Corneal Ulceration in Cats

Feline Corneal Ulcers

Corneal ulceration, commonly called corneal ulcers, is a loss of the corneal epithelium (the outermost cells of the cornea) with exposure and possibly loss of the underlying corneal collagen. Corneal epithelium is constantly being lost and replaced, and its health and thickness depend on a delicate balance between cell loss and regeneration.

Below is an overview of corneal ulcerations in cats followed by in-depth information about the diagnosis and treatment of this disease.

Causes of excessive cell loss include injury from ingrown or misplaced eyelashes, exposure to foreign material, chemicals, heat or smoke, infections with certain viruses and bacteria, and from trauma such as cat scratches. Decreased tear production (“dry eye” or keratoconjunctivitis sicca) and inadequate blink responses may cause corneal ulceration. The potential causes of corneal ulcers are almost too numerous to list.

Corneal ulceration can affect any animal; however, those breeds of cats with more protuberant (prominent) eyes and larger eyelid openings are at increased risk. Some older animals may heal more slowly and, therefore, may have ulcers that are more difficult to treat.

Corneal ulceration is a painful and potentially vision-threatening condition. Early diagnosis and appropriate treatment is usually rapidly curative. Complicated cases can progress to full thickness or perforating ulcers with serious effects on vital structures within the eye.

What to Watch For

• Squinting
• Increased tearing
• Mucus or pus draining from the eye
• Cloudiness of the cornea
• Inflamed, red conjunctiva (the normally pink tissue surrounding the cornea and lining the eyelids)
• Inability to see the eye because the third eyelid is covering it
• Rubbing at the eye
• Occasional lethargy

Veterinary Care for Corneal Ulceration in Cats

Veterinary care includes diagnostic tests and subsequent treatment recommendations.

Diagnosis

Diagnostic tests are needed to recognize corneal ulceration, any underlying cause and to exclude other diseases. Tests may include:

• Thorough ocular examination with special attention to the eyelashes, eyelids and blink reflex, status of the cornea and interior of the eye.
• Fluorescein staining of the cornea to assess ulcer size, depth and character. Fluorescein is a dye that adheres to the central layer of the cornea and makes the ulcerated area become bright green.\
• Schirmer tear test to measure tear production
• Cytology, culture or PCR (DNA testing) and IFA assays of ocular samples for the presence of infectious agents such as bacteria and viruses

Treatment

Treatments for corneal ulceration may include any of the following:

• Removal or treatment of the underlying cause
• An antibiotic eye drop or ointment to treat or prevent infection of the cornea
• Atropine to dilate the pupil and relieve pain from uveitis (inflammation of the inner layers of the eye) and spasm of the iris
• An Elizabethan collar to prevent the cat from rubbing the eye and making the ulcer worse
• Surgery to treat a rapidly progressive or deep corneal ulcer. Surgery may involve applying a soft contact lens or suturing the eyelids partially closed to bandage the eye, or the placement of conjunctival grafts over deep lesions.
• Oral antibiotics for serious infections of the cornea, and oral anti-inflammatory drugs (such as aspirin) if inflammation is present within the eye.

Home Care for Corneal Ulceration in Cats

At home, administer all veterinary prescribed medications and follow up with your veterinarian within a few days of the original diagnosis. Take care that your cat doesn’t rub at the eye or cause any extra trauma to the healing ulcer. Leave the Elizabethan collar on at all times until your veterinarian approves its removal.

Observe the eye for signs of worsening, especially cloudiness of the cornea, increased or altered ocular discharge, continued squinting or more obvious inflammation of the conjunctiva, which is the delicate lining in the eyelids and covering part of the eyeball.

Preventative Care

Examine your cat’s eyes regularly and call your veterinarian if you note any pain or color change. Try not to get anything other than saline or clean water in your cat’s eyes. For example, avoid shampoos, soaps and any other household cleaners. Do not attempt to remove foreign material from your cat’s eye. Instead, seek urgent veterinary care.

In-depth Information on Corneal Ulcerations in Cats

Related Symptoms or Diseases

Your veterinarian is usually able to diagnose corneal ulceration with a thorough examination and application of a fluorescein dye to your cat’s cornea. However, discovering the cause of the ulceration and checking for related ocular abnormalities can be challenging. The following conditions must be investigated as potential causes or effects of the corneal ulcer.

• Eyelash abnormalities. Extra eyelashes (distichia) and/or misdirected eyelashes (ectopic cilia) are very rare causes of ulcers in cats. They are much more common in the dog. These eyelashes may rub on the cornea and cause ulceration through chronic frictional irritation.
• Eyelid abnormalities. Rolling in of the eyelid/s (entropion) and/or inability to completely close the eyelids when blinking (lagophthalmos) may cause or exacerbate corneal ulceration. Entropion is uncommon in cats and may be acquired following injury or inflammationor sometimes inherited. Entropion causes eyelashes and or hair from the lids to rub across the cornea and may be associated with corneal ulceration. Lagophthalmos may develop following injury to the nerves responsible for blinking, and may sometimes occur as an inherited problem in cats that have protuberant eyes and/or excessively large eyelid openings.
• Keratoconjunctivitis sicca (“dry-eye”). Inadequate amounts of tear production or a deficiency in any of the many important tear components can cause the surface of the cornea to become more susceptible to infectious agents or to environmental irritation. The tear film is a very important protective mechanism for the eye.
• Feline herpesvirus (FHV-1) is one infectious agent that may cause cause corneal ulceration in the cat. It affects only cats and may sometimes be associated with symptoms of upper respiratory infection.
• Uveitis is a common complication of serious corneal ulcers. The pain associated with corneal ulcers causes inflammation within the eye. This inflammation is accompanied by the release of substances within the eye and subsequent uveitis. The uveitis usually resolves once appropriate treatment for the ulcer is instituted, but your veterinarian may recommend specific treatment for the uveitis.

In-depth Information on Diagnosis of Corneal Ulcers in Cats

• Your veterinarian will do a complete medical history and perform a thorough ophthalmic examination. Thorough examination provides essential information regarding the cause and severity of the corneal ulcer. It may also highlight other related symptoms or diseases such as those listed above. Parts of the examination are often conducted in a darkened room using a bright light source and some form of magnification.
• During the examination, fluorescein stain is applied to the cornea and any excess is rinsed off. Fluorescein stain adheres to any areas where the surface layer of the cornea is missing. Fluorescein staining outlines the ulcer and permits accurate assessment of the size and depth of the ulcer.
• If low tear production is suspected as the cause, a Schirmer tear test is performed. A small strip of calibrated filter paper is placed inside the lower eyelid and left in place for one minute. The distance to which tears flow along this filter paper is a measure of the volume of tears produced. This is a safe and non-painful test.
• In cases where the ulcer appears infected, special samples may be collected from the cornea for examination under a microscope, for bacterial culture and sensitivity testing, and/or for viral testing. This is particularly important if an ulcer has progressed rapidly, has failed to respond to appropriate antibiotics, or if feline herpesvirus (FHV-1) may be involved.
• If special techniques, equipment, and/or training are required, your veterinarian may refer your cat to a veterinary ophthalmologist for further evaluation.

In-depth Information on Treatment of Corneal Ulcers in Cats

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 may include the following:

• An Elizabethan collar may be applied to the cat. Corneal ulcers can be irritating and your cat can cause more serious injuries to his eye if he scratches it with his 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. This involves 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 may be guided by culture and sensitivity results. It is critical to avoid the topical use of any medications containing corticosteroids when the cornea is ulcerated.
• Antibiotics are ineffective against FHV-1. If your cat has an ulcer secondary to FHV-1 infection, the frequent application of an antiviral agent such as idoxuridine, trifluridine (Viroptic®), or vidarabine (Vira-A®) may be recommended.
• If an ulcer is deep when it is first discovered, or if it progresses rapidly despite appropriate treatment, surgery may be necessary to save the eye and vision. This may involve 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 from near 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, removal of additional or misdirected eyelashes, and surgical correction of entropion may be necessary in selected cases. These steps also limit the chance of future corneal ulcers.

Home Care of Feline Corneal Ulcers

Follow-up care of corneal ulcers is critical. Administer any prescribed medication(s) as directed and be certain to alert your veterinarian if you are experiencing problems treating your cat. Optimal follow up veterinary care involves the following:

• Because uncomplicated ulcers often heal within seven days, all ulcers are rechecked within this time period. More serious ulcers or any ulcer that appears to worsen during treatment are checked sooner and more frequently. At the recheck examination, fluorescein stain is again used to outline the ulcer. Any ulcer that worsens despite appropriate therapy requires further investigation and may warrant referral to a veterinary ophthalmologist.
• Recheck examinations also allow monitoring of any inciting causes, such as regrowth of eyelashes, return of normal blink responses, changes in tear production, or appropriateness of lid position following entropion surgery.
• Feline herpesvirus can be a chronically recurrent disease in some cats and may be complicated by other corneal disorders, such as corneal sequestration and chronic keratitis, as well as chronic intermittent conjunctivitis.