Infected, melting corneal stromal ulcer in a DSH cat

Broadly speaking, corneal ulcers and the approach to their treatment can be divided into five
categories:

1. Simple traumatic corneal ulcers

Prevent bacterial infection with chloramphenicol drops. These ulcers usually heal within 7 days.

2. Secondary corneal ulcers 

Resolve primary disease (eg entropion, distichiasis, FB, FHV in cats) and prevent bacterial infection.

Non-healing, uninfected corneal epithelial erosion (indolent erosion) in a boxer.

3. Non-healing corneal erosions (Indolent Ulcer)

Promote healing (debridement, burring or keratectomy) and prevent bacterial infection.

4. Infected (including melting) corneal ulcers

Treat bacterial infection (aggressive use of appropriate topical antibiotics) and promote healing (medically +/- surgical debridement, grafting)

5. Immune-mediated corneal ulcers

Control immune reaction (leave this to the specialists!) and prevent bacterial infection.

The Good, the Bad and the Ugly of Ulcer Treatment

ALWAYS (The Good):

 Treat with topical antibiotics (chloramphenicol or tricin if infection unlikely)
 Provide systemic pain relief (e.g. NSAIDs)
 Prevent further self-trauma (e.g. E-collar)
 Monitor healing progress every few days
 Look for a reason if healing is delayed beyond 7 days – are you missing something?

AVOID (The Bad):

 Reaching for reserve ‘high-end’ topical antibiotics like Oculox, Ciloxan or Tobramycin when
there is no evidence of infection. This will only promote bacterial resistance.
 Other inappropriate medications where there is no rationale for their use, eg anti-
collagenolytic treatments like plasma/serum drops, oral doxycycline for non-healing erosions.
 Surgeries of no proven value, like third eyelid flaps as a sole therapy for non-healing corneal
erosions.

NEVER (The Ugly):

 Debride or burr an infected ulcer can cause the infectious to spread and worsens.
 Attempt to graft a non-healing erosion will cause excessive scarring and vision loss.
 The use of corticosteroid drops in ulcer will delay healing and increase the risk of infection. As specialists we sometimes break this rule when we are confident of an immune-mediated
aetiology, but leave it to us.

Team VOR

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