Corneal Disease · Urgent Care · Los Angeles
Corneal Ulcer & Infectious Keratitis
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.
Do Not Wait
Seek Evaluation the Same Day If You Have Any of These
- Sudden eye pain — especially if you wear contact lenses
- A white, gray, or cloudy spot visible on the cornea
- Intense sensitivity to light (photophobia)
- Significant redness that came on suddenly
- Discharge or crusting from the eye
- Sudden decrease in vision in one eye
- A sensation that something is in your eye that won't go away
Do Not Wait for a Routine Appointment
Call us at 866-2-SEE FAR and describe your symptoms. We will prioritize your evaluation. If it is after hours, go to your nearest emergency room or urgent eye care center.
Understanding the Condition
What Is a Corneal Ulcer?
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.
Infectious keratitis 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 resolves, 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.
Symptoms
Recognizing Infectious Keratitis
Corneal ulcer symptoms often develop rapidly — sometimes over hours. Do not dismiss symptoms as "just pink eye." The key differences:
- Pain — typically far more painful than routine conjunctivitis
- Visible white spot — a white or gray opacity on the cornea is a hallmark sign
- Light sensitivity — often severe; patients may struggle to open the eye in a bright room
- Reduced vision — any sudden vision change requires same-day evaluation
- Contact lens intolerance — sudden inability to wear a lens comfortably
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.
Four Types of Infectious Keratitis
The Cause Determines the Treatment
Identifying the type of organism causing the infection is the single most important factor in choosing the correct treatment. Treatment for bacterial keratitis can make fungal or Acanthamoeba keratitis significantly worse.
Bacterial Keratitis
High urgency
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.
Viral Keratitis
Requires specialist care
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. Steroids must not be used without antiviral cover.
Most common risk factor: Prior HSV infection, immune suppression, stress.
Fungal Keratitis
Difficult to treat
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.
Most common risk factor: Eye trauma, outdoor exposure, steroid use.
Acanthamoeba Keratitis
High risk of vision loss
Caused by Acanthamoeba, a microscopic organism found in tap water, pools, hot tubs, and natural bodies of water. Disproportionately affects contact lens wearers who swim or shower in lenses. Notoriously difficult to treat and often misdiagnosed initially as viral keratitis.
Most common risk factor: Contact lens wear in water — shower, pool, ocean.
How We Treat It
Corneal Ulcer Treatment at Berg-Feinfield
Treatment begins with confirming the diagnosis — including corneal cultures in many cases — then initiating targeted therapy immediately, to eradicate the infection before further corneal tissue is destroyed.
Intensive Topical Antibiotics
Broad-spectrum fluoroquinolone drops (moxifloxacin, ciprofloxacin) 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.
Antiviral Therapy
HSV keratitis is treated with topical ganciclovir gel or oral acyclovir/valacyclovir. Recurrent HSV keratitis may require long-term suppressive antiviral therapy. Steroids are used cautiously and only under antiviral cover.
Antifungal Eye Drops
Natamycin is the first-line treatment for filamentous fungal keratitis. Voriconazole drops or oral voriconazole may be added for resistant cases. Treatment is prolonged — often 6–12 weeks — and clinical response is slow. Close monitoring is essential.
PHMB / Chlorhexidine Drops
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.
When Corneal Scarring Requires Transplantation
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.
What to Bring to Your Evaluation
- Your contact lenses and case — even if you've stopped wearing them
- Any eye drops you've already started using
- A list of all current medications
- History of prior eye infections or herpes (anywhere on the body)
- Recent history of eye trauma, outdoor exposure, or water exposure
Who Is at Risk
Risk Factors for Corneal Ulcers in Los Angeles
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.
Contact Lens Wear Is 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.
Los Angeles's beach and outdoor culture makes water exposure in lenses — showering, swimming, hot tubs — a particularly relevant risk for Acanthamoeba keratitis.
Eye Trauma
Any scratch or injury to the corneal surface creates an entry point for infection — especially injuries involving organic material like plant matter, soil, or wood, which carry fungal organisms.
Dry Eye Disease
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.
Water Exposure in Lenses
Showering, swimming in pools or the ocean, or using a hot tub while wearing contact lenses significantly increases Acanthamoeba keratitis risk.
Prior Herpes Simplex Virus
HSV keratitis can recur in anyone who has had a prior herpes infection. Triggers include illness, UV exposure, stress, and immunosuppression. Patients with known HSV history should be vigilant about new eye symptoms.
Immunosuppression
Patients on systemic steroids, chemotherapy, or immunosuppressive medications have reduced corneal immune defenses.
Steroid Eye Drops
Topical steroid eye drops used without appropriate antibiotic or antiviral cover can trigger or worsen infectious keratitis.
Contact Lens Safety — What Not to Do
- Never sleep in contact lenses unless specifically prescribed for overnight wear
- Never swim, shower, or use a hot tub while wearing contact lenses
- Never rinse your lens case with tap water — use only contact lens solution
- Never use contact lenses past their recommended replacement date
- Never ignore a painful or red eye — remove your lens and call us immediately
- Never use steroid eye drops without a doctor's supervision
Your Specialist
Fellowship-Trained Cornea Care for Urgent Infections
Bonnie Sklar, MD
Fellowship-Trained Cornea Specialist
- Fellowship — Duke University Eye Center
- Residency — Wills Eye Hospital, Philadelphia
- MD — Icahn School of Medicine at Mount Sinai
- Golden Apple Award — Duke Eye Center
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.
When to Call a Cornea Specialist vs. Going to an ER
- Call Berg-Feinfield same-day: painful red eye, white spot, vision change, contact lens intolerance
- Go to the ER after hours: severe pain, significant vision loss, chemical injury, foreign body penetration
- Follow up with us after the ER: any corneal infection diagnosed in an ER should be followed by a cornea specialist within 24–48 hours
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 precise targeted therapy from the first visit.
Five Locations Across Greater Los Angeles
Urgent Corneal Care Near You
Berg-Feinfield offers urgent corneal ulcer evaluation at locations throughout the Los Angeles area. Call ahead so we can prepare for your arrival.
Sherman Oaks
13320 Riverside Drive, Suite 114Sherman Oaks, CA 91423(818) 501-3937
Beverly Hills
462 N. Linden Drive, Suite 441Beverly Hills, CA 90212(866) 273-3327
Symptoms right now?
Call us and describe your symptoms — we will prioritize your evaluation today.
Call 866-2-SEE FARCorneal Ulcer Treatment Serving Greater Los Angeles
Berg-Feinfield provides urgent corneal ulcer and infectious keratitis evaluation throughout Los Angeles County — including 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, and Newhall.
Common Questions
Corneal Ulcers — Your Questions Answered
Don't Wait. Call Us Today.
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.