Background: Very severe corneal infection can lead to permanent visual loss, and there is still inadequate knowledge about these severe cases.
Objective: To identify clinical and microbiological characteristics of corneal ulcers resulting in evisceration or enucleation in a tertiary eye care center in Thailand.
Material and Method: A retrospective chart review was performed of all patients who required evisceration or enucleation due to corneal ulcer at Rajavithi Hospital, Bangkok, Thailand between October 2008 and September 2013.
Results: One hundred patients who underwent evisceration or enucleation as a result of corneal ulcer were included in the
study. The mean age of the patients was 56.5+12 years, most cases were referred from other hospitals (93%), and 13% of
patients were diabetic. At presentation, visual acuity was worse than 5/200 in almost all cases (98%), and trauma (66%),
especially by organic substances (36%), was the most common cause. Most cases had full thickness infiltration (81%) with
mean size of 6.6+2 mm. Corneal perforation was found in 18% of patients at presentation, and 60% of corneal scraping
cultures were positive. Bacteria were the most common pathogens (65%), leading by Pseudomonas aeruginosa (10 cases), and the most common fungus was Fusarium spp. (7 cases). Secondary glaucoma (39%) and corneal perforation (25%) were the main ocular complications. Over half of the patients (52%) needed therapeutic or tectonic surgical intervention during admission. Following evisceration (94%) or enucleation (6%), 23 cases had wound complications that required further surgical treatment. Bacterial infection was found to increase the risk of wound complications more than infection by other pathogen groups (40.9%, p = 0.013).
Conclusion: Despite aggressive medical and surgical treatments, very severe corneal ulcers at referral can lead to loss of an eye. Bacterial infection, especially by Pseudomonas aeruginosa, following eye trauma was the most common cause.
Evisceration in bacterial corneal ulcers had greater wound complications than ulcers infected by other pathogens.

Keywords: Corneal ulcer, Infectious keratitis, Microbial keratitis, Bacteria, Fungus, Evisceration, Enucleation, Blindness