It’s important to treat corneal ulcers quickly to avoid permanent scarring or blindness.

A corneal ulcer (keratitis) is an open sore that develops on your cornea.

The cornea is a clear layer of tissue that covers the front of your eye. About 30,000 to 75,000 people in the United States develop corneal ulcers each year.

Most develop due to infection. Most infections are caused by bacteria, but they can also be caused by other microorganisms like:

Corneal ulcer treatment should start within 12 to 24 hours of symptoms onset. Delaying or avoiding treatment can lead to permanent scarring and blindness.

Let’s look at the most common treatment options for corneal ulcers and when each treatment may be used.

Antibiotic eye drops help treat bacterial infections. Most corneal infections are caused by bacteria.

The first-line treatment for bacterial corneal ulcers is often broad-spectrum antibiotics containing fluoroquinolones like ciprofloxacin or ofloxacin.

Doctors usually swab your eye for microbiological culture so they can determine what specific bacteria is causing your infection and what antibiotic will be most effective. You may be prescribed a different antibiotic when your culture results are ready to better target that specific type of bacteria.

Severe infections that don’t respond to eyedrops may also need antibiotics administered through an IV. Untreated bacterial infections can spread to deeper tissues in your eye and lead to loss of the eye.

Viruses are a common cause of corneal ulcers and the leading cause of infectious blindness in one eye in developed countries.

Antiviral eye drops are used to treat viral infections. The most used antiviral for these infections in the United States is trifluridine. In Europe it’s acyclovir.

The most common virus that causes viral corneal ulcers is the herpes simplex virus. About 99% of cases resolve within 2 weeks with treatment.

Antifungals treat fungal infections. Fungal infections make up about 5% to 10% of corneal infections. They tend to be harder to treat than bacterial or viral infections. The first antifungal doctors prescribe is often natamycin eye drops.

About 30% of fungal infections don’t respond to therapy. People who don’t respond may need surgery or antifungals administered through an IV.

Some corneal infections are caused by microorganisms called protozoa that live in freshwater and soil. Treatment usually consists of removing the damaged tissue and 3 to 4 months of the medications chlorhexidine and poligexametilen biguanide.

Anywhere from 35% to 86% of people respond to these medications.

Corticosteroid eyedrops can potentially help reduce inflammation and scarring. They’re often administered together with other treatments like antibiotics and antivirals, although their use for infectious corneal ulcers remains controversial.

Corticosteroids have the potential to reduce damage to your cornea caused by your immune system in response to the infection. However, they might also weaken your immune response and increase the severity of the infection.

It’s widely accepted that the use of corticosteroids worsens the outcome of fungal corneal ulcers.

Immunosuppressants reduce immune system activity to treat ulcers caused by autoimmune diseases. Autoimmune corneal ulcers are often treated with medications taken orally or through an IV, such as:

A group of drugs called biologics are a newer treatment option. These drugs are administered through an IV or injection under your skin.

Your eye doctor may prescribe medications taken orally or with eyedrops or topical ointment to reduce your pain. Anesthetic eyedrops may be administered by a medical professional in a clinic during an appointment, but they won’t be prescribed for self-care because ongoing use may delay ulcer healing. Your doctor may ask you to describe your pain to understand whether it’s improving or getting worse.

As many as 30% to 40% of people with infectious corneal ulcers may need surgery. Up to 50% of cases of fungal infections may need surgical management.

A corneal transplant involves replacing your cornea with a cornea from a recently deceased donor. A corneal transplant may be performed if you don’t respond to medications. They can cure over 90% of bacterial infections, although they’re less effective for fungal infections.

Home remedies may help support medical treatments for corneal ulcers. They shouldn’t be used as a substitute for medical treatment.

You may be able to aid your healing or relieve symptoms by:

  • putting a cool compress over your eyes to soothe pain
  • taking over-the-counter (OTC) medications, such as ibuprofen or acetaminophen
  • avoiding touching your eyes with your hands
  • avoiding wearing makeup or contact lenses until your doctor tell you it’s OK

Most corneal ulcers heal within a couple of weeks. Ulcers that don’t heal within 2 weeks are often referred to as “nonhealing” ulcers.

You should start noticing at least some improvement in your symptoms about a couple of days after starting treatment. If your symptoms continue to get worse, your doctor may recommend another treatment.

The cornea is very unique. Its transparency comes from the way its internal collagen bundles are organized and kept much drier than other human tissues.

The healthy cornea has no blood vessels, so when ulceration occurs, it’s unable to heal itself like skin and other vascularized tissues. Once treatment succeeds at eliminating the infection or other cause, inflammatory cells will digest the dead cells and other debris.

Nearby healthy surface epithelium (the thin outer layer of the tissue) will slowly migrate and cover the ulcer bed. At the same time, fibroblasts (the cells in connective tissues) within the cornea begin to synthesize new collagen bundles. This new collagen may leave a grayish-white scar.

Once the inflammation has subsided and the epithelial layer is intact, the cornea will continue to remodel itself. As tissue swelling resolves, the affected cornea will regain clarity. Over time, many people will see their small or moderate corneal ulcers disappear. Larger, more complicated ulcers may leave permanent scarring. Additional surgery may be needed to fix this.

Here are some frequently asked questions people have about corneal ulcer treatment.

What is the first-line treatment for corneal ulcers?

Corneal ulcers most often develop from infections. Antimicrobial eye drops are often the first-line treatment.

What is the best treatment for corneal ulcer?

In most cases, the best treatment for corneal ulcers is to target the underlying infection with antimicrobial eye drops. Additional treatments like intravenous drugs or surgery may be needed for serious infections.

Corneal ulcers usually form due to an infection. Most infections are caused by bacteria.

Treatment usually consists of taking eyedrops to address the infection. More serious infections might require surgery or drugs administered through an IV.