Corneal Ulceration in Dogs

Corneal Ulceration in Dogs

By: Dr. Rhea Morgan

Section: Veterinary Care In-depth


Treatment In-depth

The principal goals in the treatment of corneal ulceration are to identify and treat its cause, to prevent secondary infection, and to encourage healing. Following removal of the inciting cause and appropriate treatment, repair of minor corneal ulcers is often complete within seven days. Patients with slow-healing or rapidly progressive ulcers require more protracted therapy.

The typical therapeutic approach to ulcers may include any of the following:

  • An Elizabethan collar may be applied. Corneal ulcers can be irritating and your dog may cause more serious injury to the eye if she scratches it with her paws or rubs it against carpet or furniture.

  • Bacteria are regularly implicated in the worsening of corneal ulcers, particularly ulcers that get deeper.
    Therefore, one of the most important treatments for corneal ulcers is the prevention of secondary infection with the application of a topical ophthalmic ointment or eye drop to the eye until the ulcer is healed. One of the more commonly used preparations is a combination of three antibiotics – neomycin, polymyxin, and bacitracin or gramicidin. In more serious ulcers, antibiotic choice is guided by culture and sensitivity results. It is critical to avoid the topical use of any medications containing corticosteroids when the cornea is ulcerated.

  • If an ulcer is deep when it is first detected, or if it progresses rapidly despite appropriate treatment, surgery may be necessary to save the eye and vision. This commonly involves referral to a veterinary ophthalmologist.

  • The most commonly performed surgery for deep corneal ulcers or ulcers that are threatening to perforate the eye is a conjunctival graft performed with the patient under general anesthesia. A small piece of the conjunctiva that surrounds the cornea is sutured into the ulcer. This brings a healthy blood supply to the area and provides mechanical support to the diseased cornea. Grafting decreases the chances of perforation, increases ocular comfort, and speeds healing, similar to what a skin graft does for a severe burn.

  • For more superficial ulcers, a bandaging type of procedure may be enough to encourage healing. Sometimes a soft contact lens is placed on the eye. The lens covers the ulcer and keeps it protected. If contact lenses are not available, the third eyelid may be temporarily sutured to the top lid so that it covers the cornea. While suturing the third eyelid up also protects the cornea, the cornea is hidden so it is not possible to observe whether the ulcer is improving or worsening. The animal can see through a contact lens, but it cannot see through the third eyelid while it is sutured up.

  • Another type of protective surgery is the partial tarsorrhaphy, where the external eyelids are temporarily sutured together. The lids can be partially closed, thereby protecting the cornea, but still permitting frequent observation and treatment of the ulcer.

  • Treatment of dry eye and other tear deficiencies, removal of additional or misdirected eyelashes, and surgical correction of entropion may be necessary in some cases.

     
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