My first corneal ulcer

Approximately six weeks ago I started feeling symptoms of iritis in my right eye. I assumed it was iritis and used my Voltaran eye drops previously prescribed at my first diagnosis. I noticed that many symptoms were different than previous flares of iritis. Photophobia and blurred vision were intermittent this time; my daily symptoms consisted of watery eyes, eye pain, redness, and burning. Sometimes the Voltaran would alleviate the symptoms, but not always. Weeks elapsed, and I finally went into the emergency department at Women's College Hospital in Toronto for an investigation.


I was triaged quickly and spent from 12:35 until 4pm in the Emergency Department. I waited in the ER's ophthalomogy room after the nurse performed a visual acuity test. My vision was very blurry in both eyes. I didn't see the doctor until 3:35pm. I explained my history of ankylosing spondylitis and prior episodes of iritis originating back to September 2006. He appeared familiar with AS, but didn't know what Enbrel was. He assessed my eyes, performed a fluorescein stain of my cornea (to differentiate from a simple abrasion), and diagnosed me with a right corneal ulcer, which he impressed upon me was an ocular emergency requiring an emergency referral to an ophthalmologist. His medical notes indicated a white patch on my upper cornea. He said that he did not think corneal ulcers were associated with AS or Enbrel, and got me an appointment for June 1st (tomorrow) with an ophthalmologist at Sunnybrook for 9am.


Of course, once I got home, I did my own research on corneal ulcers. The literature states that corneal ulcers are most commonly caused by an infection with bacteria, viruses, fungi or amoebae. However, other causes are abrasions (scratches) or foreign bodies, inadequate eyelid closure, severely dry eyes, severe allergic eye disease, and various inflammatory disorders. This means that there is a possibility that my AS may have contributed to my corneal ulcer. Risk factors are dry eyes, severe allergies, history of inflammatory disorders, contact lens wear, immunosuppression, trauma, and generalized infection. Treatment is an emergency referral to an ophthalmologist. Untreated, a corneal ulcer or infection can permanently damage the cornea. Untreated corneal ulcers may also perforate the eye (cause holes), resulting in spread of the infection inside, increasing the risk of permanent visual problems.