Corneal Ulcers: Contact Lens Risks and Urgent Care

Imagine waking up with your eye burning like it’s full of sand, light feels like a knife, and your vision is suddenly blurry. You reach for your phone to Google it - and find out you might have a corneal ulcer. This isn’t just a bad day. It’s a medical emergency. If you wear contact lenses, this is a risk you can’t ignore.

What Exactly Is a Corneal Ulcer?

A corneal ulcer is an open sore on the clear front surface of your eye - the cornea. It’s not a scratch. It’s not a red eye that goes away in a day. It’s tissue loss caused by infection, often from bacteria, fungi, or viruses that get trapped under your contact lens. Left untreated, it can scar your cornea, permanently blur your vision, or even lead to blindness.

The difference between a corneal abrasion and a corneal ulcer is simple: abrasions are surface-level scrapes that heal on their own. Ulcers are deeper, infected wounds that need immediate treatment. The FDA calls them “open sores” and warns they can cause blindness. That’s not a scare tactic - it’s a fact backed by decades of clinical data.

Why Contact Lenses Are the Top Cause

Over 85 million people worldwide wear contact lenses. Most do it safely. But even one mistake can tip the balance. Contact lenses reduce oxygen flow to the cornea. That’s normal. But when you wear them too long - especially while sleeping - your eye becomes a breeding ground for germs.

Here’s the hard truth: if you wear contact lenses, you’re about 10 times more likely to get a corneal ulcer than someone who doesn’t. If you sleep in them? That risk jumps to 100 times higher. That’s not a typo. Extended-wear soft lenses are the biggest culprit. The CDC and FDA both list overnight wear as the #1 preventable cause.

It’s not just the lens. It’s what you do with it. Dirty hands. Tap water. Homemade cleaning solutions. Even a tiny scratch on the lens can create a doorway for bacteria. Acanthamoeba - a nasty germ found in water - can cling to lenses and cause a fungal-like infection that’s nearly impossible to treat without early detection.

Signs You’re Not Just Having a Bad Eye Day

You might think your eye is just tired. Or dry. Or irritated from allergies. But if you’re wearing contacts and notice any of these, stop. Right now.

• Severe eye pain - not a dull ache, but a sharp, constant burn
• Redness that doesn’t fade, even after removing your lenses
• Blurry or hazy vision that gets worse
• Sensitivity to light - even turning on a lamp hurts
• White or gray spot on the clear part of your eye (visible in the mirror)
• Excessive tearing or thick, yellow/green discharge

These aren’t symptoms to wait on. The longer you wait, the more damage the infection does. A 2024 review from Penn Medicine found that treatment delays of more than 48 hours dramatically increase the chance of permanent scarring.

How Doctors Diagnose It

If you show up with these symptoms, your eye doctor won’t just look at you. They’ll use tools you’ve never seen.

First, they’ll put a drop of yellow dye - fluorescein - in your eye. Under blue light, any damaged tissue glows bright green. That’s how they see the ulcer’s size and depth.

Then comes the slit-lamp exam. It’s like a microscope with a bright light. They zoom in on your cornea, checking for swelling, pus, or signs of infection spreading.

In serious cases, they’ll scrape a tiny bit of tissue from the ulcer and send it to a lab. This culture test tells them exactly what’s causing the infection - bacteria, fungus, or virus. That’s critical because the treatment changes completely based on the culprit.

Newer tools are helping too. Some clinics now use high-resolution imaging to capture photos of the ulcer and track changes day by day. This lets them spot worsening early - before it’s too late.

Treatment: No Guesswork, No Delay

Treatment starts the moment you walk in - not after test results. That’s because every hour counts.

For bacterial ulcers - which make up 80% of cases - doctors start with strong antibiotic eye drops, usually fluoroquinolones like moxifloxacin or gatifloxacin. You’ll be told to use them every hour while awake, then taper off as it heals.

If it’s viral - often from herpes simplex - they’ll prescribe antiviral drops like acyclovir. Fungal ulcers? Those need antifungal meds like natamycin, which are harder to get and take weeks to work.

Here’s what you must never do: use steroid eye drops unless your doctor specifically orders them. Steroids reduce swelling, but they also weaken your eye’s defenses. Used without knowing the cause, they can make a bacterial or fungal infection explode.

If the ulcer is bigger than 2 mm, or it’s close to the center of your vision, or it’s getting worse after 48 hours of treatment - it’s classified as “sight-threatening.” That means you’re in the hospital system now. You might need daily visits, stronger meds, or even surgery.

In the worst cases, when the cornea is badly scarred or perforated, a corneal transplant is the only option. That’s major surgery. Recovery takes months. And even then, vision may never fully return.

How to Prevent This From Ever Happening

The good news? Almost all corneal ulcers from contacts are preventable. You don’t need magic solutions. Just discipline.

• Never sleep in your lenses. Even “extended-wear” ones aren’t risk-free. The 100x risk increase is real.
• Wash your hands before touching your lenses - soap and water, dry with a lint-free towel.
• Use only the solution your doctor recommends. Never use tap water, saliva, or homemade saline. Ever.
• Replace your lenses on schedule. Daily disposables are safest. If you use monthly lenses, toss them after 30 days - no extensions.
• Avoid water. No swimming, showering, or hot tubs with contacts in. Water carries germs that stick to lenses.
• Give your eyes a break. Wear glasses at least one day a week. Let your corneas breathe.
• Replace your case every 3 months. Bacteria grow in old cases. Rinse it daily with solution, never water, and let it air-dry upside down.

The FDA and LASIK.com both say: if you feel even a hint of discomfort, take your lenses out. Don’t wait. Don’t hope it goes away.

When to Go to the Emergency Eye Clinic

This isn’t a “call your doctor tomorrow” situation. If you have pain, vision changes, or light sensitivity - go today. Not tomorrow. Today.

Most hospitals have urgent eye care clinics. If you can’t get in within 24 hours, go to the ER. Delaying care increases your risk of permanent damage by 50% or more, according to a 2024 study in the Journal of Ophthalmology.

Don’t rely on over-the-counter redness drops. They mask symptoms, not treat the cause. And don’t try to “tough it out.” Corneal ulcers don’t heal on their own. They get worse.

What Happens After You Heal?

Even if your ulcer clears up, you’re not back to normal. Your eye is more vulnerable now. Your doctor will likely recommend switching to daily disposable lenses, reducing wear time, and having check-ups every 3-6 months.

Some people never wear contacts again. That’s not a failure. It’s wisdom.

The goal isn’t to scare you off contacts. It’s to make you respect them. They’re medical devices - not fashion accessories. When used right, they’re safe. When used carelessly, they can steal your vision.

Final Reality Check

You can’t control everything. But you can control your habits. Wash your hands. Don’t sleep in lenses. Replace your case. Get help fast.

The science is clear. The risks are real. But so is the solution. Your eyes don’t need fancy tech. They need you to be consistent.

One mistake can cost you your sight. One habit can save it.