Corneal Ulcer (microbial keratitis)

  • Bacterial
    • Remove contact lens
    • Save lens & case as maybe useful for culture
    • Usually refer to eye casualty before antibiotics, for corneal scrape – must if loss of vision, corneal opacity, thinning, or severe symptoms
    • If very mild at presentation consider hourly chloramphenicol ointment, refer to eye casualty if doesn’t respond.
  • Dendritic (herpetic)
    • Ointment acyclovir 5X,
    • refer eye casualty unless mild and resolving


Corneal erosion/abrasion


  • Exclude subtarsal FB
  • Remove corneal FB
  • Chloramphenicol ointment and mydriasis
  • Pad may help symptoms, but not speed up healing.
  • Recurrent erosion – copious lubricants and lubricant ointment at night for 3 months

When to refer

  • Refer to eye casualty if high velocity injury, suspect perforation, persistent rust ring and symptoms



  • Where to refer
    • Refer routine to the corneal consultant at RCHT clinic for corneal topography and formal diagnosis.  Once diagnosed, hospital eye service can support funding of contact lenses, fitted by community optometrists
    • Re-refer when intolerant of contact lens and needs surgery



  • Management
    • If inflamed lubrication and topical NSAID
  • When to refer
    • Refer as routine if significant growth across limbus and severe symptoms warranting surgery usually lamellar keratectomy and conjunctival graft

Date reviewed                     07/08/2019

Next review due                  07/08/2020

Sifter name                         Dr Rebecca Harling

Contributor                   Mr William Westlake



Version No. 3.10