Corneal ulcer — red flags and referral priorities
Structured for Australian optometry practice.
Clinical decision support only
OptoGuide™ supports professional judgement and does not diagnose or replace clinician responsibility.
Quick answer
- Corneal ulcer suspicion is driven by pain, photophobia, reduced vision, focal epithelial defect, infiltrate, or stromal haze.
- Contact lens wear, central location, rapid symptom progression, and anterior chamber reaction increase urgency.
- A corneal ulcer should be treated as a corneal emergency until proven otherwise.
- Same-day referral is appropriate when an ulcer, microbial keratitis, or corneal thinning risk is suspected.
Common causes
- Microbial keratitis with focal corneal ulceration.
- Contact lens-related corneal ulcer.
- Herpetic corneal ulcer or neurotrophic epithelial breakdown.
- Peripheral ulcerative or inflammatory corneal lesion requiring differentiation.
Red flags (must not miss)
- Reduced vision or marked photophobia.
- Central ulcer, dense infiltrate, or stromal haze.
- Anterior chamber reaction, hypopyon, or rapid progression.
- Contact lens wear or overnight wear history.
- Corneal thinning or poor epithelial healing.
Use OptoGuide™ to guide this decision during consult.
What to check
- Visual acuity and pain severity.
- Ulcer size, depth, location, and edge characteristics.
- Fluorescein staining and surrounding infiltrate pattern.
- Anterior chamber reaction and corneal thinning risk.
- Contact lens history, trauma, and exposure history.
When to refer
- Same day for suspected corneal ulcer or microbial keratitis.
- Urgent corneal review for central lesions, vision change, hypopyon, or thinning risk.
- Do not observe a likely ulcer without specialist input.
Initial management
- Frame the lesion as corneal ulceration first, then refine the differential.
- Record acuity, lesion location, stain pattern, and chamber findings clearly.
- Escalate early when the cornea is threatened or the lesion is not clearly superficial and low risk.
Clinical basis
This guidance reflects standard optometric clinical reasoning based on:
- Australian optometry clinical practice patterns
- Australian medicines regulation and PBS prescribing context
- Common ophthalmology referral standards
- Evidence-based clinical training and practice
Use OptoGuide™ during consult for structured clinical guidance.