Goals of Treating Corneal Ulcers
All corneal injuries should be treated by a veterinarian. Emergency surgery may be necessary to save the eye. The type and level of treatment for canine corneal ulcers depends upon their severity. The goals of treatment are to prevent progressive loss of corneal tissue, eliminate pain, prevent or resolve any infection, promote regrowth of healthy corneal tissue, minimize scarring of the cornea, and of course prevent blindness. Superficial, simple ulcers usually can be treated with prescription eye drops on an outpatient basis. Complex, deep or refractory corneal ulcers require much more extensive medical - and normally surgical - treatment.
Simple, superficial corneal ulcers normally are treated with topical broad spectrum antibiotic and/or antifungal eye drops or ointments to manage infection, together with topical medication to help reduce pain, such as atropine. Sometimes, systemic oral non-steroidal anti-inflammatory drugs (NSAIDs) will be added to the mix. For slightly more severe ulcers, the veterinarian may apply a therapeutic soft contact lens to affected eyes and an Elizabethan (cone) collar to protect the eyes while they heal. The patient should be confined indoors, except for occasional leash walks for exercise and to potty, until the ulcers are completely healed. Bright light should be avoided. The veterinarian will want to recheck progress at regular intervals, especially if a contact lens is used as part of the treatment protocol.
It is important for owners to follow their veterinarians’ treatment regimen to the letter. Simple corneal ulcers can quickly become complex. If they do not heal within one or two weeks of aggressive medical treatment, there may be an underlying problem such as a weak attachment of the cornea to the basement membrane of the eye. Treatment will then need to progress as for deep, complex corneal ulcers.
Complex corneal ulcers usually require all of the treatments described above for simple ulcers, followed by surgical intervention to save the eye. Depending upon the cause of the ulcers, topical treatments may be tried before surgery. These currently include a number of strong antibiotics, antifungal drugs and possibly “autogenous serum,” prepared from a sample of the dog’s own blood. If none of these resolve the problem, surgical repair is the next option.
There are a number of surgical techniques to correct corneal ulcers, and more are being developed all the time. Generally, these procedures involve removing the damaged or diseased portion of the cornea and, if necessary, placing some form of corneal or conjunctival graft over that area. Surgery must be followed by long-term treatment with topical antibiotics, anti-pain medication and possibly soft contact lenses, topical tear supplementation and bandaging.
As long as owners are diligent in complying with all recommended treatments, both before and after any surgical procedure, the prognosis for recovery from corneal ulceration is quite good.