Corneal ulcers part 2: aetiology and management of deep corneal ulcers

The second part of this two-part series of articles aims to discuss deep corneal ulcers including descemetoceles, a condition where the basement membrane of the endothelium (the Descemet's membrane) becomes exposed. Descemetoceles can protrude through the cornea and pose an imminent risk of corneal perforation, with leakage of aqueous humour and collapse of the anterior chamber (Figure 1, Aldridge et al, 2013). A number of factors and existing ophthalmic conditions can predispose a patient to corneal ulceration including; keratoconjunctivitis sicca (KCS), eyelid malformation or dysfunction and various forms of trauma (Table 1). Unfortunately, with exception to traumatic ulcers, most corneal ulcerations have an underlying pathogenesis such as KCS, eyelid malformation or conditions such as entropion or distichiasis. Treatment of the underlying cause will inevitably reduce the risk of further corneal ulceration and improve the patient's quality of life.