Clinical Consequences of Delayed Corneal Ulcer Treatment: A Systematic Review

M Fadhil  Syafridon; Fadhilah Nisa  Tanjung; Yusuf

doi:10.55927/ajha.v5i1.16308

Authors

M Fadhil Syafridon UPTD RSUD Sidikalang, Dairi
Fadhilah Nisa Tanjung Department of Ophthalmology RSUD Drs. H. Amri Tambunan
Yusuf Rumah Sakit Jiwa Aceh

DOI:

https://doi.org/10.55927/ajha.v5i1.16308

Keywords:

Corneal Ulcer, Delayed Treatment, Corneal Perforation, Visual Acuity, Keratoplasty

Abstract

Corneal ulcer is an ophthalmic emergency that can lead to irreversible blindness if not treated promptly. Multiple studies have linked delayed management to an increased risk of severe complications such as corneal perforation, reduced visual acuity, and the need for keratoplasty. This study aims to assess the impact of delayed management of corneal ulcers on clinical outcomes and to identify factors contributing to treatment delays. This study is a systematic review of publications from 2020 to 2025, retrieved from the PubMed, Scopus, and ScienceDirect databases, using the keywords “infectious corneal ulcer,” “treatment delay,” and “visual outcome.” Eligible studies included observational designs (cohort, cross-sectional, retrospective) evaluating the association between delayed treatment (≥48-72 hours after symptom onset) and clinical outcomes. Three studies met the inclusion criteria following PRISMA 2020 screening guidelines. The analysis confirms that the interval between symptom onset and initiation of topical antibiotic therapy is a critical determinant of visual outcome. Early intervention guided by microbiological culture and resistance profiles markedly improves prognosis. Strengthening referral systems and adopting teleophthalmology services can effectively reduce diagnostic delays, particularly in resource-limited regions. Delayed management of corneal ulcers leads to severe clinical consequences affecting patients’ visual function. Public education, improved primary care capacity, and the application of rapid, technology-assisted referral systems are essential strategies to ensure timely diagnosis and prevent blindness-related complications.

Downloads

Download data is not yet available.

References

Atta, S., Perera, C., Kowalski, R. P., & Jhanji, V. (2022). Fungal keratitis: clinical features, risk factors, treatment, and outcomes. Journal of Fungi, 8(9), 962.

Cabrera-Aguas, M., & Watson, S. L. (2023). Updates in diagnostic imaging for infectious keratitis: A review. Diagnostics, 13(21), 3358.

Christy, J. S., Mathews, P., Ravisankar, R., & Akpek, E. K. (2023). Long-term outcomes of therapeutic corneal transplants performed in a tertiary eye care hospital in South India. Indian Journal of Ophthalmology, 71(9), 3171-3177.

Das, A. V., Chaurasia, S., Joseph, J., Roy, A., Das, S., & Fernandes, M. (2022). Clinical profile and microbiological trends of therapeutic keratoplasty at a network of tertiary care ophthalmology centers in India. International Ophthalmology, 42(5), 1391-1399.

Egger, M., Higgins, J. P., & Smith, G. D. (2022). Systematic Reviews in Health Research. Wiley.

Hoffman, J. J., Yadav, R., Das Sanyam, S., Chaudhary, P., Roshan, A., Singh, S. K., ... & Burton, M. J. (2022). Delay in accessing definitive care for patients with microbial keratitis in Nepal. Frontiers in medicine, 9, 915293.

Kanski, J. J., & Bowling, B. (2011). Clinical ophthalmology: a systematic approach. Elsevier Health Sciences.

Kodali, S., Khan, B., Zong, A. M., Moon, J. Y., Shrivastava, A., Daily, J. P., & Gibralter, R. P. (2024). Prognostic indicators of corneal ulcer clinical outcomes at a tertiary care center in the Bronx, New York. Journal of Ophthalmic Inflammation and Infection, 14(1), 18.

Page, M. J., McKenzie, J. E., Bossuyt, P. M., Boutron, I., Hoffmann, T. C., Mulrow, C. D., ... & Moher, D. (2021). The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ, 372.

Rathi, V. M., Thokala, P., MacNeil, S., Khanna, R. C., Monk, P. N., & Garg, P. (2022). Early treatment of corneal abrasions and ulcers: Estimating clinical and economic outcomes. The Lancet Regional Health-Southeast Asia, 4.

Ting, D. S. J., Cairns, J., Gopal, B. P., Ho, C. S., Krstic, L., Elsahn, A., ... & Dua, H. S. (2021). Risk factors, clinical outcomes, and prognostic factors of bacterial keratitis: the Nottingham Infectious Keratitis Study. Frontiers in Medicine, 8, 715118.

Ting, D. S. J., Ho, C. S., Deshmukh, R., Said, D. G., & Dua, H. S. (2021). Infectious keratitis: an update on epidemiology, causative microorganisms, risk factors, and antimicrobial resistance. Eye, 35(4), 1084-1101.

Ung, L., Bispo, P. J., Shanbhag, S. S., Gilmore, M. S., & Chodosh, J. (2019). The persistent dilemma of microbial keratitis: Global burden, diagnosis, and antimicrobial resistance. Survey of Ophthalmology, 64(3), 255-271.

Venugopal, A., Andhare, P., Rao, A. V., Gunasekaran, R., & Ravindran, M. (2024). Clinical perspective and outcome of culture-negative microbial keratitis: A retrospective study. Indian Journal of Ophthalmology, 72(8), 1130-1135.

Woodward, M. A., Niziol, L. M., Ballouz, D., Lu, M. C., Kang, L., Thibodeau, A., & Singh, K. (2023). Prediction of visual acuity in patients with microbial keratitis. Cornea, 42(2), 217-223.

Zhao, N., Liang, L., Hao, M., Liu, D., Fan, Z., Wu, J., & Cheng, Y. (2025). A case series of overnight orthokeratology-related Acanthamoeba keratitis in Northwest China: Clinical presentation, management, and outcomes. Contact Lens and Anterior Eye, 102406.