Corneal Ulcer Treatment in Ranchi
Prompt, evidence-based management of corneal infections at Neurovision Clinic, preventing vision loss through early diagnosis and targeted antimicrobial therapy.
What is Corneal Ulcer (Infectious Keratitis)?
A corneal ulcer, or infectious keratitis, is a breach in the corneal epithelium with underlying stromal infiltration, suppuration, and tissue necrosis caused by microbial invasion. It represents one of the most common preventable causes of corneal blindness worldwide, with an estimated 1.5 to 2 million new cases annually, predominantly in low- and middle-income countries. The causative organisms include bacteria (Staphylococcus aureus, Streptococcus pneumoniae, Pseudomonas aeruginosa), fungi (Fusarium, Aspergillus, Candida), viruses (herpes simplex, herpes zoster), and protozoa (Acanthamoeba). In India, particularly in agrarian states like Jharkhand, fungal keratitis accounts for a significant proportion of corneal ulcers due to corneal trauma with vegetative matter. Bacterial keratitis tends to be more acute and aggressive, with rapid stromal melting, while fungal keratitis follows a subacute course with feathery, dry infiltrates. The presence of a hypopyon, a layer of inflammatory cells in the anterior chamber, indicates severe disease regardless of the aetiology. Without timely and appropriate treatment, corneal ulcers can result in permanent visual impairment from corneal scarring, irregular astigmatism, thinning, descemetocele, or frank perforation.
Symptoms of Corneal Ulcer (Infectious Keratitis)
- •Severe ocular pain disproportionate to clinical findings on gross inspection, as the ulcerated corneal epithelium exposes the richly innervated stromal nerve endings; marked redness and circumcorneal injection (ciliary flush); excessive tearing and watery or mucopurulent discharge, which may be profuse in bacterial infections; photophobia so intense that the patient keeps the eye tightly shut; blurred or hazy vision that worsens as the infiltrate expands and corneal oedema develops; a whitish or greyish spot visible on the cornea to the naked eye when the ulcer is central and large; and in advanced cases, a visible layer of pus (hypopyon) settled in the anterior chamber. The time course is diagnostically helpful, with bacterial ulcers progressing over hours to a day, while fungal ulcers evolve more slowly over several days to weeks. Herpetic ulcers often present with a distinctive dendritic branching pattern and may be associated with periocular vesicles and reduced corneal sensation.
Clinical Observations at Neurovision
Dr. Dibya Prabha at Neurovision sees a high volume of fungal corneal ulcers in farmers from Jharkhand's paddy-growing regions — caused by vegetative trauma from rice stalks, hay, and thorns during field work. These patients often present 5–7 days after injury, having used steroid-containing eye drops from local chemists that worsen fungal infections.
Standard medical literature states:
Standard corneal textbooks describe infectious keratitis as a microbial infection of the cornea, with bacterial causes most common in contact lens wearers and fungal keratitis more common in agricultural settings.
We perform corneal scraping for KOH mount and Gram stain on the day of presentation to guide antimicrobial selection. We counsel patients and local chemists in Hindi that using steroid eye drops ('safed boond') on a red, painful eye after a plant injury can cause the ulcer to 'explode' — making a treatable infection sight-threatening.
— Dr. Dibya Prabha
Causes & Risk Factors
- •Microbial invasion following a breach in the corneal epithelial barrier is the proximate cause. Corneal trauma with vegetative matter such as a tree branch, thorn, hay, or paddy leaf is the most common predisposing factor for fungal keratitis in agricultural regions of Jharkhand. Contact lens wear, particularly extended or overnight wear and inadequate lens hygiene, predisposes to bacterial (especially Pseudomonas) and Acanthamoeba keratitis. Pre-existing ocular surface diseases including severe dry eye, chronic blepharitis, lagophthalmos, trichiasis (in-turned lashes), and neurotrophic keratopathy compromise the corneal epithelium. Topical corticosteroid abuse, often from over-the-counter steroid-antibiotic drops used for red eye without proper diagnosis, is a major iatrogenic cause that suppresses immunity and worsens infection. Vitamin A deficiency and malnutrition, though less common, remain relevant in undernourished populations. Occupational hazards such as welding arc burns, industrial dust, and agricultural work in paddy fields are regionally significant risk factors in and around Ranchi.
Diagnostic Tests
Corneal Scraping and Microbiological Workup
The gold standard diagnostic procedure. Under topical anaesthesia and slit-lamp magnification, Dr. Dibya Prabha collects corneal scrapings from the advancing edge and base of the ulcer using a sterile Kimura spatula or surgical blade. The sample is smeared for Gram staining (bacteria) and KOH wet mount (fungal hyphae), and inoculated onto culture media including blood agar, chocolate agar, and Sabouraud dextrose agar. Culture and sensitivity results guide targeted antimicrobial therapy, typically available within 48 to 72 hours.
Slit-Lamp Biomicroscopy with Serial Photography
Detailed slit-lamp examination documents ulcer size (in millimetres), depth (percentage of stromal thickness), infiltrate morphology, epithelial defect staining pattern with fluorescein, presence of hypopyon and its height, anterior chamber reaction, and endothelial plaque. Serial photographs taken at each visit at Neurovision Clinic, Ranchi, allow objective monitoring of healing, failure to respond, or worsening that would prompt a change in therapy.
Anterior Segment OCT
High-resolution anterior segment OCT provides cross-sectional imaging of the cornea, allowing precise measurement of stromal thinning, infiltrate depth, descemetocele formation, and corneal thickness. It is particularly useful in monitoring deep fungal ulcers and post-herpetic stromal necrosis, where clinical assessment of depth may be unreliable. AS-OCT helps Dr. Dibya Prabha determine when a cornea is at risk of perforation and may require emergency tectonic intervention.
Treatment Approach
Corneal ulcer management at Neurovision Clinic, Ranchi, follows a protocol of urgent diagnosis, immediate initiation of broad-spectrum antimicrobials, and daily monitoring until the infection is controlled. Dr. Dibya Prabha employs a stepwise strategy that is adjusted dynamically based on clinical response, microbiology results, and the development of any complications.
- Empiric and Culture-Directed Antimicrobial Therapy
- Antibiotics are started on the day of presentation. For bacterial ulcers, fortified cefazolin 5% combined with fortified tobramycin or gentamicin 1.4% are given hourly around the clock initially, later tapered based on clinical improvement. Alternatively, a fourth-generation fluoroquinolone such as moxifloxacin 0.5% may be used for small, non-central ulcers. For fungal ulcers, natamycin 5% suspension is the first-line antifungal, with voriconazole or amphotericin B reserved for resistant cases. Oral ketoconazole or voriconazole are added for deep stromal fungal infections. Herpetic keratitis is treated with oral acyclovir or valacyclovir and topical ganciclovir gel.
- Cycloplegic Agents and Adjunctive Therapy
- Cycloplegic drops such as homatropine 2% or atropine 1% are prescribed to immobilise the ciliary muscle and iris, providing significant pain relief by reducing ciliary spasm and preventing posterior synechiae formation. Lubricating preservative-free tear substitutes support re-epithelialisation once the infection is under control. Oral analgesia with NSAIDs or paracetamol is provided. Dr. Dibya Prabha also addresses predisposing factors such as treating blepharitis, epilating trichiatric lashes, and optimising tear film status.
- Inpatient Admission and Surgical Intervention
- Patients with large, central, or deep ulcers, poor compliance, or inability to self-administer frequent drops are admitted to a partnered eye hospital in Ranchi for round-the-clock treatment. Surgical options are considered when medical therapy fails or perforation is imminent: cyanoacrylate tissue adhesive with bandage contact lens for small perforations or descemetoceles, conjunctival flap or amniotic membrane grafting to promote healing and provide tectonic support, and therapeutic penetrating keratoplasty when the cornea perforates or remains recalcitrant despite maximal medical therapy.
- Visual Rehabilitation After Infection Resolution
- Once the infection is completely resolved and the corneal epithelium is intact, Dr. Dibya Prabha assesses residual corneal opacity, irregular astigmatism, and cataract formation. Options for visual rehabilitation include rigid gas permeable contact lenses to mask irregular astigmatism, optical penetrating keratoplasty for dense central scars, and cataract surgery with toric intraocular lenses for significant astigmatism. Corneal cross-linking may be considered as an adjunct for resistant cases. All rehabilitation is deferred until the eye is completely quiet for at least three to six months.
When to See a Doctor
- !You develop sudden, severe eye pain with redness, tearing, and light sensitivity, especially after any eye injury involving soil, plant material, or a foreign body.
- !You notice a white or grey spot on your cornea that was not there before, regardless of whether the eye is painful or not.
- !You are a contact lens wearer and experience eye discomfort, redness, or blurred vision that does not resolve immediately after removing your lenses.
- !An episode of 'red eye' that was initially mild does not improve within 24 hours and instead worsens with increasing pain or visual decline.
- !You have a history of cold sores or shingles and develop eye pain with a branching corneal pattern or a vesicular rash around the eye.
- !You have had any eye surgery, corneal abrasion, or ocular surface disease and subsequently develop worsening pain, haze, or discharge that is not explained by the original condition.
Frequently Asked Questions
What is a corneal ulcer and why is it an emergency?
A corneal ulcer, or infectious keratitis, is an open sore on the cornea characterised by epithelial defect with underlying stromal infiltration and inflammation, usually caused by microbial infection. It is a true ocular emergency because the cornea is the transparent window of the eye and any scarring or thinning can permanently impair vision. Bacterial corneal ulcers can progress rapidly, with some aggressive organisms like Pseudomonas aeruginosa liquefying the corneal stroma and perforating the eye within 24 to 48 hours. Fungal keratitis, more common in agricultural regions of India including Jharkhand, follows a more indolent but equally destructive course. Dr. Dibya Prabha at Neurovision Clinic, Ranchi, prioritises immediate corneal scraping for microbiological diagnosis and initiates empiric broad-spectrum antimicrobial therapy on the same day of presentation to halt the infective process.
What are the common causes and risk factors for corneal ulcer?
Corneal trauma with vegetative matter such as a tree branch, paddy leaf, or thorn is the most significant risk factor for fungal keratitis, especially in agricultural workers. Contact lens wear, particularly extended or overnight wear and poor lens hygiene, is a major risk factor for bacterial and acanthamoeba keratitis. Pre-existing corneal surface disease including dry eye, chronic blepharitis, entropion with trichiasis (in-turned eyelashes rubbing on the cornea), and exposure keratopathy compromise the epithelial barrier. Topical corticosteroid use without antibiotic cover in a misdiagnosed red eye can suppress immunity and flare a latent infection. Malnutrition, diabetes mellitus, and systemic immunosuppression are additional predisposing factors that impair corneal healing. Ocular surface trauma from dust, sand, or minor industrial injuries is common in Ranchi and surrounding districts.
How is corneal ulcer diagnosed and treated at Neurovision Clinic?
Diagnosis begins with a detailed history and slit-lamp examination documenting ulcer size, depth, infiltrate characteristics, and anterior chamber reaction. Dr. Dibya Prabha performs corneal scraping under topical anaesthesia for Gram staining, potassium hydroxide wet mount (to detect fungal hyphae), and culture on blood agar, chocolate agar, and Sabouraud dextrose agar. Treatment is initiated immediately based on clinical features and smear results: fluoroquinolone monotherapy or fortified cephalosporin and aminoglycoside combinations for bacterial ulcers, natamycin 5% for filamentous fungal ulcers, and oral voriconazole or intrastromal antifungal agents for deep fungal keratitis. Patients are reviewed daily during the acute phase at Neurovision Clinic, Ranchi, with serial slit-lamp photography to track healing.
Can a corneal ulcer cause permanent vision loss?
Yes, corneal ulcer is one of the most common causes of monocular corneal blindness, particularly in developing countries. After the infection resolves, residual corneal scarring (leucoma or nebula) in the visual axis permanently reduces visual acuity. Severe ulcers can lead to corneal perforation, iris prolapse, endophthalmitis (intraocular spread of infection), or secondary glaucoma. Even successfully treated ulcers may leave irregular astigmatism that affects the quality of vision. Dr. Dibya Prabha emphasises that early presentation is the single most important determinant of outcome; ulcers presenting within 48 hours of symptom onset have a significantly better prognosis than those left untreated for a week or more. For patients with post-infectious corneal scars, Neurovision Clinic provides counselling on optical iridectomy, rigid gas permeable contact lenses, and keratoplasty options when indicated.