How are vision threatening corneal ulcers and ulcerative keratitis treated?

Updated: Aug 05, 2019
  • Author: Jesse Borke, MD, FACEP, FAAEM; Chief Editor: Barry E Brenner, MD, PhD, FACEP  more...
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Large (>1.5 mm) and/or central infiltrate, deep anterior chamber inflammation, and/or any scleral involvement

Consult with ophthalmologist immediately, and consider emergent ophthalmology consult in the ED; transfer may be appropriate in order to effect this evaluation.

Two fortified eyedrops every 5 minutes in the ED for 5 doses, tobramycin 15 mg/mL every 1 hour, alternating every 30 minutes with fortified vancomycin 25-50 mg/mL every 1 hour (alternative, cefazolin 50 mg/mL every 1 hour in place of vancomycin) [9]

Consider adding oral or intravenous ciprofloxacin


Cycloplegic drops (atropine 1% or cyclopentolate 1% [most common agent]) are applied to provide comfort and to prevent synechiae formation (adhesions between the iris and the lens capsule or cornea, posterior or anterior).

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