Melting Corneal Ulcer

Melting corneal ulcers typically arise as a result of bacterial infection of a simple corneal ulcer. Enzymatic breakdown of corneal tissues or keratomalacia causes the corneal surface to appear to be melting, like wax dripping from a candle. A brief physical examination should be performed, and evaluation of tear production via a Schirmer Tear Test and corneal culture should be considered. Aggressive medical therapy is necessary to halt this melting process, treat the coincident corneal infection, minimize intraocular inflammation, and maintain patient comfort. Treatment typically comprises topical and systemic antimicrobials, systemic anti-inflammatories, and systemic analgesia. Topical anticollagenases, like serum, plasma, and EDTA, and systemic doxycycline have been shown to reduce corneal breakdown. An Elizabethan collar should be placed to prevent self-trauma. Referral for intensive medical management and/or surgical intervention should be considered.