What is a Complicated Corneal Ulcer?
• A complicated corneal ulcer is an ulcer that, in addition to loss of the epithelium, the underlying corneal stroma is lost. These are usually divided into superficial stromal ulcers (which are less than halfway through the thickness of the cornea) and deep stromal ulcers (which are more than halfway through the thickness of the cornea). • A complicated corneal ulcer begins with a superficial corneal ulcer. Once the protective layer of the epithelium is gone, the ulcer can become infected with bacteria. Certain bacteria produce degrading enzymes that breaks down or ‘‘melt” the stroma of the cornea. In addition, the bacteria draw white blood cells into the cornea to fight off the infection which can produce more degrading enzymes. The result is an ulcer that becomes larger and grows deeper into the cornea. It can extend all the way down to Descemet’s membrane, (termed descemetocele). This is the last stage before the eye ruptures.
