Eye ulcers in children: What to do if your child has a serious eye condition

Eye ulcers are open wounds that form on the cornea, or the clear front part of the eyeball. Also called corneal ulcers or keratitis, these ulcers begin with an injury or infection that worsens over time.

“A corneal abrasion can begin with a scratch on the eye, which will typically heal on its own. But if the damage reaches a deeper layer, the infection can lead to an ulcer, which can cause scars on the cornea,” said Dr. Charline Boente, a pediatric ophthalmologist at Riley Children’s Health.

What causes eye ulcers

Corneal ulcers are usually caused by an infection, which can be bacterial, viral or fungal. Poor hygiene when wearing contact lenses or an eye injury can also cause this condition. These eye problems are also common in children who have neurotrophic keratopathy, a condition where there’s no sensation in the cornea. These children cannot feel pain from an ulcer and must be monitored for it, just like people with diabetes are monitored for foot problems.

“Patients with neurotrophic keratopathy cannot heal the surface of the eye as they would if their nerves were intact,” said Dr. Gregory Borschel, a plastic surgeon at Riley Children’s Health. “These patients don’t feel problems like scratches or ulcers. And once these problems begin, it’s harder to heal them.”

What if an eye ulcer goes untreated

If left untreated, these ulcers lead to vision problems and can cause permanent damage to the eye.

“You can think about the cornea as the window to your eye. If there’s a scar, it creates an opacity or cloudiness in your vision. The worst-case scenario is that the eye injury ulcerates, and the surface of the cornea thins so much that it perforates,” Dr. Boente said. “Right behind the cornea, your eye is like a snow globe; it’s full of fluid. A puncture can cause fluid to gush out and create a pathway for an infection inside the eye. That can lead to blindness or even loss of the eye. That’s what we’re trying to prevent. We’ve seen kids develop perforations, and it’s quite devastating.”

Symptoms of eye ulcers

A child with an eye ulcer may:

• Feel severe pain in their eye and difficulty opening the eye
• Feel the sensation of something irritating or stuck in their eye
• Have an eye that is red or swollen
• Have tears or pus in the eye
• Have a visible ulcer on the front of the eye that appears cloudy or opaque
• Have decreased vision

A corneal ulcer requires urgent care. Take your child to their eye doctor, pediatrician or a walk-in clinic as soon as you notice symptoms.

How eye ulcers are diagnosed

Corneal ulcers are usually diagnosed in kids who wear contact lenses, kids who have had an eye injury or children diagnosed with neurotrophic keratopathy. If your child shows symptoms of a corneal ulcer, your pediatrician or eye doctor should be able to diagnose it. However, some doctors do not see these conditions very often. A pediatric ophthalmologist is likely to manage care for corneal ulcers.

Your doctor will first determine what caused your corneal ulcer to understand how to treat it. Your doctor may test fluid from your eye to identify what is causing the infection.

Treatment for eye ulcers

If your child wears contact lenses, they should remove them immediately. The first treatment for corneal ulcers is typically prescription eye drops. These are often antimicrobial drops, which are special antibiotics to target eye infections. If the eye infection is more severe or does not improve, the doctor may recommend hospital admission or surgery.

“If the ulcer’s not responding to these topical treatments, we’ll escalate the therapy,” said Dr. Boente. “This might include specialized contact lenses or tissue grafts. Sometimes we’ll suture the eyelid close to help the eye heal.”

Most children will heal from an eye ulcer with the proper treatment. Children with neurotrophic keratopathy will need ongoing monitoring to check for recurrent eye infections. If you have any concerns about an infection in your child’s eye, contact your eye doctor or an ophthalmologist as soon as possible. It’s important to treat eye infections promptly in children to avoid future damage to their vision.