Pathogenesis and pathology of corneal ulcer

Once the damaged corneal epithelium is invaded by

the offending agents the sequence of pathological
changes which occur during development of corneal
ulcer can be described under four stages, viz.,
infiltration, active ulceration, regression and
cicatrization. The terminal course of corneal ulcer
depends upon the virulence of infecting agent, host
defence mechanism and the treatment received.
Depending upon the prevalent circumstances the
course of corneal ulcer may take one of the three
forms:
(A) Ulcer may become localised and heal;
(B) Penetrate deep leading to corneal perforation;
or
(C) Spread fast in the whole cornea as sloughing
corneal ulcer.
The salient pathological features of these are as
under:
[A] Pathology of localised corneal ulcer
1. Stage of progressive infiltration (Fig. 5.2A). It is
characterised by the infiltration of polymorphonuclear
and/or lymphocytes into the epithelium
from the peripheral circulation supplemented by
similar cells from the underlying stroma if this tissue
is also affected. Subsequently necrosis of the
involved tissue may occur, depending upon the
virulence of offending agent and the strength of host
defence mechanism.
2. Stage of active ulceration (Fig. 5.2B). Active
ulceration results from necrosis and sloughing of the
epithelium, Bowman's membrane and the involved
stroma. The walls of the active ulcer project owing to
swelling of the lamellae by the imbibition of fluid and
the packing of masses of leucocytes between them.
This zone of infiltration may extend to a considerable
distance both around and beneath the ulcer. At this
stage, sides and floor of the ulcer may show grey
infiltration and sloughing.
During this stage of active ulceration, there occurs
hyperaemia of circumcorneal network of vessels which
results into accumulation of purulent exudates on the
cornea. There also occurs vascular congestion of the
iris and ciliary body and some degree of iritis due to
absorption of toxins from the ulcer. Exudation into
the anterior chamber from the vessels of iris and ciliary
body may lead to formation of hypopyon.