Complicated corneal ulcers are epithelial defects that remain unresolved after several days, become infected, or show progressive deepening into the stroma. Complete ocular examination—including a Schirmer’s tear test and a light examination of the eyelids and conjunctiva—may or may not reveal the underlying cause. Recognizing a complicated ulcer is critical for appropriate management of these potentially vision-threatening keratopathies.

1. Clinical Findings

An ulcer is considered complicated based in part on its depth and duration. Even without a detailed history, the cornea offers clues during the course of the disease. Corneal vessels generally appear at the limbus after 7-10 days, then grow approximately 1 mm per day, so corneal vascularization is a sign of chronicity.

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