23 Complicated corneal ulcer
CLINICAL EXAMINATION
The ulcer should be obvious on clinical examination. However, the conjunctiva is likely to be hyperaemic, the nictitans membrane elevated and chemosis might also be present which could make visualization of the cornea difficult (Figure 23.1). Sometimes the ocular discharge will be extensive such that the eye is ‘glued’ shut. Gently bathing this away (and taking swabs for culture and sensitivity at the same time – but see below) will assist in examination. Overt ulceration might not initially be visible – there is likely to be significant vascularization (even granulation tissue) on the cornea, along with oedema, both of which obscure the actual ulcer. If areas of cornea appear gelatinous, and creamy or grey in colour, this could suggest keratomalacia or corneal melting (Figure 23.2).