• Highland Health and Social Care Partnership
  • Primary and Secondary Care

Corneal infection with overlying ulcer / defect in the corneal epithelium


  1. Bacterial
  2. Viral (Herpes simplex)
  3. Others (rare) - Fungal, Acanthamoeba

Risk factors:

  • Contact lens use
  • Blepharitis (sticky eyelashes, red eyelids)
  • Severe dry eye, especially elderly
  • Previous Herpes simplex virus of eye or skin


  • Red eye
  • Watery eye
  • Pain – strong foreign body sensation or more severe constant pain
  • Photophobia - pain in bright light
  • Reduced vision


  • Use Proxymetacaine local anaesthetic drops to reduce pain and allow examination / swabs
  • Grey / white opacity in cornea - typically fairly central rather than at very edge of cornea
  • Fluoroscein drops - ulcer stains green in blue light
  • Red eye maximal around corneal edge
  • Hypopyon (white ‘fluid level’ visible against inferior iris)
  • Dendritic ulcer (branching linear pattern) indicates Herpes simplex


  • If Herpes simplex dendritic ulcer - Ganciclovir ointment 5 times daily , review Ophthalmology within 72h
  • All other corneal ulcers - treat as bacterial keratitis:
    1. Conjunctival swab for C&S
    2. Corneal swab from ulcer for C&S
    3. Admit to NTC Ophthalmology, side room
    4. Ofloxacin drops hourly day and night
    5. Cyclopentolate 1% drops three times a day
    6. Arrange for follow up with Ophthalmology that day or, if out of hours, the following day.


  • C&S: Culture and Sensitivity
  • NTC: National Treatment Centre

Last reviewed: 14/02/2023

Next review date: 28/02/2026

Author(s): Ophthalmology Review Group.

Version: 1

Approved By: TAM subgroup of the ADTC

Reviewer name(s): Dr T Leslie, Consultant Ophthalmologist.

Document Id: TAM556

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