CORNEAL ULCER

Corneal Ulcer can cause severe and irreversible damage to vision within hours[1], destruction of an eye within a day[2]. Most ulcers are less aggressive, but the virulence of the infection cannot be determined with certainty at first view. A standard, vigorous approach to investigation and treatment may be overkill for most ulcers but is essential for the few.

PRACTICE POINT

All primary care physicians must:

1. recognise a corneal ulcer
2. refer to an opthalmologist as an emergency


This ophthalmic emergency will be seen occasionally by general practitioners and emergency-room physicians alike. It requires emergency ophthalmic referral[2].

PRACTICE POINT

Standard treatment of Corneal Ulcer:

1. Corneal scrapings and culture
2. Broad combination antibiotic
3. fortified drops
4. applied hourly


Various Clinical Practice Guidelines have been developed by corneal specialists[3] but compliance, even by general ophthalmologists, is patchy. Some specialists appear to act as if they can predetermine the virulence of the germ, reserving standardised treatment for the most severe infections[4].

Even damage from virulent infections may be litigated successfully, if opportunity for vigorous treatment was missed through misdiagnosis or ignorance.

Copyright © 2008 Electronic Handbook of Legal Medicine