Keratitis (corneal ulcer)

Keratitis, also known as “corneal ulcer”, is an inflammation of the cornea. If detected early, the ophthalmological disorder is easy to treat and heals quickly.

What is keratitis and how many types can it be?

The cornea is like a transparent window, 0.9 mm thick at the edges and 0.5 mm in the center. It covers the iris and pupil of the eye. Its main role is to protect the eye and focus light on the retina.

Keratitis or corneal ulcer occurs when the cornea becomes inflamed. The disease can be of two types, depending on the cause: infectious or non-infectious.

  1. Non-infectious keratitis can be caused by a minor injury, such as prolonged contact lens wear, improper contact lens hygiene or the insertion of a foreign object into the eye.
  2. Infectious keratitis is also known as “microbial keratitis” or “bacterial keratitis”, and is caused by bacteria or microbes. It can be passed from person to person by coughing, sneezing or touching contaminated objects. Untreated infectious keratitis carries a high risk of blindness for the patient concerned.

What are the risk factors?

Anyone can get keratitis. However, the main risk factor is contact lenses.

  • Contact lenses. They increase the risk of keratitis, both infectious and non-infectious. The problem can have several sources: wearing them longer than recommended, improper disinfection or wearing contact lenses while swimming. Keratitis is more common in people who wear contact lenses continuously than in those who wear them only during the day.
  • Weakened immune system. If your immune system is weakened because of an illness or medicines you take, you have a higher risk of getting corneal ulcer.
  • Corticosteroids. The use of corticosteroid eye drops to treat an ophthalmological disorder may increase the risk of developing infectious keratitis, or aggravate existing keratitis.
  • Eye injuries. If you’ve suffered an injury in the past that affected your cornea, you are more likely to develop keratitis in the future.

What causes keratitis?

Causes of infectious keratitis

  • Bacteria (staphylococcus, streptococcus and pseudomonas)
  • Fungi or parasites – these organisms can live on the surface of contact lenses or in the lens case. The cornea can become contaminated when the lens is in the eye, causing infectious keratitis.
  • Viruses (herpes simplex and shingles)
  • Contaminated water (bacteria, fungi and parasites in water – especially from oceans, rivers, lakes and warm water pools – can get into your eyes when you swim. However, the risk of keratitis is reduced if you have a healthy cornea and have not experienced a corneal injury in the past).

Causes of non-infectious keratitis

  • Eye damage. An object that scratches or injures the surface of the cornea can lead to non-infectious keratitis. Furthermore, if the injury allows micro-organisms to enter the damaged cornea, the keratitis can become infectious.
  • Dry eyes – in this case, the patient has a problem with the tear film, which cannot optimally perform its function of protecting the eye. This results in irritated and dry eye syndrome, which can later lead to keratitis.
  • Wearing contact lenses for an extended period of time.
  • Presence of a foreign object in the eye.
  • Prolonged exposure to ultraviolet light.
  • A vitamin A deficiency.
  • A disorder of the eyelids.
  • Allergies.

What are the symptoms?

Among the most common symptoms of keratitis are:

  • Eye discomfort and pain
  • Excessive tearing (not to be confused with epiphora)
  • Red, irritated eyes
  • Sensitivity to light (photophobia)
  • Blurred vision
  • Problems opening the eyelid due to pain or irritation
  • Sensation of foreign object in the eye
  • Decreased visual acuity

How is keratitis diagnosed?

If you notice any of the symptoms of keratitis in yourself or a loved one, make an appointment at an ophthalmological clinic. If you wear contact lenses, don’t put them on until you see a specialist. Take your contact lenses and their case with you.

During your basic ophthalmological examination, the doctor will start by asking you questions about your medical history and symptoms. Then, will perform the following tests:

  • Visual acuity test (to assess the quality of your vision)
  • Flashlight examination (to check pupil reaction, size and other factors)
  • Microscope with slit lamp. The instrument emits a light into one eye at a time so that the doctor can closely examine the outside and inside of the eye. The ophthalmologist may apply a fluorescein substance to the surface of the eye to see any damage to the cornea.
  • Laboratory tests. The specialist may take a sample of tears or cells from your cornea to send to the laboratory. It may also take a separate sample from the contact lens case. This will help determine the cause of the keratitis and create a treatment plan.

How is keratitis treated?

Because the causes of corneal ulcers are so different, ophthalmologic treatment regimens also vary.

Treatment for non-infectious keratitis

If you’re dealing with a mild case of non-infectious keratitis, the disorder is likely to heal itself. However, it’s imperative that you see a doctor. You may also be advised to use artificial tears (eye drops).

If it’s a more severe non-infectious keratitis and you have excessive tearing and eye pain, you may be prescribed antibiotic eye drops to prevent possible infection.

Treatment of infectious keratitis

  • Bacterial keratitis: Depending on the severity of the infection, antibiotic eye drops may be used in mild cases. In moderate or severe cases, oral antibiotics may be prescribed.
  • Fungal keratitis: Is treated with antifungal eye drops and oral medicines.
  • Viral keratitis: Artificial tears, antiviral eye drops or oral antiviral medicines may be prescribed, depending on the severity of the case.
  • Parasitic keratitis: This keratitis can be difficult to treat. Antibiotic drops may be prescribed. A severe case may even require a corneal transplant.

The ophthalmologist may also prescribe corticosteroid eye drops (not in cases of fungal keratitis) after the infection has relieved or disappeared. These drops help reduce inflammation and prevent scarring.

Keratitis surgery

Ophthalmological surgery to treat keratitis involves replacing the damaged cornea with a healthy donor cornea. A corneal transplant is needed if:

  • The disease does not respond to medication.
  • Corneal scarring severely affects vision.

How do you prevent this eye disorder?

You can reduce your risk of developing keratitis if you:

  • Follow the instructions on wearing time, cleaning and disinfection of contact lenses.
  • Maintain good hand hygiene (especially before applying contact lenses or if dealing with sick people).
  • Do not bathe wearing contact lenses (shower, swim, jacuzzi, etc.).
  • Wear safety glasses if you do activities that can cause eye damage.
  • Wear sunglasses to protect you from UV light.

Frequently asked questions

1. What are the possible complications of keratitis?

Possible complications of keratitis include:

  • Chronic corneal inflammation and scarring.
  • Chronic or recurrent viral infections of the cornea.
  • Temporary or permanent vision loss.
  • Blindness.

2. What is the difference between keratitis and uveitis?

The difference between uveitis and keratitis has to do with the site of inflammation. The signs and symptoms are similar, but uveitis affects the uvea. The uvea is the middle layer of the eye that includes the iris, choroid and ciliary body. Keratitis affects the cornea, the protective layer above the iris.

Another ophthalmological disorder with similar symptoms is conjunctivitis. It affects the conjunctiva, the tissue that “lines” the eyelid. You can have keratoconjunctivitis if the inflammation affects both the cornea and the conjunctiva. Children tend to develop a mild form of this disorder. In this case, a pediatric ophthalmologist examination is mandatory.

The Dr. Holhoș ophthalmology network offers high quality services in its clinics in Cluj-Napoca, Alba-Iulia, Sibiu, Turda and Mediaș. Don’t hesitate to make an appointment for a consultation if you are facing an ophthalmological problem.

Text medically reviewed by Dr. Teodor Holhoș, Ophthalmic Surgeon
Written by Dr. Holhos Team

Nystagmus is the eye condition where the eyes make repetitive and uncontrollable movements. Discover other symptoms and treatment options.

Color vision deficiency, also known as dyschromatopsia, is a general term referring to various vision disorders characterized by a deficiency in color perception.

“Flying flies” are most often harmless and represent a normal stage in the aging process. Find out what the causes are and how you can reduce the symptoms.

Ocular allergies occur as a reaction of the body to an allergen, causing inflammation and itching in the eyes. The most common ocular allergies are seasonal.

Ophthalmic migraine is most common in the 40s. It manifests itself in visual impairment and even temporary blindness.

Keratitis, also known as “corneal ulcer”, is an inflammation of the cornea. If detected early, the ophthalmological disorder is easy to treat and heals quickly.

Diplopia is an ophthalmological disease in which you see two images of the same thing. The condition can affect anyone, but is more common after the age of 60.

Xanthelasma is a member of the xanthomas family and represents fatty deposits in the skin cells around the eyes. It is visible as yellow, harmless bumps.

Colorblind people perceive colors differently from most people. Most of the time, this ophthalmological disorder makes it difficult to distinguish between certain colors.

Epiphora is an ophthalmological disorder manifested by excessive tearing of the eyes. Most of the time, it is not severe and disappears on its own. However, if you are experiencing this and the problem persists, we recommend that you make an appointment for an ophthalmological examination. Treatment can be different, depending on the cause of the epiphora.

If you notice a yellow spot on the white of your eye, you are most likely dealing with pinguecula. The ophthalmological disorder is not severe, but the symptoms can be uncomfortable. Find out how to treat pinguecula and, more importantly, how you can prevent it.

Entropion is the ophthalmological disorder in which the eyelid of the eye turns inwards. It is different from ectropion, where the eyelid turns outwards. It most often occurs in older people and usually only affects the lower eyelid.

It is possible that you may also be experiencing ocular toxoplasmosis without knowing it. This retinal disorder is extremely common in our century and is manifested by eye discomfort and blurred vision.

Ectropion is the ophthalmic disorder in which the eyelid and eyelashes pull away from the cornea, and reorient outwards.

One of the most common types of headache is headache of ocular origin. It occurs as a result of an ophthalmological disorder.

Blepharitis is an ophthalmological disorder that manifests itself by inflammation of the eyelids. At the base of the eyelids, the patient notices small crusts formed by solidified oil particles or bacteria that collect in the crease at the corner of the eye.

Uveitis is an ophthalmological disorder of the uveal tract, manifested by changes in vision and eye pain.

Among the most common ophthalmological disorders is hordeolum. This is popularly known as an “stye” and is an infection of the eyelids.

The drooping eyelid is known in medical terms as “palpebral ptosis”. It manifests itself by narrowing the visual slit of one or both eyes, creating aesthetic and functional discomfort.

Amblyopia is a vision problem, popularly known as “lazy eye”. This disorder can occur in one or both eyes, and studies show that around 3% of the population suffer from this eye disease.

The sensation of “dry eyes” or “tired eyes” is known in medical terms as “dry keratoconjunctivitis” or “xerophthalmia”, and refers to a dysfunction of the tear film.

Strabismus, also known as “crossed-eyes” or “crossed vision”, is an ophthalmological disorder in which the visual axis of the eyes is not aligned. This causes one eye to deviate when it needs to look at a fixed point.

Conjunctivitis is one of the most common ophthalmological disorders. It can occur in adults, children and babies.

Chalazion is manifested by inflammation of the upper or lower eyelid. It is one of the most common ophthalmological disorders, and occurs when the secretion of sebaceous glands in the eye is blocked.

Macular degeneration involves deterioration of the macula and therefore of the quality of central vision. This disease does not affect peripheral vision and therefore cannot lead to complete blindness.

Hypermetropia affects the ability to see nearby objects. You may be able to see distant objects clearly, but closer objects, even words in a book, are usually out of focus. Hypermetropia occurs when the eye does not focus light properly on the retina (the light-sensitive layer at the back of the eye).

Myopia is a disorder that falls into the category of refractive errors (along with astigmatism and hypermetropia). In common terms, myopia manifests itself as blurred distance vision, while near vision is not a problem.

Astigmatism, like myopia and hypermetropia, is a refractive error. In general terms, the disorder manifests itself in blurred, fuzzy vision, regardless of the distance to objects, surfaces.

Presbyopia is an age-related disorder characterized by decreased near vision. It usually appears around the age of 40.

Cataract is a common ophthalmological disorder that causes progressive loss of vision through loss of lens transparency. Studies show that about 50% of the population loses their vision due to this disorder.

See all

You can make an appointment quickly via the form on the right, or directly over the phone. Our colleagues at the reception desk will be happy to provide you with the availability and information you need to make an appointment. Filling in the form does not represent the registration or confirmation of an appointment, but submitting an appointment request. You will be contacted by our team to check the availability of doctors and make an appointment.


Important note regarding patient consultations and surgery appointments

A patient who cancels a consultation or surgery appointment once, at least one day prior to the scheduled appointment, has the right to a second appointment under the same conditions.
If the patient cancels the second consultation and/or surgery appointment, a new appointment can be made only if the patient accepts to pay for both the consultation and the surgery in advance. This can be done either by payment order or in cash at the clinic reception.
A patient who does not show up for their consultation or surgery, who does not cancel the appointment in due time, or does not answer the clinic’s calls, may request a second appointment only if they pay for the consultation/surgery in advance. 
Patients requesting an appointment for retinal surgeries or laser Prk/Femtolasik/Smile Pro must pay 30% of the cost of the surgery in advance. The appointment will be scheduled only after receiving the advance payment. If the patient is unable to attend the scheduled consultation or surgery, and cancels the intervention at least 48 hours beforehand, they will be refunded in full. If the patient does not show up and does not cancel or contact the clinic at least 48 hours in advance, the advance paid is considered to be lost as damages and will no longer be refunded.