• DVM360_Conference_Charlotte,NC_banner
  • ACVCACVC
  • DVM 360
  • Fetch DVM 360Fetch DVM 360
DVM 360
dvm360 | Veterinary News, Veterinarian Insights, Medicine, Pet Care
dvm360 | Veterinary News, Veterinarian Insights, Medicine, Pet Care
By Role
AssociatesOwnersPractice ManagerStudentsTechnicians
Subscriptions
dvm360 Newsletterdvm360 Magazine
News
All News
Association
Breaking News
Conference Coverage
Education
Equine
FDA
Law & Ethics
Market Trends
Medical
Politics
Products
Recalls
Regulatory
Digital Media
dvm360 LIVE!™
Expert Interviews
The Vet Blast Podcast
Medical World News
Pet Connections
The Dilemma Live
Vet Perspectives™
Weekly Newscast
dvm360 Insights™
Publications
All Publications
dvm360
Firstline
Supplements
Top Recommended Veterinary Products
Vetted
Clinical
All Clinical
Anesthesia
Animal Welfare
Behavior
Cardiology
CBD in Pets
Dentistry
Dermatology
Diabetes
Emergency & Critical Care
Endocrinology
Equine Medicine
Exotic Animal Medicine
Feline Medicine
Gastroenterology
Imaging
Infectious Diseases
Integrative Medicine
Nutrition
Oncology
Ophthalmology
Orthopedics
Pain Management
Parasitology
Pharmacy
Surgery
Toxicology
Urology & Nephrology
Virtual Care
Business
All Business
Business & Personal Finance
Hospital Design
Personnel Management
Practice Finances
Practice Operations
Wellbeing & Lifestyle
Continuing Education
Conferences
Conference Listing
Conference Proceedings
Resources
CBD in Pets
CE Requirements by State
Contests
Veterinary Heroes
Partners
Spotlight Series
Team Meeting in a Box
Toolkit
Top Recommended Veterinary Products
Vet to Vet
  • Contact Us
  • Fetch DVM360 Conference
  • Terms and Conditions
  • Privacy
  • Do Not Sell My Information
  • About Us

© 2023 MJH Life Sciences and dvm360 | Veterinary News, Veterinarian Insights, Medicine, Pet Care. All rights reserved.

Advertisement
By Role
  • Associates
  • Owners
  • Practice Manager
  • Students
  • Technicians
Subscriptions
  • dvm360 Newsletter
  • dvm360 Magazine
  • Contact Us
  • Fetch DVM360 Conference
  • Terms and Conditions
  • Privacy
  • Do Not Sell My Information
  • About Us
  • MJHLS Brand Logo

© 2023 MJH Life Sciences™ and dvm360 | Veterinary News, Veterinarian Insights, Medicine, Pet Care. All rights reserved.

Corneal disease in dogs: there is a hole in my cornea (Proceedings)

August 1, 2011
Lynsey Smith, DVM, DACVO

Perforation, especially if leaking, is a definite emergency if globe is to be saved. Perforation typically has a fibrin plug, blood, iris adhered to cornea, collapsed anterior chamber, aqueous humor leakage

Topics

Dermoids, Corneal Ulcers, Trauma-induced corneal lesions, Lipid Keratopathy, Pigmentary Keratitis, Endothelial Degeneration

Corneal Ulcers

    1) Superficial Ulcers

    2) SCCED (superficial chronic corneal epithelial defect)

          • Indolent Ulcers

          • Boxer ulcers

          • Non-healing ulcers

     3) Complicated Ulcers

Superficial Ulcers

     – Duration

          • Uncomplicated ulcer will heal in 2 days

          • If doesn't behave "typically" consider underlying conditions

     – Age

          • Young dog: distichia, ectopic cilia, entropion

          • Old dog: indolent/non-healing ulcer

     – Work-Up

          • Fluorescein Stain

          • Close look at eyelids and conjunctiva for hairs or foreign bodies

     – Treatment for uncomplicated, superficial ulcers

          • Topical Antibiotic

               o BNP ointment/ Neo-Poly-Gramicidin

               o Tobramycin drops

          • Atropine

               o One drop in office should be sufficient

          • E Collar

     – Recheck 2 - 3 days

Indolent Ulcers

     – Must Haves:

          • Older patient (at least 5yrs)

          • Epithelial undermining (lipping edges)

          • No depth – always superficial

          • 1 week+ duration

     – These will get smaller and larger during treatment

     – Treatment options

          • Corneal debridement (cotton tipped applicator)

          • Linear Grid Keratotomy

          • Anterior Stromal Puncture

Advertisement

          • Diamond Burr

          • Contact lens

     – Medications

          • Tobramycin or Ofloxacin

          • Atropine

          • E Collaran

          • Tramadolan

     – Recheck

          • 2 weeksan

          • Do not re-debride before 2 weeks

     – Mistakes I see:

          • Debriding deep ulcers

          • Deep linear grid lacerations

          • Treating with one antibiotic and then changing because the ulcer didn't heal ... the scarring is going to get worse and worse

          • Debriding young dogs .... There is an underlying cause for young dogs not healing

Complicated Ulcers: Deep Stromal Ulcers / Perforations / Melting Ulcers

     – These are Corneal Emergencies

     – Descemetocele is a impending perforation: ulcer to the depth of endothelial basement membrane, Peripheral Fluorescein uptake with clear center. Rarely see bulging of membrane, usually deeeeeep crater

     – Perforation, especially if leaking, is a definite emergency if globe is to be saved. Perforation typically has a fibrin plug, blood, iris adhered to cornea, collapsed anterior chamber, aqueous humor leakage

     – These cases can rupture in the exam room!

     – They don't all look the same

     – Acute perforations usually very painful

     – Treatment: Prompt, careful, thorough exam, avoid excessive restraint, look for underlying cause

          • Dry eye, Distichiasis, trichiasis, ectopic cilia, entropion, Foreign body (esp. behind third eyelid)

          • Mineral degeneration, Facial nerve, trigeminal nerve disease, Corneal sequestrum (cat)

          • Numbing the surface of the eye with topical anesthetic can be very helpful

          • Examine non-painful eye first: may give clues to inciting cause of painful eye (i.e. Dry eye, extra hairs, etc.)

          • Slow, careful examination of affected eye if possible

          • Proper diagnostics to rule out underlying dry eye, assess depth of ulcer, etc.

     – Prognostic clues:

          • Presence of direct or consensual PLR

          • Clear view into eye

          • Size of ulcer

          • Integrity of cornea

          • Presence of other ocular disease such as cataracts, retinal disease, glaucoma

     – Treatment - Complicated Ulcers

     – These ulcers typically need surgery, True ocular emergency

     – Medical Management

          • Ofloxacin q 2 h

          • Serum q 2 h

          • Oral Antibiotics

          • Oral Anti-inflammatory

          • Tramadol

          • Atropine BID

          • E Collar

     – Recheck – 24 hours

     – Surgical repair options: Conjunctival pedicle flap, Corneoconjunctival transposition flap, Direct suture if lesion < 2mm, Conjunctival island graft, Conjunctival hood flap, Corneal graft, Other tectonic grafts (scleral, small intestinal sub mucosa (BIOSIS))

Melting Ulcers

     – Corneal perforation within 12-24 hours if not treated aggressively

     – Causes usually bacterial

          • Pseudomonas aeroginosa

          • Beta-hemolytic streptococcus

     – Fungal uncommon in dog; common in horse

     – Melting due to collagenases either from organism or self

     – Examination and diagnostics: Look for underlying causes (Dry eye, lid abnormalities, hairs, ear/ skin infection, etc.), Schirmer tear test, Culture and sensitivity, Cytology, Fluorescein stain, Tonometry

Treatment and follow up

     – Topical antibiotics every 1-2 hr

          • Avoid ointments in case it ruptures

          • Fluoroquinolones

     – Topical anti-collagenase every 1-2 hr

          • Serum (aseptically prepared, keep refrigerated, discard after 5 days)

          • EDTA, N- acetylcysteine

          • Mucomyst, tetracyclines

     – Topical mydriatics

     – Systemic antibiotic

     – Systemic steroid or NSAID

     – Pain Management

     – E- COLLAR

     – Treatment protocol

     – Ofloxacin, ciprofloxacin q 1-2 hours

          • good against gram- bacteria

          • good corneal penetration

     – Neomycin, polymyxin w/ bacitracin or gramicidin q 4-6 hours

          • good broad spectrum activity

          • poor penetration

          • won't touch pseudomonas

     – Atropine 1% or tropicamide 1%

          • prevent synechia, ciliary spasm, stabilize blood aqueous barrier

     – May need hospitalization if client unable to treat round the clock

     – Follow up within 24-48 hours

Trauma Induced Corneal Lesions: Penetrating Corneal Wounds, Lacerations / Punctures, Penetrating Corneal Lacerations

     – Signs: Aqueous leakage (seidel), Fibrin seal or iris prolapse, Scleral lacerations

     – Avoid manipulation

     – Corneal lacerations

          • Lacerations that are leaking are best treated surgically ASAP

          • Degree of intraocular damage and integrity of cornea will determine type of surgical treatment

          • If surgery must be delayed due to other injuries, long traveling distance, etc. treat medically

     – Medical treatment

          • Topical antibiotic solution (NO ointments)

          • Topical mydriatic solution if miotic

          • Systemic anti-inflammatory to treat intraocular inflammation

          • Systemic antibiotics to prevent intraocular infection

          • Pain management

          • E-collar

     – Surgical treatment: Direct suture, Conjunctival flap, Corneal transplant with or without flap

     – Complications of lacerations: Anterior/posterior synechia, Chronic uveitis, Phthisis bulbi, Secondary glaucoma, Cataract, Blindness

Crystalline Keratopathy

     – Corneal Dystrophy: inherited

     – Lipid Keratopathy: secondary to systemic lipid abnormalities

     – Corneal Degeneration: secondary to local inflammation or irritation

     – Causes

          • Inherited propensity: Shetland Sheepdog, Siberian Husky, Beagles, Cavalier, Airedale, Rough Collie

          • Hypothyroid dogs: do not metabolize fats appropriately

          • Diet

     – Work Up

          • Blood work with thyroid panel, Calcium, Cholesterol, Triglyceride levels

     – Treatment:

          • Correct underlying problem if you find one

          • Low fat diet, ask about treats!

          • If stable, visual, and comfortable: leave it

     – If visual deficits or chronic ulcerations refer for

          • Superficial keratectomy, TCA, grafts

Pigmentary keratitis

     – Brachycephalics predisposed

     – Cause: chronic corneal irritation, Medial canthal entropion, KCS, Distichia, Nasal fold trichiasis, Excessive corneal exposure

     – Treatment

          • Address underlying cause

               o Medial canthoplasty

               o Tear stimulants

               o Cryotherapy for distichia

          • Medical Therapy

               o Topical Tacrolimus

               o Topical steroids

Endothelial degeneration

     – Diffuse corneal edema

     – Rule Outs: Glaucoma, Lipid Aqueous, Anterior Lens Luxation

     – Diagnostics: Intraocular pressure, Corneal stain

     – Treatment

          • Sodium Chloride Ointment

          • Early → Keratoleptnysis

          • Late →Thermokeratoplasty

Related Content:

Ophthalmology
UC Davis study on eye diseases in kittens
UC Davis study on eye diseases in kittens
American College of Veterinary Ophthalmologists to offer service and working animals free eye exams
American College of Veterinary Ophthalmologists to offer service and working animals free eye exams
Senior penguins receive revolutionary cataract surgery
Senior penguins receive revolutionary cataract surgery

Advertisement

Latest News

FDA approves generic drug for managing allergic dermatitis in cats

CBD provides one mustang with a second chance

Thriving when life is hard

Hospital design expert shares his favorite design element

View More Latest News
Advertisement