Next-Day Follow-Up for Corneal Ulcers
Next-day follow-up is NOT sufficient for severe corneal ulcers—these cases require daily monitoring until clinical improvement is confirmed, while less severe ulcers may be safely followed at 24-48 hours. 1
Risk Stratification Determines Follow-Up Timing
The appropriate follow-up interval depends entirely on ulcer severity and risk factors:
Severe Cases Requiring Daily Follow-Up
Daily examination is mandatory initially for severe corneal ulcers until stability or improvement is documented. 1 The American Academy of Ophthalmology defines severe cases as:
- Deep stromal involvement 1
- Infiltrates larger than 2 mm with extensive suppuration 1
- Central corneal involvement compromising the visual axis 1
- Presence of hypopyon 2
- Impending or frank perforation 1
Less Severe Cases
For smaller, peripheral ulcers without deep stromal involvement, re-examination at 24-48 hours is appropriate to confirm healing and rule out developing infection. 3 However, any persistent symptoms, worsening pain, or development of stromal infiltrates requires immediate re-evaluation. 3
Critical Risk Factors Requiring Closer Monitoring
Immunocompromised patients and those with diabetes warrant more aggressive follow-up schedules due to increased risk of rapid progression and poor outcomes. 2 Additional high-risk scenarios include:
- Contact lens wearers (significantly increased bacterial keratitis risk) 3
- Patients on chronic topical corticosteroid therapy 1
- History of ocular surface disease (epithelial defects, tear deficiency, lagophthalmos) 2
- Gonococcal keratitis (requires systemic therapy and close monitoring) 1
Special Monitoring Considerations with Corticosteroid Use
When corticosteroids are added to treatment, patients must be examined within 1-2 days after initiation to monitor intraocular pressure and assess response. 1 This applies regardless of the underlying ulcer severity, as corticosteroids carry risks of:
- Increased intraocular pressure 1
- Recrudescence of infection 1
- Corneal melting from collagen synthesis inhibition 1
- Development of infectious crystalline keratopathy with chronic use 1, 2
Common Pitfalls to Avoid
Never assume a corneal ulcer is improving based solely on symptom relief—bacterial keratitis can develop at sites of epithelial defects even when pain decreases. 3 The key distinguishing feature between simple abrasion and bacterial keratitis is the presence of stromal infiltrates, which requires slit-lamp examination. 3
Do not delay appropriate follow-up for contact lens wearers, as they have substantially elevated risk of secondary bacterial keratitis even with traumatic abrasions. 2, 3 These patients require prophylactic antibiotics and close monitoring. 2
Patients with pre-existing systemic immunosuppression or autoimmune disease require both topical and systemic management, making daily monitoring even more critical until the infection is controlled. 4