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What Is Ulcerative Keratitis?

Ulcerative keratitis is inflammation of the cornea with an epithelial defect and underlying ulceration, often called a corneal ulcer. Many cases are infectious (bacteria, viruses, fungi, or parasites), but ulceration can also occur from severe dryness or autoimmune disease, especially at the corneal edge. Symptoms can progress quickly and may lead to scarring or perforation if not treated promptly. Evaluation by an eye care professional is urgent.

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What Is Ulcerative Keratitis?

Ulcerative keratitis is inflammation of the cornea with an epithelial defect and underlying ulceration, often called a corneal ulcer. Many cases are infectious (bacteria, viruses, fungi, or parasites), but ulceration can also occur from severe dryness or autoimmune disease, especially at the corneal edge. Symptoms can progress quickly and may lead to scarring or perforation if not treated promptly. Evaluation by an eye care professional is urgent.

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Common causes and risk factors

Infections are the most common causes of corneal ulceration, and contact lens wear is a major risk factor for infectious keratitis. Trauma, contaminated water exposure, and poor ocular surface health also raise risk. Peripheral ulceration can be linked to systemic inflammatory disease.

  • Contact lens overwear or poor hygiene
  • Bacterial, viral, fungal, or Acanthamoeba infection
  • Corneal abrasion or foreign body
  • Autoimmune disease associated peripheral ulceration

Symptoms and warning signs

Ulcerative keratitis usually causes significant discomfort and noticeable redness. A white or gray spot on the cornea may be visible, and vision can drop depending on location. Do not self-treat with leftover drops because incorrect therapy can worsen infection.

  • Eye pain, light sensitivity, and tearing
  • Redness and discharge
  • Blurred vision or a new central haze
  • Visible corneal spot or swelling

Diagnosis

Diagnosis is made by slit-lamp examination and fluorescein staining to identify the ulcer and its size and depth. For larger, central, severe, or atypical ulcers, clinicians may take corneal cultures before starting or while adjusting treatment. Optical coherence tomography (OCT) or additional imaging may be used in selected cases, and systemic evaluation may be considered for peripheral ulcers. Close follow-up tracks response and prevents complications.

Treatment

Treatment depends on the cause and typically starts immediately with prescription eye drops. Infectious ulcers are treated with topical antimicrobials (antibiotic, antiviral, or antifungal), and contact lenses are stopped during treatment. Steroid drops are sometimes added only after infection is improving and under specialist guidance to reduce scarring risk. Severe cases may require procedures such as debridement, corneal glue, or transplant if there is impending perforation.

FAQs on ulcerative keratitis

Is ulcerative keratitis the same as a corneal ulcer?

In many contexts, yes. Ulcerative keratitis describes a corneal ulcer with inflammation. Some clinicians also use it broadly to include noninfectious ulceration, such as peripheral ulcerative keratitis linked to autoimmune disease.

Can contact lenses cause ulcerative keratitis?

Yes. Overwear, sleeping in lenses, poor cleaning, and water exposure while wearing lenses increase the risk of infectious keratitis. Prompt evaluation is important if a contact lens wearer develops pain and redness.

When should I seek emergency care?

Seek same-day care for severe pain, light sensitivity, a visible white spot on the cornea, or any sudden decrease in vision. Corneal ulcers can worsen quickly and may scar or perforate without treatment. If you cannot access an eye clinic, urgent care or an emergency department is reasonable.

Will it leave a scar?

It can. The risk depends on ulcer depth, location, and how quickly treatment starts. Early, appropriate therapy reduces the chance of permanent scarring and vision loss.

References

Peripheral Ulcerative Keratitis. Fu L, et al. (StatPearls Publishing). https://www.ncbi.nlm.nih.gov/books/NBK574556/. Date Accessed: February 19, 2026.

Updates on Systemic Immunomodulation in Peripheral Ulcerative Keratitis. Maleki A, et al. https://www.mdpi.com/2813-1053/2/4/11. Date Accessed: February 19, 2026.

Peripheral Ulcerative Keratitis. EyeWiki (American Academy of Ophthalmology). https://eyewiki.org/Peripheral_Ulcerative_Keratitis. Date Accessed: February 19, 2026.

Mooren’s Ulcer: A Narrative Review. (PubMed). https://pubmed.ncbi.nlm.nih.gov/41306497/. Date Accessed: February 19, 2026.

Keratitis. Singh P, et al. (StatPearls Publishing). https://www.ncbi.nlm.nih.gov/books/NBK559014/. Date Accessed: February 19, 2026.