Vol. 7, Issue 2, Part D (2025)

Background: Corneal ulcer continues to pose a significant risk to vision, especially in tropical areas where bacterial and fungal keratitis are common. It is often difficult to tell the difference between the causes because clinical signs are similar and microbiological yield may be low.
Case Presentation: We present three patients exhibiting hypopyon and compromised vision resulting from severe central corneal ulcers. Wearing contact lenses, experiencing vegetative trauma, and having systemic comorbidities such as diabetes mellitus were identified as risk factors. Empirical broad-spectrum antibiotics and antifungals were necessary due to the delays or inconclusiveness of the initial smears and cultures. Two patients underwent amniotic membrane transplantation (AMT); one required additional intracameral antibiotics and hypopyon aspiration. In one instance, Pseudomonas aeruginosa was identified by microbiological confirmation; the others were culture-negative. 
Outcome: All patients experienced a decrease in pain and stabilization of the ocular surface; however, the affected eyes' visual outcomes were still restricted to light perception. 
Conclusion: These cases highlight the diagnostic uncertainty in infectious corneal ulcers and justify early combination antibiotic–antifungal therapy alongside surgical adjuncts such as AMT. Corneal integrity can be maintained by prompt surgical intervention and early empirical coverage, especially in cases where smear/culture results are delayed or negative.