Can I Wear Contacts if I Have a Corneal Ulcer?
Should You Wear Contacts with a Corneal Ulcer?
If you have a corneal ulcer or even suspect you might have one, you must stop wearing your contact lenses right away. Continuing to wear contacts with an ulcer can trap bacteria, fungi, or other germs against your cornea and make the infection much worse. Remove lenses from both eyes and do not put them back in.
Your cornea needs oxygen and time to heal, and contact lenses reduce oxygen reaching the cornea and can slow healing. We strongly advise putting your contacts away until our eye doctor clears you to wear them again. Save, but do not reuse, the lenses and case so your doctor can decide whether to culture them.
Contact lenses sit directly on the cornea. Lenses reduce oxygen transmission, disrupt tear flow, and can trap microbes and debris against the cornea.
- Contacts reduce the amount of oxygen reaching your cornea
- A lens can impede medication delivery and dilute drops
- Friction from the lens can aggravate the defect and slow healing
- Microbes can adhere to the lens surface and reintroduce infection
Wearing contact lenses while you have a corneal ulcer puts your vision in serious danger. The infection can spread deeper into your cornea and cause scarring that blurs your sight permanently.
In severe cases, the ulcer can lead to a perforation of the cornea, which is a medical emergency that may require surgery. Some people have lost significant vision or even needed a corneal transplant because they did not stop wearing contacts when an ulcer developed. Complications include corneal thinning, perforation, and in rare cases spread of infection inside the eye.
Understanding Corneal Ulcers: Symptoms and Causes
A corneal ulcer is an open sore on the clear front surface of your eye, known as the cornea. It forms when germs like bacteria, fungi, or viruses break through the protective outer layer of the cornea and cause an infection underneath.
The body tries to fight the infection, which leads to inflammation, inflammatory cells and infiltrate, and tissue damage. This creates a crater or pit in the cornea that we call an ulcer. Ulcers can also be sterile or neurotrophic, but they still require urgent evaluation.
Corneal ulcers usually cause noticeable symptoms that should never be ignored. Recognizing these signs early can save your vision and speed up your recovery.
- Severe eye pain that gets worse over time
- Redness and swelling of the white part of your eye
- Thick discharge that may be white, yellow, or green
- Blurred vision or sensitivity to light
- A white or gray spot on your cornea that you or others can see
- Tearing, severe light sensitivity, or inability to keep the eye open
Any contact lens wearer with new pain, light sensitivity, or reduced vision should be seen the same day.
You should contact our eye doctor the same day if you notice any symptoms of a corneal ulcer. Do not wait to see if the symptoms go away on their own, because ulcers can get worse quickly.
If you experience sudden vision loss, extreme pain, or a sensation that something is stuck in your eye that will not go away, seek emergency care right away. These signs can mean the ulcer is advancing or causing complications that need urgent treatment. Do not patch the eye and do not use any steroid eye drops unless specifically prescribed by an ophthalmologist.
Contact lens wearers are at higher risk for corneal ulcers than people who wear glasses. Sleeping in your lenses, wearing them longer than recommended, or not cleaning them properly can all introduce germs to your eye.
Even a tiny scratch on your cornea from putting in or removing a lens can become an infection if bacteria are present. Using tap water to rinse your lenses or case can also expose your eyes to dangerous microorganisms that thrive in water. Avoid water exposure with lenses - no swimming, hot tubs, or showering in contacts. Do not top off solution. Always use a fresh, recommended disinfecting solution and rub-and-rinse lenses.
While contact lenses are a leading cause of corneal ulcers, other factors can also raise your risk. These include eye injuries, very dry eyes, or conditions that weaken your immune system.
- Eyelid problems that prevent your eye from closing fully
- Severe dry eye disease that causes breaks in the corneal surface
- Previous eye surgery or other corneal damage
- Infections like herpes simplex that affect the eye
- Blepharitis or meibomian gland dysfunction
- Use of steroid eye drops
- Immune compromise or autoimmune disease
How Our Eye Doctor Diagnoses a Corneal Ulcer
When you visit us with possible ulcer symptoms, we will ask about your contact lens habits, recent eye injuries, and the timeline of your symptoms. This helps us understand what might have caused the ulcer and how serious it may be.
We will check your vision and look closely at the front of your eye using specialized tools. We use numbing drops to keep you comfortable during testing and any gentle scraping for culture.
We use a safe orange dye called fluorescein to make the ulcer easier to see. Our eye doctor places a small drop or strip of the dye on your eye, and it temporarily stains any damaged areas of the cornea bright green under a blue light.
This staining shows us the exact size, shape, and depth of the ulcer. The dye may transiently stain tears or skin and can permanently stain soft contact lenses or fabrics, so they are kept out of the way.
A slit lamp is a special microscope that lets us examine the layers of your cornea in great detail. You rest your chin and forehead on the machine while we shine a narrow beam of light into your eye.
- We can see how deep the ulcer goes into the cornea
- We check for signs of infection spreading to other parts of the eye
- We look for any scarring or thinning of the cornea
- We evaluate the health of the surrounding tissue
If the ulcer looks serious or is not responding to initial treatment, we may take a culture from the surface of your cornea. This involves gently scraping a tiny sample of cells from the ulcer and sending it to a lab.
The lab grows the germs from the sample to identify exactly what kind of bacteria, fungus, or other organism is causing the infection. This helps us choose the most effective medication to treat your particular ulcer. We may also perform rapid stains or microscopy to guide early treatment, especially if fungal or Acanthamoeba infection is suspected.
Treatment Options for Corneal Ulcers
Treatment is tailored to the cause and severity. Many bacterial ulcers in contact lens wearers are covered with high-frequency fluoroquinolone drops that target Pseudomonas. Large, deep, or central ulcers often require fortified antibiotics compounded by a pharmacy.
If a fungal or viral cause is suspected or confirmed, antifungal or antiviral therapy is used. Oral antivirals are commonly used for HSV or shingles affecting the eye. Deep fungal infections may require oral antifungals in addition to drops.
In addition to antimicrobial drops, several other treatments may be used or avoided during your care.
- Cycloplegic drops such as cyclopentolate or homatropine to reduce pain and light sensitivity
- Artificial tears without preservatives for comfort
- Do not use steroid eye drops unless an ophthalmologist tells you to start them after infection control is established. They are not used for suspected fungal, Acanthamoeba, or active herpetic epithelial disease.
- Do not patch the eye
- A therapeutic bandage contact lens may be used by your doctor in select situations - do not place any lens yourself
- Avoid eye makeup and discard products used just before symptoms began
Treating a corneal ulcer requires frequent application of your drops, especially in the first few days. You may need drops every 30 to 60 minutes at first, including overnight for the first day, exactly as prescribed.
- Set alarms to remind you to use your drops on time
- Keep the medication with you at all times during the day
- Plan for someone to help you during the night if needed
- Follow the schedule exactly as our eye doctor prescribes
- If using more than one drop, separate them by at least 5 minutes to prevent washout
Corneal ulcers can be very painful, but there are safe ways to ease the discomfort while your eye heals. We may recommend over-the-counter pain relievers like acetaminophen or ibuprofen to help with the aching. Cold compresses can help.
Avoid rubbing your eye, and wear sunglasses if light bothers you. You should not use numbing drops at home, as they can interfere with healing and mask symptoms that might signal a problem. Avoid driving if vision is reduced.
Some corneal ulcers are too severe to treat at home with drops alone. If your ulcer is very large, deep, or located in the center of your cornea, we may recommend that you stay in the hospital for intensive treatment.
In rare cases where the infection does not respond to medication or the cornea is at risk of perforation, surgery may be considered. Some cases require intrastromal or intracameral antimicrobial injections, tissue adhesive with a protective lens, or corneal transplantation.
Healing, Follow-Up, and Returning to Contact Lenses
The healing time for a corneal ulcer depends on how deep and large it is, what caused it, and how quickly you started treatment. Small, shallow ulcers may heal in one to two weeks with proper care.
Larger or deeper ulcers can take several weeks or even months to fully heal. During this time, you must continue using your medication and avoid anything that could irritate your eye, including all contact lenses. With effective treatment, pain and redness should start to improve within 24 to 48 hours. If not, contact us promptly.
We will schedule frequent follow-up visits to monitor how your ulcer is healing. At each appointment, we will examine your cornea with the slit lamp and check whether the infection is clearing up.
- We measure the size of the ulcer to see if it is shrinking
- We adjust your medication schedule based on your progress
- We watch for signs of scarring or other complications
- We answer your questions and make sure you understand your care plan
- Severe ulcers are typically checked daily until clearly improving
You cannot return to wearing contact lenses until the ulcer is completely healed and our eye doctor has examined your eye and given you clear permission. Rushing back into contacts can cause the infection to flare up again or lead to permanent scarring.
Even after the ulcer looks healed, the cornea may still be fragile for a while. We will let you know the safest time to start wearing lenses again based on your individual healing. You may need refitting and dry eye treatment before lens wear is safe again.
You should never reuse the contact lenses or lens case that you were using when the ulcer developed. These items may still carry the germs that caused your infection, and putting them back in your eye can restart the problem.
We will provide you with a fresh prescription and recommend new lenses and a new storage case. This clean start helps protect your eyes as you return to contact lens wear. Daily disposable lenses are often recommended to reduce future infection risk.
Once you have had a corneal ulcer, it is important to take extra care to prevent another one. Good contact lens hygiene is your best defense against future infections.
- Wash your hands thoroughly before touching your lenses
- Replace your lenses and case on the recommended schedule
- Use only fresh contact lens solution and never tap water
- Remove your lenses immediately if your eye feels irritated
- Do not swim, shower, or use hot tubs while wearing contacts
- Rub and rinse lenses as directed by your solution manufacturer
- Replace your case every 1 to 3 months and let it air dry between uses
- Never top off old solution
- Avoid sleeping in lenses even if they are approved for extended wear unless your doctor specifically instructs it
- Treat eyelid inflammation or dry eye if present
Some people decide to switch to glasses full time or explore other vision correction methods after recovering from a corneal ulcer. If you found the treatment difficult or are worried about another infection, this can be a good choice.
We can discuss options like prescription glasses. If scarring causes irregular astigmatism, rigid gas permeable or scleral lenses may provide the best vision. Refractive surgery is considered only after the cornea is stable and healthy. Prior corneal scarring or a history of herpetic eye disease may limit candidacy. PRK may be preferred over LASIK in select cases. The best solution is the one that fits your lifestyle and keeps your eyes healthy.
Frequently Asked Questions
No, you should not wear contact lenses at all if you have any size of corneal ulcer. Even a small ulcer can become a serious problem if you put a lens over it, because the lens traps germs and blocks healing.
Yes. Bring the lenses, case, and solution you were using so your doctor can decide whether to culture them.
No. Do not wear contacts until your doctor confirms the ulcer is healed and gives you explicit permission.
No. Patching can worsen an infection. Keep the eye uncovered and use your prescribed drops.
Over-the-counter drops are not strong enough to treat a corneal ulcer. You need prescription medication that targets the specific germs causing your infection, and only our eye doctor can determine the right treatment after examining your eye.
Daily disposable lenses can reduce the risk of infection because you throw them away after each use and never store them in a case where germs can grow. Many eye doctors recommend dailies for patients returning to contacts after an ulcer, as long as you still practice good hygiene when handling them.
Getting Help
If you are experiencing eye pain, redness, discharge, or vision changes while wearing contacts, remove your lenses immediately and contact our eye doctor for an urgent appointment. Remove your lenses and bring them, the case, and your solutions to your visit. If after hours, go to an emergency eye care clinic or emergency department. Early diagnosis and treatment are the keys to protecting your vision and ensuring a full recovery from a corneal ulcer.