Corneal ulcer

Japanese: 角膜潰瘍 - かくまくかいよう（英語表記）Corneal ulcer
Corneal ulcer

What is the disease?

Unlike the corneal erosion mentioned above, when the corneal epithelium on the surface of the cornea is affected, as well as the underlying substance, becoming cloudy or thin, this is called a corneal ulcer. This is a more serious condition, and visual impairment may remain even after healing. Corneal perforation ( Concealment ) That is, the cornea Hole ( hole ) This can lead to blindness, and in rare cases, to loss of vision.

What is the cause?

The main causes are trauma and various infections (herpes, bacteria, fungi, amoeba). Other causes include corneal ulcers caused by an abnormal immune reaction (autoimmunity) that clouds or dissolves the cornea (erosive corneal ulcers), corneal ulcers caused by acid or alkali entering the eye (chemical corneal corrosion), diabetes, and nervous system disorders. tumor ( Main ) In some cases, the sensory nerves of the cornea may be damaged.

It is important to understand that while keratotic corneal ulcers will always develop into ulcers, only severe cases of keratitis will develop into corneal ulcers.

How symptoms manifest

The symptoms include eye irritation, pain (sometimes severe), and bloodshot eyes. If an ulcer forms in the area that covers the pupil, vision will be significantly reduced. A lot of tears will be produced. In cases of bacterial or fungal infection, a lot of eye discharge will be produced.

Sometimes there may be no pain, but in that case the nerves in the cornea are damaged and the condition becomes more difficult to heal.

Testing and diagnosis

If an infection is suspected, a small amount of the affected area will be scraped off to check for bacteria, fungi, and herpes viruses. Tests may be done to check for loss of corneal sensitivity, and blood tests may be taken to check for diabetes or autoimmune diseases.

Treatment methods

In the case of infection, medication against the causative microorganism is administered in the eyes. Eye ointment ( Cancer ) It can be administered intravenously, orally, or as a subconjunctival injection (injecting the medication into the space between the conjunctiva, the outermost layer of the white of the eye, and the sclera underneath it).

If it is not an infection, doctors may administer anti-inflammatory drugs and/or apply an eye patch and/or therapeutic soft contact lenses to promote healing of the corneal epithelium.

If these treatments fail or if corneal perforation occurs, a corneal transplant is necessary. Even if the condition is successfully cured, if severe opacity remains in the center of the cornea and vision is poor, a corneal transplant is still required.

Related Topics

Corneal herpes, bacterial keratitis, keratomycosis, acanthamoeba keratitis, corneal ulcer, chemical corrosion of the cornea

Koji Inoue

Source: Houken “Sixth Edition Family Medicine Encyclopedia” Information about the Sixth Edition Family Medicine Encyclopedia

Japanese:

どんな病気か

　前項の角膜びらんと異なり、角膜の表面の上皮だけでなく、その奥の実質にもにごったり、薄くなったりといった影響が出ている場合は角膜潰瘍といわれます。より重症であり、治ったあとも視力障害が残ります。場合によっては角膜穿孔(かくまくせんこう)といって、角膜に孔(あな)があいてしまうことがあり、失明に至るケースもまれにあります。

原因は何か

　外傷やいろいろな感染（ヘルペス、細菌、真菌、アメーバ）が主たる原因です。その他、自分の角膜をにごらせたり溶かしたりするような異常な免疫反応（自己免疫）によって生じる場合（蚕蝕性(さんしょくせい)角膜潰瘍）、酸やアルカリが眼に入って起こる場合（角膜化学腐蝕(かくまくかがくふしょく)）、糖尿病や神経系の腫瘍(しゅよう)などで角膜の知覚神経が障害されて起こる場合もあります。

　蚕蝕性角膜潰瘍は必ず潰瘍になりますが、それ以外は、そのなかの重症例が角膜潰瘍になると理解してください。

症状の現れ方

　眼のころつき、痛み（時に激痛）、白目の充血が起こり、瞳にかかる部分に潰瘍ができると、かなり視力が低下します。涙もたくさん出ます。細菌性や真菌性の場合は、目やにがかなり多量に出ます。

　時に痛みを伴わないことがありますが、この時は角膜の神経が障害されており、かえって治りにくいのが特徴です。

検査と診断

　感染が疑われた場合は、角膜の悪い部分を少し削って、そこに細菌や真菌、ヘルペスウイルスがいないかどうか検査します。角膜の知覚の低下をみる検査や、血液検査で糖尿病や自己免疫疾患がないかを確認することもあります。

治療の方法

　感染の場合は、その原因となっている微生物に対する薬剤を点眼、眼軟膏(がんなんこう)、点滴、内服、結膜下注射（白目の部分の最表面の結膜とその下の強膜の間に薬が入るように注射する）などの方法で投与します。

　感染でない場合は、抗炎症薬を投与したり、角膜の上皮の治癒を促進するために、眼軟膏を入れて眼帯をしたり、治療用のソフトコンタクトレンズを入れたりします。

　これらの治療でどうしても治らない場合や、角膜穿孔を起こした場合は角膜移植を行う必要があります。また、うまく治った場合でも、角膜の中央に強い混濁が残って視力が不良の場合は、やはり角膜移植を行います。

関連項目

　角膜ヘルペス、細菌性角膜炎、角膜真菌症(かくまくしんきんしょう)、アカントアメーバ角膜炎、蚕蝕性角膜潰瘍、角膜化学腐蝕

井上　幸次

出典　法研「六訂版 家庭医学大全科」六訂版 家庭医学大全科について　情報

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