In corneal ulcer management, when are anti-proteases typically considered?

• A. Two to three anti-proteases may be used if needed
• B. Anti-proteases are never used
• C. Only steroids require anti-proteases
• D. Anti-proteases must be used with antibiotics only

Answer: (A)

Proteolysis driving stromal melting is the key challenge in some corneal ulcers. Anti-proteases help by blocking the enzymes that break down corneal collagen and other structural proteins, slowing or halting thinning and giving antimicrobial therapy and healing a chance to work. When there is active melting or marked thinning, it’s common to add multiple anti-proteases to broaden coverage against different proteases. Using two to three anti-proteases if needed reflects this approach: you tailor the regimen to the severity and response, rather than relying on a single agent in all cases.

Anti-proteases are not universally required in every ulcer, and they’re not exclusive to steroid-treated scenarios. They are used as adjuncts to antimicrobials (and other therapies as appropriate) when proteolytic activity is a major concern.