What Eye Drop Is Used For Ulcers?: Understanding Topical Pharmacotherapy

October 9, 2025 •

3 min read

In the United States, bacteria are the most common cause of corneal ulcers, necessitating specific and potent topical antibiotic eye drops for effective treatment. The correct eye drop used for ulcers depends entirely on the cause, which can range from bacteria and viruses to fungi or even parasites. Self-treatment is not an option, as misdiagnosis or inappropriate medication can lead to serious complications and vision loss.

Quick Summary

Treatment for corneal ulcers requires a specific eye drop based on the cause, which could be bacterial, viral, fungal, or parasitic. A professional diagnosis is crucial, as the wrong medication can worsen the condition. This guide covers the various topical treatments and supportive care used for different types of ulcers.

Key Points

Diagnosis is Key: The specific type of eye drop depends entirely on the cause of the ulcer, which can be bacterial, viral, fungal, or parasitic.
Bacterial Ulcers are commonly treated with fluoroquinolone antibiotics like moxifloxacin or ciprofloxacin, often with very frequent initial dosing.
Viral Ulcers, typically caused by herpes simplex, require specific antiviral medication such as ganciclovir gel.
Fungal and Parasitic Ulcers are less common and require specialized, often compounded, eye drops like natamycin for fungus or PHMB for parasites.
Supportive Eye Drops include atropine for pain relief and autologous serum tears for severe, non-healing defects.
Steroid and NSAID Eye Drops can be dangerous and are typically avoided, especially in infections, as they can delay healing and worsen the condition.
Professional Care is Mandatory: Never attempt to self-treat a corneal ulcer. It is a serious condition that requires immediate evaluation and management by an ophthalmologist to prevent vision loss.

A corneal ulcer is a painful open sore on the surface of the cornea and is considered a medical emergency due to the risk of permanent vision damage. Determining what eye drop is used for ulcers requires a diagnosis by an eye care professional, often involving a slit lamp examination and sometimes a lab culture, to identify the specific cause. Treatment varies depending on whether the ulcer is caused by bacteria, viruses, fungi, or parasites, and may include medicated and supportive drops.

Eye Drops for Bacterial Corneal Ulcers

Bacterial infections are the most common cause of corneal ulcers, particularly in contact lens wearers. Treatment is aggressive and timely to prevent the spread of infection. For less severe ulcers, broad-spectrum topical antibiotics like fluoroquinolones (moxifloxacin, ciprofloxacin, or ofloxacin) are often used frequently in the initial stages. Severe or central ulcers may require fortified (compounded) antibiotic drops, such as concentrated vancomycin and tobramycin.

Eye Drops for Viral Corneal Ulcers

Viral keratitis, often caused by herpes simplex virus (HSV), can lead to corneal ulcers requiring antiviral treatment. Topical antivirals like ganciclovir gel (Zirgan) are preferred. Trifluridine is another option but is more toxic to the cornea. Oral antiviral medications like acyclovir or valacyclovir may also be prescribed in some cases.

Eye Drops for Fungal and Parasitic Ulcers

Fungal and parasitic (Acanthamoeba) corneal ulcers are less common but challenging to treat. These often require compounded eye drops. Natamycin is the only FDA-approved topical antifungal, though compounded amphotericin B or voriconazole may be used. Acanthamoeba keratitis treatment involves compounded biguanides like polyhexamethylene biguanide (PHMB) and chlorhexidine.

Supportive and Adjunctive Eye Drops

Supportive drops help manage symptoms and promote healing. Cycloplegic drops like atropine are used to relieve pain and inflammation by dilating the pupil and paralyzing eye muscles. Autologous serum tears, made from a patient's blood serum, contain healing factors used for severe, non-healing defects. Lubricating drops and ointments are also used to keep the eye comfortable and aid healing.

Caution with Steroid and NSAID Eye Drops

Steroid (corticosteroid) and non-steroidal anti-inflammatory drug (NSAID) eye drops should be used with extreme caution. Steroids can worsen infections, especially viral ones. NSAIDs can delay healing and potentially lead to corneal melting. Their use is typically limited to specific circumstances under strict ophthalmologist supervision.

When Eye Drops Aren't Enough

Severe cases not responding to eye drops may require debridement (removing damaged tissue) or a corneal transplant to replace a scarred cornea.

Comparison of Eye Drop Treatments for Corneal Ulcers


Cause of Ulcer	Type of Eye Drop	Examples of Medication	Key Considerations
Bacterial	Topical Antibiotics (Fluoroquinolones)	Moxifloxacin, Ciprofloxacin	First-line, broad-spectrum. Frequent dosing is crucial.
Severe Bacterial	Fortified Antibiotics	Vancomycin, Tobramycin	Compounded, higher concentration for serious infections.
Viral (HSV)	Topical Antivirals	Ganciclovir Gel, Trifluridine	Requires specific antiviral therapy; steroids are often contraindicated.
Fungal	Topical Antifungals	Natamycin, Compounded Amphotericin B	Typically harder to treat, longer course of therapy required.
Parasitic (Acanthamoeba)	Topical Disinfectants/Antimicrobials	Compounded PHMB, Chlorhexidine	Very difficult to treat; compounded medications necessary.
Pain Management	Cycloplegic Drops	Atropine	Helps relax muscles and reduce pain, but can cause light sensitivity.
Healing Support	Autologous Serum Tears	Patient's own blood serum	Promotes natural healing in severe, non-responsive cases.

Conclusion

Understanding what eye drop is used for ulcers is dependent on a precise diagnosis of the underlying cause. Treatment is tailored to the specific infection, using potent antimicrobial drops alongside supportive therapies for pain and healing. Corneal ulcers are a medical emergency requiring immediate professional care. Self-medication is strongly discouraged as it can lead to severe and irreversible vision loss. Proper diagnosis and adherence to the prescribed treatment are crucial for a successful outcome.

For more detailed guidance on a specific diagnosis, consult the American Academy of Ophthalmology's resources on corneal ulcers.

Frequently Asked Questions

No, antibiotic eye drops will not work on a viral infection. Using the wrong medication, especially an antibiotic for a viral ulcer, is ineffective and can sometimes cause complications or delays in proper treatment.

Initially, the application of eye drops for a corneal ulcer may be very frequent, sometimes as often as every hour around the clock, especially for bacterial infections. The schedule will be adjusted by your doctor as the condition improves.

Pain associated with a corneal ulcer is often managed with cycloplegic eye drops, such as atropine. These drops work by relaxing the eye muscles and dilating the pupil, which helps reduce discomfort. Oral pain medication may also be recommended.

OTC eye drops, including those for allergies or minor irritation, are not effective for treating corneal ulcers. These drops do not contain the specific antimicrobial agents needed to kill the infectious cause of the ulcer, and their use can delay appropriate treatment.

No, you must stop wearing contact lenses immediately if you have a corneal ulcer. Contact lenses, especially extended-wear ones, are a major risk factor for bacterial and parasitic ulcers and should be avoided completely until after the ulcer has fully healed.

Fortified antibiotics are high-concentration eye drops compounded in a pharmacy. They are reserved for severe or central corneal ulcers to deliver a more powerful dose of medication directly to the infection.

Autologous serum tears are special eye drops made from the patient's own blood serum. They are used for severe, persistent corneal ulcers and defects that are not healing with conventional therapies. They contain natural growth factors and nutrients to promote healing.