Urgent evaluation and treatment by Dr. Bonnie Sklar
A corneal ulcer is not a condition to watch and wait on. It is a vision-threatening infection that can cause permanent scarring within days if not treated promptly. Berg-Feinfield offers urgent evaluation at five Los Angeles area locations.
A corneal ulcer is an open sore on the cornea — the clear front surface of the eye — caused by infection. The medical term is infectious keratitis, and it can be caused by bacteria, viruses, fungi, or parasites. All four types can threaten vision, but they require different treatments, and distinguishing between them early is critical.
The cornea has no blood vessels — it relies entirely on the tear film and surrounding tissue for immune defense. When that defense is breached by an infectious organism, the cornea can be destroyed rapidly. Bacterial corneal ulcers, for example, can penetrate the full thickness of the cornea within 24–48 hours in severe cases.
Even after the infection is resolved, corneal scarring can permanently reduce vision. In severe cases, corneal transplantation may ultimately be needed to restore clarity. This is why prompt treatment — not just monitoring — is essential from the moment a corneal ulcer is suspected.
Corneal ulcer symptoms often develop rapidly — sometimes over hours. Do not dismiss symptoms as “just pink eye.” Key differences:
Corneal ulcer vs. pink eye: Bacterial conjunctivitis (pink eye) typically causes redness and discharge with minimal pain and no vision change. A corneal ulcer typically causes significant pain, light sensitivity, possible vision change, and may have a visible white spot. When in doubt, see a specialist — not a general practitioner.
Getting the diagnosis right — specifically identifying the type of organism causing the infection — is the most important factor in choosing the correct treatment. Treatment for bacterial keratitis can make fungal or Acanthamoeba keratitis significantly worse.
The most common type — usually caused by Pseudomonas aeruginosa or Staphylococcus aureus, particularly in contact lens wearers. Progresses rapidly. Treated with intensive topical fluoroquinolone antibiotic drops, often applied every 30–60 minutes initially.
Most common risk factor: Contact lens wear, especially overnight or in water.
Usually caused by herpes simplex virus (HSV) or herpes zoster. HSV keratitis can recur throughout a patient’s lifetime and cause progressive corneal scarring with each episode. Treated with antiviral medications (topical and/or oral). Steroids must not be used without antiviral cover.
Most common risk factor: Prior HSV infection, immune suppression, stress.
Caused by fungi such as Fusarium or Aspergillus. Often follows eye trauma involving organic matter — soil, plant material, or vegetable matter. Progresses more slowly than bacterial keratitis but is much harder to eradicate. Requires prolonged antifungal therapy (natamycin, voriconazole).
Most common risk factor: Eye trauma, outdoor exposure, steroid use.
Caused by Acanthamoeba, a microscopic organism found in tap water, swimming pools, hot tubs, and natural bodies of water. Disproportionately affects contact lens wearers who swim or shower in lenses. Notoriously difficult to treat — requires months of intensive therapy with PHMB or chlorhexidine drops. Often misdiagnosed initially as viral keratitis.
Most common risk factor: Contact lens wear in water — shower, pool, ocean.
Treatment begins with confirming the diagnosis — including corneal cultures in many cases — then initiating the appropriate targeted therapy immediately. The goal is to eradicate the infection before further corneal tissue is destroyed.
Broad-spectrum fluoroquinolone drops (moxifloxacin, ciprofloxacin) are applied at very high frequency — every 30 to 60 minutes around the clock in the acute phase. Frequency is reduced as the ulcer responds. Cultures guide antibiotic selection if initial treatment is insufficient.
HSV keratitis is treated with topical ganciclovir gel or oral acyclovir/valacyclovir. Recurrent HSV keratitis may require long-term suppressive antiviral therapy to reduce future episodes. Steroids are used cautiously and only under antiviral cover.
Natamycin is the first-line treatment for filamentous fungal keratitis. Voriconazole drops or oral voriconazole may be added for resistant cases. Treatment duration is prolonged — often 6–12 weeks — and clinical response is slow. Close monitoring is essential.
Acanthamoeba keratitis requires prolonged treatment with antiseptic eye drops — polyhexamethylene biguanide (PHMB) and/or chlorhexidine — applied frequently for many months. Treatment is demanding and outcomes are better when diagnosis is made early, before deep stromal involvement.
Even with successful treatment, some corneal ulcers leave permanent scars that significantly reduce vision. When scarring is dense, central, or deep enough to be visually disabling, corneal transplantation may be the best path to restoring functional vision.
The appropriate procedure depends on the depth and extent of scarring. Superficial scars may be addressed with PTK (phototherapeutic keratectomy). Full-thickness or deep stromal scarring typically requires PKP (Penetrating Keratoplasty). Dr. Sklar evaluates all post-infectious corneal scars individually.
About corneal transplant surgery at Berg-Feinfield →Anyone can develop a corneal ulcer, but certain factors significantly increase risk. Understanding yours is the first step to prevention — and to knowing when to seek urgent care without delay.
The single largest risk factor. Overnight wear, swimming in lenses, poor lens hygiene, and extended use beyond the replacement schedule all dramatically increase risk. Any contact lens wearer with a painful red eye should be seen the same day.
Any scratch or injury to the corneal surface creates an entry point for infection. This is especially true of injuries involving organic material — plant material, soil, or wood — which carry fungal organisms.
Severe dry eye disrupts the protective tear film and can lead to corneal exposure and breakdown — creating conditions favorable for infection. Managing dry eye proactively reduces corneal ulcer risk.
Showering, swimming in pools or the ocean, or using a hot tub while wearing contact lenses significantly increases Acanthamoeba keratitis risk. Los Angeles’s beach and outdoor culture makes this risk particularly relevant.
HSV keratitis can recur in anyone who has had a prior herpes infection — oral or genital. Triggers include illness, UV exposure, stress, and immunosuppression. Patients with known HSV history should be vigilant about any new eye symptoms.
Patients on systemic steroids, chemotherapy, or immunosuppressive medications have reduced corneal immune defenses. Topical steroid eye drops used without appropriate antibiotic or antiviral cover can also trigger or worsen infectious keratitis.
Corneal infections require a specialist who can correctly identify the causative organism, initiate appropriate targeted therapy immediately, and monitor the response closely — adjusting treatment when needed. A general ophthalmologist or emergency room physician may initiate empirical treatment, but a cornea fellowship-trained specialist brings the depth of experience that complex or atypical infections require.
Dr. Bonnie Sklar’s fellowship at Duke University Eye Center included extensive training in ocular infectious disease, corneal ulcer management, and the full spectrum of anterior segment surgical care for post-infectious scarring. Her residency at Wills Eye Hospital in Philadelphia — one of the busiest eye emergency centers in the country — gave her direct experience managing high volumes of acute corneal disease.
View Dr. Sklar’s full profile →For any eye emergency outside of clinic hours, go to the nearest emergency room. For urgent but non-after-hours situations — a painful red eye, white spot, or vision change that developed today — call Berg-Feinfield directly. We will prioritize your evaluation the same day.
A cornea specialist evaluation is superior to an ER visit for suspected corneal ulcers because we can perform corneal cultures, identify the organism type on slit lamp examination, and initiate the precise targeted therapy from the first visit.
Urgent evaluations available at our Burbank, Sherman Oaks, Beverly Hills, and Valencia offices.
Call 866-2-SEE-FAR NowBerg-Feinfield offers urgent corneal ulcer evaluation at locations throughout the Los Angeles area. Call ahead so we can prepare for your arrival.
Berg-Feinfield provides urgent corneal ulcer and infectious keratitis evaluation and treatment to patients throughout Los Angeles County. Communities served include Burbank, Glendale, Sherman Oaks, Encino, Studio City, North Hollywood, Van Nuys, Tarzana, Beverly Hills, West Hollywood, Bel Air, Brentwood, Santa Monica, Malibu, Culver City, Arcadia, Pasadena, Monrovia, Temple City, Valencia, Stevenson Ranch, Santa Clarita, Saugus, Newhall, and surrounding communities throughout the greater Los Angeles metropolitan area.
Very quickly. Aggressive bacterial corneal ulcers — particularly those caused by Pseudomonas — can penetrate the full thickness of the cornea within 24–48 hours in the absence of treatment. Even with treatment, permanent scarring can develop within days if the infection is severe or the organism is resistant to initial antibiotics. This is why same-day evaluation is not an abundance of caution — it is the appropriate standard of care for suspected corneal ulcers.
Yes — take it seriously. Any contact lens wearer who develops a red eye should remove their lens immediately and call an eye care provider the same day. If there is any associated pain, light sensitivity, discharge, white spot on the cornea, or vision change — seek evaluation urgently, not tomorrow. Contact lens-related bacterial keratitis is one of the most common preventable causes of vision loss in otherwise healthy young adults. The threshold for getting it checked should be very low.
No. Over-the-counter redness drops, allergy drops, and lubricating drops will not treat a corneal ulcer. Using redness-relieving drops (vasoconstrictors) may temporarily mask symptoms while the infection progresses. More concerning: over-the-counter steroid-containing drops (which exist in some countries) can dramatically worsen a bacterial or fungal corneal ulcer and should never be used without a doctor’s guidance. The only appropriate treatment for an infectious corneal ulcer is a prescription antimicrobial agent — and the right one depends on identifying the causative organism.
Most corneal ulcers are managed with intensive topical medications and do not require surgery during the acute phase. Surgery may become necessary in specific situations: if the ulcer perforates (ruptures through the full thickness of the cornea) requiring emergency repair, or if significant scarring after healing causes visually disabling corneal opacity. In the latter case, corneal transplantation — typically PKP (full-thickness) or PTK (superficial laser treatment) — may be performed once the eye is fully healed and infection-free, typically many months after the acute event.
An untreated corneal ulcer can progress through increasingly serious stages: deep stromal involvement, endophthalmitis (infection spreading inside the eye), corneal perforation, and ultimately loss of the eye in the most severe cases. Even infections that are eventually controlled may leave permanent central corneal scarring that significantly reduces vision. The outcome of a corneal ulcer is almost entirely determined by how quickly appropriate treatment is initiated — which is why we cannot emphasize same-day evaluation strongly enough.
A corneal ulcer treated promptly can heal with minimal scarring. A corneal ulcer treated late can cause permanent vision loss. If you have a painful red eye, a white spot on your cornea, or sudden vision change — call now.
866-2-SEE-FAR | Burbank · Sherman Oaks · Beverly Hills · Arcadia · Valencia
