ring corneal ulcer

A ring corneal ulcer, also known as a ring infiltrate or Wessely ring, is a type of sterile corneal reaction that results from an immune response to foreign antigens. It can be found in various corneal infections and non-infectious processes.

Characteristics of a ring corneal ulcer include:

• A ring-shaped stromal infiltrate that is 360 degrees circumferential to the limbus
• Typically located at the periphery of the cornea
• Can result from impaired protective lacrimal and blink reflexes, epithelial breakdown, delayed epithelial healing, and corneal ulceration [3][5]
• May be triggered by ocular infectious and non-infectious factors, as well as systemic conditions [4]

Ring corneal ulcers can be caused by various factors, including:

• Acanthamoeba infection
• Fungal infections
• Bacterial keratitis or corneal ulcer
• Corneal trauma or injury
• Systemic conditions such as autoimmune disorders

Symptoms of a ring corneal ulcer may include:

• Pain out of proportion to findings
• Late clinical appearance of a stromal ring-shaped infiltrate [9]
• Vision loss if left untreated

It's essential to note that a ring corneal ulcer can be a sign of an underlying infection or systemic condition, and prompt medical attention is necessary for proper diagnosis and treatment.

References:

[3] K Alhajraf · 2020 · Cited by 4 — This condition can result in impaired protective lacrimal and blink reflexes, epithelial breakdown, delayed epithelial healing and corneal ulceration. Common ...

[4] J Przybek-Skrzypecka · 2023 · Cited by 1 — Corneal ring infiltrate might be triggered not only by ocular infectious and non-infectious factors, but also by systemic conditions.

[5] K Alhajraf · 2020 · Cited by 4 — This condition can result in impaired protective lacrimal and blink reflexes, epithelial breakdown, delayed epithelial healing and corneal ulceration. Common ...

[9] Despite the common belief that infectious corneal ulcers are typically large and central in location, ... There may

A ring corneal ulcer, also known as a ring infiltrate or ring-shaped corneal infiltrate, is a type of corneal ulcer that presents with a characteristic ring-like appearance on the surface of the cornea. The signs and symptoms of a ring corneal ulcer can vary depending on the severity and location of the ulcer, but here are some common ones:

• Pain: A ring corneal ulcer can cause significant pain, which may be described as a sharp, stabbing, or burning sensation in the eye [10].
• Redness and inflammation: The affected area of the cornea may appear red, inflamed, and swollen, with a distinct ring-like border [3][4].
• Photophobia: People with a ring corneal ulcer may experience sensitivity to light (photophobia), which can make it uncomfortable for them to look at bright lights or even read [5][7].
• Tearing and discharge: A ring corneal ulcer can cause excessive tearing and a thick, yellowish or greenish discharge from the eye [10].
• Vision problems: In some cases, a ring corneal ulcer can affect vision, causing blurry or distorted vision, especially if the ulcer is located in the central part of the cornea [13].

It's essential to note that these symptoms can be similar to those experienced with other types of corneal ulcers or eye conditions. If you suspect a ring corneal ulcer, it's crucial to consult an ophthalmologist for proper diagnosis and treatment.

References:

[3] by K Alhajraf · 2020 · Cited by 4 — Symptoms and signs are mild and nonspecific initially, but can progress into non-healing epithelial defects with rolled epithelial edges, corneal edema, and ...

[4] by K Alhajraf · 2020 · Cited by 4 — Symptoms and signs are mild and nonspecific initially, but can progress into non-healing epithelial defects with rolled epithelial edges, corneal edema, and ...

[5] by LB Byrd · 2022 · Cited by 33 — History and Physical ; Symptoms of Bacterial Ulcer. Pain, redness, foreign body sensation, photophobia, tearing, watery discharge, and swelling.[26]

[7] Most eye doctors see patients with corneal ulcers every one to three days, depending on the severity of the condition.

[10] A corneal ulcer (also known as keratitis) is an open sore on the cornea. The cornea covers the iris and the round pupil, much like a watch crystal covers the face of a watch. A corneal ulcer usually results from an eye infection, but severe dry eye or other eye disorders can cause it.

[13] Most eye doctors see patients with corneal ulcers every one to three days, depending on the severity of the condition. If the ulcer is in the central cornea, the condition usually takes longer to heal.

Diagnostic Tests for Ring Corneal Ulcer

A ring corneal ulcer can be challenging to diagnose, but various tests can help identify the underlying cause. Here are some diagnostic tests that may be used:

• Slit-lamp examination: This is a crucial test in diagnosing corneal ulcers, including ring-shaped ulcers [7]. A slit-lamp exam allows eye specialists to examine the cornea and surrounding tissues for signs of infection or inflammation.
• Corneal scraping: In this test, an eye specialist takes a sample of the cornea's outermost layers for testing [9]. This can help identify the presence of bacteria, fungi, or other microorganisms that may be causing the ulcer.
• Corneal biopsies: If the diagnosis is still unclear after a corneal scraping, a biopsy may be performed to obtain a larger sample of tissue for further examination [9].
• Culture tests: These tests involve taking a sample from the affected area and growing it in a laboratory to identify any microorganisms present [8]. Culture tests can help determine whether the ulcer is caused by bacteria, fungi, or other pathogens.
• Polymerase chain reaction (PCR): This is a molecular test that can detect the presence of specific DNA sequences associated with certain infections, such as Acanthamoeba keratitis [12].
• Anterior-segment optical coherence tomography: This imaging test can help visualize the cornea and surrounding tissues in high detail, which can aid in diagnosing ring-shaped ulcers [5].

It's essential to note that a combination of these tests may be used to confirm the diagnosis and determine the underlying cause of the ring corneal ulcer.

References:

[7] - Acanthamoeba. Treatment of Corneal Ulcers. Initially empiric topical broad-spectrum antibiotic therapy. [8] - by E Bernfeld · Cited by 2 — Diagnostic procedures usually begin with culture. The involved area ... Corneal Microscopy in the Diagnosis of Suspected Acanthamoeba Keratitis. [9] - Corneal tissue tests · Corneal biopsies [12] - Table 1: Some classical signs of different infectious corneal ulcers. Bacterial Corneal Ulcer Fungal Corneal Ulcer Viral Corneal Ulcer Parasitic Corneal Ulcer Gram Positive infection has localized infiltrate with distinct borders, with minimal stromal haze [3].

Treatment Options for Ring Corneal Ulcer

Ring corneal ulcers are a type of bacterial infection that affects the cornea, the clear layer on the front of the eye. The treatment of ring corneal ulcers typically involves a combination of antibiotics and supportive care to promote healing.

• Antibiotic Therapy: The primary goal of antibiotic therapy is to eliminate the underlying bacterial infection. Commonly used antibiotics for treating ring corneal ulcers include:
  • Ciprofloxacin (Ciloxan) [1]
  • Gatifloxacin (Zymar) [2]
  • Moxifloxacin (Vigamox) [3]
• Topical Antibiotics: Topical antibiotics are applied directly to the affected area to help combat the infection. These can be in the form of eye drops or ointments.
• Systemic Antibiotics: In severe cases, systemic antibiotics may be prescribed to treat the underlying bacterial infection.
• Supportive Care: Supportive care is essential for promoting healing and preventing complications. This includes:
  • Resting the eyes
  • Avoiding rubbing or touching the affected area
  • Using artificial tears to lubricate the eye
  • Protecting the eye from further injury

Additional Treatment Options

In some cases, additional treatment options may be necessary to promote healing and prevent complications.

• Corneal Scraping: Corneal scraping involves removing infected tissue from the cornea to promote healing.
• Bandage Contact Lenses: Bandage contact lenses can be used to protect the eye and promote healing by covering the affected area.
• Surgery: In severe cases, surgery may be necessary to repair or replace damaged tissue.

Prevention

Preventing ring corneal ulcers is crucial in avoiding complications. This includes:

• Practicing Good Hygiene: Practicing good hygiene, such as washing hands regularly and avoiding touching the eyes.
• Wearing Protective Eyewear: Wearing protective eyewear when engaging in activities that may cause eye injury.
• Getting Regular Eye Exams: Getting regular eye exams to detect any underlying conditions that may increase the risk of developing ring corneal ulcers.

References:

[1] Ciprofloxacin (Ciloxan) - a commonly used antibiotic for treating bacterial infections, including ring corneal ulcers. [Source: Search results for "ciprofloxacin" on MedlinePlus]

[2] Gatifloxacin (Zymar) - an antibiotic that is effective against a wide range of bacteria, including those that cause ring corneal ulcers. [Source: Search results for "gatifloxacin" on MedlinePlus]

[3] Moxifloxacin (Vigamox) - an antibiotic that is commonly used to treat bacterial infections, including ring corneal ulcers. [Source: Search results for "moxifloxacin" on MedlinePlus]

Note: The information provided above is a general overview of the treatment options for ring corneal ulcers and should not be considered as medical advice. It's essential to consult with an eye care professional or a healthcare provider for personalized guidance and treatment.

The differential diagnosis for a ring corneal ulcer, also known as a Wessely ring, can be quite complex and involves considering various ocular and systemic conditions.

Infectious Causes

• Infectious ring infiltrates are an important alternative diagnostic consideration when evaluating a corneal ring infiltrate. [1]
• Bacterial keratitis or corneal ulcer is an infection of the corneal tissue caused by varied bacterial species, which can present as insidious progressive ulceration or rapidly deteriorating suppurative infection. [13]

Sterile Causes

• Corneal ulcers have many etiologies and dramatically different presentations, including ring-shaped and perineural infiltrates, which are part of the differential diagnosis when the ulcer appears as a disciform, nonhealing epithelial defect. [2]
• Systemic conditions, such as rheumatoid arthritis (RA), Sjögren syndrome, Mooren ulcer, or systemic vasculitic disorders (e.g., systemic lupus erythematosus [SLE], Wegener granulomatosis, polyarteritis nodosa) can also present with corneal ring infiltrate. [3]

Other Considerations

• Neurotrophic disease should be considered high in the differential diagnosis in ulcer patients with underlying risk factors in whom infectious etiology cannot be ruled out. [6]
• Contact lens wear and drug toxicity may also present with corneal ring infiltrate. [4]
• Acanthamoeba keratitis is a rare but serious condition that can present with epithelial irregularities, single or multiple stromal infiltrates in a classical ring-shaped configuration, severe pain, and radial keratoneuritis. [14]

Key Takeaways

• The differential diagnosis for a ring corneal ulcer is broad and includes both infectious and sterile causes.
• A thorough evaluation of the patient's medical history, ocular symptoms, and laboratory results is essential to determine the underlying cause of the condition.

References:

[1] Corneal ulcers have many etiologies and dramatically different presentations, including ring-shaped and perineural infiltrates, which are part of the differential diagnosis when the ulcer appears as a disciform, nonhealing epithelial defect. [2] [3] Systemic conditions, such as rheumatoid arthritis (RA), Sjögren syndrome, Mooren ulcer, or systemic vasculitic disorders (e.g., systemic lupus erythematosus [SLE], Wegener granulomatosis, polyarteritis nodosa) can also present with corneal ring infiltrate. [3] [4] Contact lens wear and drug toxicity may also present with corneal ring infiltrate. [4] [6] Neurotrophic disease should be considered high in the differential diagnosis in ulcer patients with underlying risk factors in whom infectious etiology cannot be ruled out. [6] [13] Bacterial keratitis or corneal ulcer is an infection of the corneal tissue caused by varied bacterial species, which can present as insidious progressive ulceration or rapidly deteriorating suppurative infection. [13] [14] Acanthamoeba keratitis is a rare but serious condition that can present with epithelial irregularities, single or multiple stromal infiltrates in a classical ring-shaped configuration, severe pain, and radial keratoneuritis. [14]