A simple systematic approach to canine corneal ulcer by Allyson Groth

1. Allyson D. Groth
BVSc(hons), MANZCVS, DACVO
Specialist in Veterinary Ophthalmology

2.  Diagnosis
 Classification
 What’s known
 What to do
 Cases

3.  Pain
 Redness
 Discharge
 Cloudiness

4.  Topical anaesthetic always OK – exam ONLY
 Corneal defect
 Fluorescein stain retention**
 Miosis
 Anterior chamber reaction
** Care with descemetoceles & “indolent” ulcers

5. Uncomplicated Complicated

6.  History
◦ <7 days duration
 No vascularisation
 No change in stromal character:
◦ No malacia
◦ No cellular infiltrate
◦ No stromal loss (divot)

7.  Prophylactic antibiotics TID
◦ Chloropt, Opticin, Tricin
 Atropine (q24-72h)
 Oral NSAIDs
 NO topical steroids or NSAIDs
 E-collar
 Monitor for deterioration q3-5 days
 Continue until healed or “complicated”

8. Uncomplicated Complicated

9. Complicated

10.  Signalment: brachycephalic
 History: previous medications, ocular
disease/surgery
 Change in stromal character:
◦ Malacia
◦ Loss (depth/divot)
◦ Cellular infiltrate – colour change
 Anterior chamber reaction

12.  Cytology predicted culture result in 50/71
cases (70%)
 19%: -ve cytology, +ve culture
 11%: +ve cytology (PMN’s or bacteria), -ve
culture

13.  β-Hemolytic Streptococcus spp:
◦ 14/45, 31%
◦ Resistant to neomycin, polymyxin B, gentamicin,
framycetin & fusidic acid
◦ >80% resistant to ciprofloxacin
◦ Susceptible to chloramphenicol & cephalexin
 Pseudomonas aeruginosa:
◦ 14/45, 31%
◦ Resistant to chloramphenicol, cephalexin, and
fusidic acid
◦ >90% susceptible to ciprofloxacin, polymyxin B &
gentamicin

14.  Pseudomonas aeruginosa:
◦ 14/45, 31%
◦ Resistant to chloramphenicol, cephalexin, and
fusidic acid
◦ >90% susceptible to ciprofloxacin, polymyxin B &
gentamicin
 Staphylococcus spp:
◦ 8/45, 18%
◦ Susceptible to chloramphenicol, fusidic acid,
gentamicin, ciprofloxacin

15.  23.9% Staph spp methicillin resistant
 23.5% dogs with MRS corneal isolates had +ve MRS
nasal cultures
 Client occupation significantly (P = 0.01) associated
with MRS isolation
 Dogs belonging to owners employed in veterinary or
human healthcare fields 4X more likely to have MRS
keratitis

16.  Best: 26/37 (70%) isolates susceptible to
ciprofloxacin
◦ NOT alone for Strep spp.
◦ Good combined with chloramphenicol for Strep spp.
 Worse: 5/36 (14%) isolates susceptible to
fusidic acid

17.  Hospitalize for aggressive medical therapy: topical
AB’s, atropine, NSAIDs, serum
 Surgery indicated if >50% stromal loss – obvious
divot
◦ Referral for corneal/conjunctival/biomaterial graft
 TEL flap generally no use/counterproductive
 Monitor closely

18. Complicated

19.  Foreign body - acute
 Trichiasis
◦ Entropion: primary/conformational, secondary/spastic
◦ Periocular, nasal fold
◦ Distichia, ectopic cilia – young dogs

20.  Qualitative/quantitative tear film deficiency
◦ Immune-mediated, neurogenic (nose), toxic/drugs
 Exposure: conformational, neuropathy
 Degeneration: usually calcium, geriatric
 Excessively frequent debridement
 Topical epithelial toxicity – medications

22. Complicated

23.  Spontaneous Chronic Corneal Epithelial Defects
(SCCED)
 >7-10 days
 *ALWAYS superficial*
 *NEVER stromal change*
◦ Malacia
◦ Loss (thinning)
◦ Infiltrate
 Boxers, all ages
 Middle-aged/older dogs, any breed
 +/- oedema
 +/- vascularisation (chronicity, ~50% cases)

29.  Cotton bud debridement: ~50% healed
 Grid/multifocal punctate keratotomy: ~80%
healed
 Superficial keratectomy: 100% healed

31.  95% BCL retention (Acrivet, 2 sizes)
 >90% healed by ~2 weeks
 100% healed within 19 days
 Second tx in 12.5% cases
 Suspected bacterial infection in 1 case

33. Uncomplicated Complicated
 Prophylactic antibiotics TID
 Atropine (q24-72h)
 Oral NSAIDs
 NO topical steroids or NSAIDs
 E-collar
 Monitor for deterioration q3-5 days
 Continue until healed or “complicated”

34. Uncomplicated Complicated

36. http://davidlwilliams.org.uk/

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