The study highlights how delayed diagnosis and treatment of corneal ulcers remain one of the most dangerous threats to eye health, particularly in developing countries such as Indonesia. Researchers described the condition as an ophthalmic emergency that requires immediate medical intervention within the first 24–48 hours after symptoms appear.
A corneal ulcer is an open sore on the cornea, commonly caused by bacterial, fungal, viral, or protozoal infections such as Acanthamoeba. Without prompt treatment, the infection can permanently damage corneal tissue and lead to irreversible vision loss.
In their scientific article titled Clinical Consequences of Delayed Corneal Ulcer Treatment: A Systematic Review, the researchers analyzed international studies published between 2020 and 2025 to evaluate the clinical impact of delayed corneal ulcer management.
The review found strong evidence that every delay in treatment increases the risk of tissue destruction caused by inflammation and microbial toxins. In severe cases, patients who arrive late to medical facilities may experience corneal perforation or rupture of the eyeball, conditions that often require emergency corneal transplantation.
The researchers used a systematic review method by searching PubMed, Scopus, ScienceDirect, and Google Scholar databases. Out of 219 scientific publications screened using PRISMA 2020 guidelines, only three studies met the criteria for final analysis.
The findings consistently showed that patients receiving delayed therapy had significantly poorer visual outcomes compared to those treated earlier.
Key findings from the study include:
- Delays exceeding seven days substantially increased the risk of corneal perforation, reaching nearly 48 percent in some cases.
- Patients presenting late were more likely to require therapeutic penetrating keratoplasty or emergency corneal transplantation.
- Longer diagnostic delays were associated with worse final visual acuity after treatment.
- Fungal and Acanthamoeba infections showed the poorest prognosis when diagnosis was delayed.
One of the reviewed studies involved 86 patients with severe corneal infections in India. The study found that patients who arrived late at referral hospitals experienced significantly higher rates of corneal perforation and poorer vision outcomes than those treated earlier.
Another study from China examining Acanthamoeba keratitis among orthokeratology lens users revealed that even a median diagnostic delay of five days greatly increased the likelihood of surgical intervention.
According to the researchers, infectious corneal damage can progress rapidly. Microorganisms trigger inflammatory reactions and release tissue-destroying enzymes that damage the stromal layer of the cornea. Early antimicrobial therapy can suppress microbial growth and minimize tissue destruction. However, delayed treatment allows the infection to penetrate deeper into the cornea, dramatically increasing the risk of blindness.
The study also identified several non-medical factors contributing to delayed treatment, particularly in rural and developing regions.
Major causes of treatment delays include:
- Low public awareness of serious eye infection symptoms.
- Unsupervised use of eye drops, especially steroid medications.
- Limited availability of ophthalmologists in primary healthcare centers.
- Long travel distances to referral hospitals.
- Financial and healthcare access barriers.
The researchers emphasized that delayed treatment is not only a clinical problem but also a broader healthcare system issue.
“Time is the most critical factor in corneal ulcer management,” the authors stated in their report. They stressed that interventions initiated within the first 24–48 hours are crucial for preserving vision and preventing severe complications.
The study also highlighted the importance of strengthening rapid referral systems and expanding teleophthalmology services. Digital eye consultation systems could help accelerate early diagnosis in regions with limited access to specialists.
In addition, the researchers recommended improving the skills of primary healthcare workers so they can recognize early warning signs of corneal ulcers and refer patients before the infection becomes severe.
From a public health perspective, the study supports the implementation of standardized national protocols for early diagnosis and management of corneal ulcers. These protocols should include rapid microbiological testing, evidence-based empirical therapy, and telemedicine monitoring systems.
The researchers also warned about the social and economic burden caused by vision loss from corneal ulcers. Blindness can reduce work productivity, increase long-term medical expenses, and negatively affect the quality of life of patients and their families.
The research team hopes the findings will support the development of more responsive eye healthcare policies, especially in countries with limited healthcare access.
Author Profiles
M Fadhil Syafridon is a researcher from UPTD RSUD Sidikalang, Dairi, focusing on ophthalmology and clinical healthcare services.
Fadhilah Nisa Tanjung is an ophthalmologist from the Department of Ophthalmology at RSUD Drs. H. Amri Tambunan with expertise in corneal diseases and eye health.
Yusuf is affiliated with Rumah Sakit Jiwa Aceh and contributes to multidisciplinary healthcare research.
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