Trends and Associations in Hospitalizations Due to Corneal Ulcers in the United States, 2002–2012

Purpose: To estimate incidence, temporal trends, and factors associated with inpatient hospitalization due to corneal ulcers in the United States. Methods: Data on inpatient hospitalizations due to corneal ulcers between 2002 and 2012 were reviewed using the National Inpatient Sample. A literature review was conducted to identify the most common causes of corneal ulcers, and use of contact lenses. Results: An estimated 19,878 patients were seen in US emergency departments for evaluation of corneal ulcers in 2012. Rates of inpatient hospitalization due to corneal ulcers remained comparable over the decade (2003: 4.9, 95% confidence interval, CI, 3.0–6.7; 2012: 2.7, 95% CI 2.2–3.3 patients per million US population). Among those hospitalized for ophthalmic disease, patients holding public or no insurance (odds ratio, OR, 1.8 and 2.5, respectively, p<0.001), from low-income neighborhoods (OR 1.6, p < 0.001), and of older age (OR 3.4, p < 0.001) were more likely to be hospitalized for corneal ulceration. Medical conditions associated with hospitalization for corneal ulcer included history of keratitis (7.7%, p < 0.001), HIV infection (2.6%, p = 0.003), history of contact lens-related complications (2.5%, p < 0.001), and history of eye injury (2.5%, p = 0.001). Patients with a history of keratitis (p = 0.006) or rheumatoid arthritis (p = 0.001) were each twice as likely to receive a corneal transplant. Conclusions: Factors associated with hospitalization for corneal ulcer include insurance status in addition to history of contact lens-related disease and keratitis. Efforts should be made to address these factors prior to development of severe ulcers.