What are the corneal ulcer healing stages? How long does it take to heal? What happens when it doesn’t heal? This article briefly covers this and more.
Table of Contents
What is a corneal ulcer?
A corneal ulcer is an active infection of the cornea. The classification of the ulcer is based on the depth (based on the 5 layers of the cornea), etiology, and location (R).
Some common causes of infectious ulcer is directly related to contact lens use. This can be caused by cleaning the contact lenses with water, overwearing the contact lenses, contamination, or other improper cleaning uses.
Some systemic causes include trauma, dry eyes, vitamin A deficiency, ectropion / entropion, lagophthalmos, or prolonged use of corticosteroids.
Corneal ulcer healing stages:
The healing stages of a corneal ulcer when there is no complications is a step-by-step process that must be followed very carefully to ensure adequate recovery.
Stage 1 – Infection and inflammation control
This stage is dedicated to reducing the inflammation on the cornea, and ensuring the infection stays in control. The amount of drop use is based on the severity / location of the ulcer.
Vision threatening / severe ulcers are required to be on drops more frequently (a drop every single hour – including overnight as well). If the infection has become severe enough, hospitalization with an IV antibiotic might also be needed as well.
Smaller or peripheral ulcer locations might only need to be on antibiotic drops every single hour your awake with some antibiotic ointment for overnight as well.
This stage can take anywhere between
- 24-72 hours or more depending on how large or vision threatening the ulcer is.
This stage you might notice:
- Your vision and pain improve a little but will still be a little uncomfortable.
Stage 2 – Epithelial healing
After the infection gets under control the epithelial tissue will finally be able to re-grow. This permits the removal of dead cells and growth of fresh healthy tissue to start the healing process.
This stage is entirely dependent on how quickly the infection was able to be stopped.
This stage can take anywhere between:
- 3 – 7 days or longer depending on the severity.
- Smaller / peripheral ulcers can potentially completely heal at this stage.
This stage you might notice:
- An improvement in both vision and comfort.
Stage 3 – Stromal repair
The stroma is the thickest layer of the cornea and must activate fibroblasts to permit the tissue to begin healing
This promotes the formation of collagen, and the tissue slowly begins to start healing.
This stage can take anywhere between:
- 7 days or longer depending on the severity
This stage you might notice:
- A significant improvement in vision, and comfort.
- However, because the infection has reached this tissue there is the potential for scar formation.
Stage 4 – Remodeling and scar formation
This is the final stage of the healing process. By this stage the tissue has completely recovered. However, there might be the potential for scarring if the ulcer was very deep.
This stage can take anywhere between:
- 7 days or possibly longer depending on the severity
This stage you might notice:
- A complete resolution of discomfort, and your vision should return (unless there is scarring).
How long does each stage take
It is entirely dependent on how severe the ulcer is.
Smaller / peripheral ulcers might heal very quickly, and multiple stages can happen at once. Stage 1 and 2 might only take 24-36 hours. By hour 48-72 we might expect to be in the early stages of remodeling. In the majority of cases it might be between 3-7 days for recovery.
More severe ulcers can expect to take much longer. Sometimes the initial stage might take 24-48 hours just to begin controlling the infection. However in the majority of causes it might be somewhere between several weeks to months for a complete recovery.
Signs your corneal ulcer is healing
The most important way to tell if your corneal ulcer is resolving is based on discomfort / pain, and your vision. You should gradually start to notice an improvement in your vision and comfort levels.
Signs your corneal ulcer is not healing
Very similar to the healing process but reversed, some signs your corneal ulcer is not healing is that your vision is getting noticeable worse or there is worsening pain / discomfort on your eye. At this point you should reach our to your eye care provider to make an appointment as soon as possible.
Healing time by severity (mild to severe)
Mild corneal ulcers: 3-7 days
Severe corneal ulcers: Possible weeks to months
Will your vision fully recover?
Yes, you can expect your vision to make a complete recovery for smaller / peripheral corneal ulcers. If your ulcer is vision threatening and the infection was controllable within a reasonable time frame you can likely expect your vision to make a full recovery.
However, there is still the risk of potential scarring with vision threatening ulcers.
FAQ:
Does a corneal ulcer always leave a scar?
Not always! The more severe an ulcer is, the deeper it will penetrate the layers of the cornea. If it penetrates enough layers or causes enough damage, you can expect a scar. Smaller ulcers can expect to make a complete resolution with no scars.
Can it come back?
Yes, however, if the cause of the initial ulcer was treated the chances of it coming back are slim.
Ex: Over wearing contact lenses caused a corneal ulcer. The fix being proper contact lens hygiene.
Ex: Severe dry eye caused a corneal ulcer. The solution being to control the dry eye.
Why is my eye blurry after healing?
There are several reasons why your vision could remain blurry after the infection has been resolved. At this point I’d recommend you go visit your eye care provider so they can adequately determine the potential cause of the blurry vision.