infection has responded to therapy, but they should be avoided in cases of suspected Acanthamoeba, Nocardia, or fungus, as recommended by the study 1.
From the FDA Drug Label
DOSAGE AND ADMINISTRATION: SHAKE WELL BEFORE USING. The preferred initial dosage in fungal keratitis is one drop of NATACYN ® (natamycin ophthalmic suspension) 5% instilled in the conjunctival sac at hourly or two-hourly intervals. INDICATIONS AND USAGE: NATACYN ® (natamycin ophthalmic suspension) 5% is indicated for the treatment of fungal blepharitis, conjunctivitis, and keratitis caused by susceptible organisms including Fusarium solanikeratitis.
The treatment for fungal corneal ulcer (keratitis) is natamycin ophthalmic suspension 5%. The initial dosage is one drop instilled in the conjunctival sac at hourly or two-hourly intervals 2. The treatment should be determined by the clinical diagnosis, laboratory diagnosis by smear and culture of corneal scrapings, and drug response 2.
- Key points:
- Natamycin is used to treat fungal keratitis.
- Initial dosage is one drop at hourly or two-hourly intervals.
- Treatment should be based on clinical diagnosis and laboratory diagnosis.
- In vitro activity of natamycin against the responsible fungus should be determined whenever possible 2.
From the Research
Treatment Options for Corneal Ulcers
- The primary treatment for infectious corneal ulcers involves the use of antimilo crate [ 3 ].
- Topical application with a broad-spectrum antimicrobial remains the preferred method for the pharmacological management of infectious corneal ulcers [ 3 ].
- For noninfectious ulcers, treatment may include eliminating toxic medications and providing surface support with lubrication and collagenase inhibitors [ 4 ].
Antibacterial Treatment
- Moxifloxacin 0.5% has been shown to be equivalent to a combination of fortified cefazolin sodium 5% and tobramycin sulfate 1.3% in the treatment of moderate bacterial corneal ulcers [ 5 ].
- Gatifloxacin 0.3% has been found to be at least as effective as ciprofloxacin 0.3% in healing corneal ulcers infected with Pseudomonas aeruginosa [ 6 ].
Referral and Management
- Urgent referral of trauma and infectious keratitis to an ophthalmologist can prevent endophthalmitis and loss of vision and/or the eye [ 7 ].
- General practitioners can play an important part in timely referral, in some cases initiating oral antiviral treatment, and by educating patients on preventive measures, especially contact lens hygiene [ 7 ].