A challenging case: A dog with nonhealing corneal ulcers - Veterinary Medicine
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A challenging case: A dog with nonhealing corneal ulcers
Corneal ulcers usually heal rapidly with appropriate treatment, but this Labrador developed two that were slow to heal. A technique used commonly in people—diamond burr superficial keratectomy—appeared to help in this case.


VETERINARY MEDICINE


One-week recheck

One week later, the left eye had increased periocular tear staining, mild blepharospasm, mildly injected conjunctiva, and a 2-mm-x-4-mm area of positive fluorescein uptake in the dorsal portion of the cornea. The results of the remainder of the ophthalmic examination were normal. The corneal ulcer appeared to be decreasing in size and there was no lip of loose epithelium, so the antibiotic ophthalmic ointment was continued and the topical morphine was discontinued.

Three-week recheck

At a three-week recheck appointment, the left eye still had moderate blepharospasm and mildly injected conjunctiva. The dorsal cornea had a 4-mm-x-1-mm area of positive fluorescein uptake, and a lip of loose epithelium was present around the ulcerated area. The loose epithelium indicated that the ulcer had not healed and, in fact, had again become undermined.


5. The dog in this report undergoing corneal débridement with a diamond burr to treat a spontaneous chronic corneal epithelial defect in the left eye.
We again applied a topical anesthetic and débrided the ulcer with a sterile cotton-tipped applicator soaked in dilute povidone-iodine solution. This time the 3.5-mm, diamond-tipped motorized burr was applied to the surface of the corneal ulcer to provide additional epithelial débridement and to remove a thin area of the underlying corneal stroma, which would improve the likelihood of good epithelial adherence (Figure 5).4

The dog's therapy of topical 1% morphine solution administered three times a day for pain management was reinstituted and the antibiotic ophthalmic ointment was continued. The owner declined placement of a bandage contact lens to protect the cornea and help alleviate pain.

A two-week recheck appointment was scheduled, but the owner instead returned in three weeks.

Follow-up

At the recheck appointment, the dog showed no clinical signs of ocular discomfort. No areas of fluorescein dye uptake were present on either cornea. A small area of granulation tissue was present at the site of the ulcer in the left eye. Medications were discontinued, and no rechecks were scheduled. The client was informed of the potential for the SCCED to recur in either the same or the contralateral eye.

The dog had no further ocular lesions. However, it was euthanized eight months later because of an unrelated disease.

DISCUSSION

Corneal ulcers are one of the most common ophthalmic diseases seen in veterinary private practice. The affected patient may present with a history of suspected trauma to the eye or without any apparent cause. The results of a comprehensive ophthalmic examination as well as the dog's signalment and history are important factors to take into consideration when determining the underlying cause and instituting appropriate therapy. A routine, uncomplicated corneal ulcer generally heals quickly, and thus, an ulcer that does not heal quickly should be further evaluated to determine the underlying cause.

SCCED has also been called indolent ulcer, refractory ulcer, boxer ulcer, persistent corneal erosion, recurrent ulcer, and nonhealing erosion.1,2,6 SCCED is a unique form of superficial corneal ulceration that fails to heal through a normal wound healing process.6,9 This delayed healing time usually lasts more than 14 days.


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Source: VETERINARY MEDICINE,
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