Recent Advances in the Management of Corneal Ulcer: Current and Emerging Therapeutic Approaches

Corneal ulcer is a potentially vision-threatening condition characterized by corneal epithelial disruption and stromal involvement, most commonly associated with infectious causes. Although antimicrobial therapy remains the cornerstone of treatment, management can be challenging in refractory, persistent, neurotrophic, and drug-resistant corneal ulcers. This literature review aims to describe recent advances in the management of corneal ulcers, focusing on current and emerging therapeutic approaches. Recent literature highlights the continued importance of prompt empiric antimicrobial therapy followed by culture-guided treatment, particularly in the setting of increasing antimicrobial resistance. Amniotic membrane transplantation (AMT) has emerged as an important adjunctive treatment because of its epithelial-promoting, anti-inflammatory, and anti-scarring properties, with reported benefits in epithelial healing, ocular discomfort, and selected visual outcomes. Self-retained cryopreserved amniotic membrane provides a less invasive alternative and has demonstrated favorable healing outcomes in recalcitrant corneal ulcers, particularly those associated with neurotrophic keratitis. Other emerging approaches include corneal collagen cross-linking (CXL) and topical 1% povidone-iodine, which have demonstrated comparable clinical improvement in refractory corneal ulcers. In extensively drug-resistant Pseudomonas aeruginosa infection, alternative antimicrobial strategies, including fortified colistin combined with tobramycin-soaked collagen shields, may provide a potential rescue option when conventional antibiotics are ineffective. Overall, recent advances indicate a shift toward individualized and multimodal management of corneal ulcers, combining antimicrobial therapy with regenerative, tissue-stabilizing, and targeted approaches according to disease severity, etiology, and treatment response. Further clinical research is needed to establish standardized protocols and determine the long-term efficacy and safety of these emerging therapies.