O.D. Infectious corneal ulcers are one of the most feared presentations you might face. Once a bacterial infection takes hold in the avascular cornea, the body's ability to fight the infection is limited by the lack of a blood supply to deliver infection-fighting elements to the site. Even if the body were able to fight the infection on its own, the cornea would scar with devastating visual consequences if the visual axis were affected.
Contact lens wear, especially extended wear, greatly exacerbates the risk of infection.
When faced with a corneal infection, we can provide intensive antimicrobial therapy and reduce the risk of associated visual loss. As always, the key to managing infectious ulcers is prompt diagnosis. Whenever a patient presents with acute onset of pain, photophobia and tearing, you need to carefully scrutinize the cornea. If the patient has a confluent epithelial defect with an underlying corneal infiltrate, then by definition he has a corneal ulcer. An increasing number of gram-positive bacteria show resistance to fluoroquinolone antibiotics.