Ron Hines DVM PhD 9/14/07
The clear outer capsule of the front of the eye is called the cornea. Corneal cells are the only cells in the body that are transparent. Instead of being nourished by blood vesicles, it is bathed in a nourishing protective liquid, the tears. Because of its delicate nature, and its position on the outermost edge of the eye, the cornea is subject to scratches, abrasions and ulceration. Superficial tears and scratch to the cornea heal rapidly. They are most common in young active animals. Older dogs and Persian cats are more subject to erosions of the cornea called ulcers. The most common cause of these ulcers is a lack of protective tears but they can also be due to bacterial and fungal infection. Adult cats also develop these ulcers due to infection with feline herpesvirus. Left untreated, corneal ulcers can develop serious complications that can destroy vision.
corneal ulcer dog cat eye disease cornea
Ulcers of the cornea may be shallow or deep. They result from everything from pawing to bee stings, the scratch of a thorn or an infectious bacteria. Once the outermost layer of the cornea has been torn the area becomes irritated and painful causing the pet to squint and tear. We call this reflex blepharospasm.
Corneal ulcers are quite painful and itch. In response, dogs and cats will rub the affected eye causing the condition to become worse. A discharge may accumulate in the corner of the eye nearest the nose (medial canthus) and the vesicles of the white of the eye (sclera) fill with blood. If the damaging object is no longer in the eye and the scratch is not deep it will rapidly heal. However if an infection is present it may progress to affect the deeper layers of the cornea. Once much of the cornea has been eroded away a bulge may form similar to a sidewall blowout on a tire. Such a bulge is called a descemetocele. If a descemetocele bursts, the anterior portion of the eye will collapse and the contents will spill out destroying the eye. This is why all corneal ulcers need to be observed closely and frequently.
Corneal abrasion (scraping) causes the entire cornea to swell (edema) and the cornea to turn white in color. If the eye is normal, within a few days tiny blood vessels will form in the cornea to aid in the healing process.
corneal ulcer dog cat eye disease cornea
Corneal ulcers are graded according to their depth. If only the outer layer is lost the lesion is called a superficial corneal ulcer. When more than one half the thickness of the cornea is lost it is called a deep corneal ulcer. Superficial ulcers in health eyes heal in a matter of days. Deep ulcers may take several weeks to heal. Deep ulcers require new blood vesicles to penetrate the area. They may also leave a corneal scar. When there are underlying causes for the ulcer some refuse to heal or heal only to re-ulcerate again.
Diagnosis of corneal ulcers:
Fluorescein dye strips are used to detect and demonstrate that there is a tear or abrasion on the surface of the cornea. First the eye is anesthetized with a drop of topical anesthetic (lidocaine). Then the strips are moistened with saline and the dye allowed to flow out over the cornea. The eye is then gently washed with saline to remove all excess dye. In a normal eye no dye remains on the cornea. Fluorescein dye attaches only to raw abraded areas where it can be seen when viewed with an ultraviolet light source through an ophthalmoscope.
A second test used to evaluate the eye is the Shirmer tear test. This test measures the amount of tears present in the eye. One predisposing cause of corneal ulcers is a lack of adequate tear flow.
If I suspect that the pressure in the eye is too high (glaucoma) and that this increased pressure and distortion of the shape of the eye is the underlying cause of the ulceration I perform another test. For this test I use a Schiotts tenometer, an instrument that measures pressure within the eye. Ulcers due to increased intraoccular pressure require a different course of treatment.
Corneal ulcers due to accidents:
Scraping and puncture wounds of the eye are the most common cause of corneal ulcers in dogs. Cats are less likely to poke their eyes with blunt or sharp objects or to damage the cornea with their claws while scratching. These ulcers are often linear or oblong in shape. If they are not deep they tend to heal quite rapidly.
Corneal ulcers due to eye conformation:
Dogs and cats with bulging eyes are more susceptible to corneal ulcers. This is because bulging eyes are more likely to be scraped and scratched. Misplaced eyelashes (dystrichiasis) and eyelids that curl inwardly (entropion) or outwardly (ectropion) can also cause corneal ulcers.
Corneal ulcers due to dry eye:
The film of tears over protruding eyes often does not reach the center. Dryness of the eye is sufficient to cause ulceration. Other pets are born with deficient tear production. Tear flow over the eye can be increased using cyclosporin ophthalmic drops or corrective surgery.
Corneal ulcers in cats due to herpesvirus-1 infection:
The rhinotracheitis or herpes-1 virus can form a carrier state in the eyes of cats causing periodic corneal ulcers. These ulcers come and go with stress. When inactive, the cornea is left with milky white rounded scars. If this disease is suspected and the signs are severe and persistant, the cat should recieve topical antiviral drugs such as diluted trifluridine(Viroptic,trifluorothymidine).
The amino acid, l-lysine, has been found to help many cases of rhinotracheitis conjunctivitis resolve. This amino acid reduces the amount of another amino acid, arginine, that is present in the cat's body. Arginine is thought to be necessary for herpesvirus to reproduce. The suggested lysine dose is 250-500 mg per day sprinkled on canned cat food. I would give this suplement until the acute flare-up has resolved. But many cat owners continue the suplement indefinitely. Lysine can be purchased at health food stores. Pick a brand that is propylene glycol-free.
Corneal dystrophy:
This rare condition is characterized by abnormal deposits within the cornea, which contain calcium and cholesterol. It is sometimes associated with hypothyroidism.
Breed-related problems:
Boston Terriers and Boxers have corneas that just do not seem to heal well. When these breeds develop corneal ulcers vitamin E solution may hasten healing.
Corneal ulcers due to bacterial or fungal infection:
Certain bacteria have an affinity for the eye causing redness and itching. Self-trauma in these cases can cause corneal ulcers. These cases need to be placed on antibiotic or antifungal eye drops.
Indolent ulcers:
Some corneal ulcers refuse to heal. These are called indolent ulcers. These occur when a ledge of dead corneal tissue surrounds the ulcer. These ulcers can be encouraged to heal if this dead tissue is scraped away. These long-standing ulcers also respond when the third eyelid is sutured across the defect in a procedure called tarsorrhapy.
Corneal ulcers that progress to a descemetocele:
Some corneal ulcers become so deep that the inner lining, Descemet's membrane, balloons out forming a descemetocele, which is similar to sidewall damage on a tire. If this structure ruptures, fluid from the anterior chamber of the eye leaks out over the cornea and the eye collapses. The iris in these eyes becomes sticky and will often stick to or protrude through the defect. When these eyes heal the normal anatomy of the eye does not recover. Distortions of the iris in these eyes often leads to glaucoma and loss of vision or the eye when the iridocorneal angle is changed (see diagram).
Treatment of corneal Ulcers:
The treatment I prescribes for dogs and cats with corneal ulcers depends on the severity of the ulcer, how long it has been present and what I feel is the underlying cause of the problem. I focus on treating and preventing secondary infection, controlling inflammation and pain , preventing additional corneal damage, and minimizing damage to the cornea by limiting scar formation.
Pets with corneal ulcers are in considerable discomfort and pain. These animals squint or keep their eye tightly shut. They may be sensitive to bright light. I often dispense the drug atropine, which dilates the pupil, and helps relieve this pain. This is the same medicine that ophthalmologists use to dilate your eyes. These pets are also more comfortable if they are kept out of bright light. Topical anesthetic eye drops are good during initial examinations but retard healing and therefore can not be dispensed for long term use.
I place all pets with corneal ulcers on antibiotic ointment or salves applied frequently to the affected eye. Corticosteroid-containing medicines should never be used with corneal ulcers because they retard the healing process. If the pet is pawing at the eye it may need to be placed in an Elizabethan collar or have its paws bandaged.
Corneal tissue heals very rapidly so uncomplicated superficial ulcers take only a few days to heal. I usually recheck eyes in four days when I perform another fluorescein dye test.
Cats with persistent viral-induced corneal ulcers receive anti-viral ointments or drops.
Deep corneal ulcers need more complicated treatment. Since these cases can be medical emergencies I usually hospitalize these pets. If Descemet's membrane is bulging through the ulcer I anesthetize these pets. As much tissue as possible is replaced through the ulcer. I will often reinforce the area of the ulcer with very fine suture material and then sew a patch composed of an attached slice (flap) of the third eyelid over the ulcer to shield it and bring it a blood supply. When I am through with this surgery I suture the lower lid over the eye to protect it. After three weeks these ulcers have usually healed sufficiently for the patch to be removed. If Descemet's membrane has burst and the eye has already leaked its contents, the outcome of this surgery is less successful. Some of these eyes cannot be saved. Short-faced (bracheocephalic) breeds of dogs such as Pekingese and Lhasa Apsos are particularly prone to this condition.
Superficial ulcers that are slow to heal (indolent) sometimes need to be scraped clean of dead tissue, especially around the margins of the ulcer, in order for new tissue to spread over the defect. This is carefully done under general anesthesia with a small scalpel blade. Tissue adhesives, which are forms of super glue, can be used to provide protection while these ulcers heal.
Ointments and drops need to be applied very frequently to affected eyes. I generally suggest every two to four hours in newly treated eyes. During this time the pet must be observed closely so that it does not rub or scratch the eye.
If the pet developed an ulcer because of insufficient tears (keratoconjunctivitis sicca) or a bulging eye I often place them on cyclophosphomide eye drops or artificial tears. An alternative to this is surgical transplantation of the duct of the salivary gland.
It is important that your veterinarian check the eye after four or five days of treatment. Most ulcers will have healed in this time but some will require additional time. If the ulcer has not healed in two weeks, treatment needs to be reevaluated and other procedures such as scraping (debridment) or a corneal patch may be required.
Recently, an article reported that 58% of cats with uveitis or inflammation of the anterior portion of the eye,51% of cats with conjunctivitis and 86% of cats with chorioretinitis (inflammation of the retina) as well as 75% and 58% respectively of cats with keratitis and corneal ulcers respectively, were positive for Bartonella. This would make Bartonella one of the most common causes of eye inflammation in the United States. This condition responded well to treatment with Doxycycline (5mg/pound twice a day for 6 weeks) azithromycin (5mg/pound once a day for 21 days) or rifampin (5mg/pound once a day for 21 days). When using doxycycline capsules one must follow the capsule administration with a considerable amount of water to keep the capsule from lodging in the esophagus. Azithromycin is the prefered drug for treatment because it is also effective against mycoplasma which may be present.
The clear outer capsule of the front of the eye is called the cornea. Corneal cells are the only cells in the body that are transparent. Instead of being nourished by blood vesicles, it is bathed in a nourishing protective liquid, the tears. Because of its delicate nature, and its position on the outermost edge of the eye, the cornea is subject to scratches, abrasions and ulceration. Superficial tears and scratch to the cornea heal rapidly. They are most common in young active animals. Older dogs and Persian cats are more subject to erosions of the cornea called ulcers. The most common cause of these ulcers is a lack of protective tears but they can also be due to bacterial and fungal infection. Adult cats also develop these ulcers due to infection with feline herpesvirus. Left untreated, corneal ulcers can develop serious complications that can destroy vision.
corneal ulcer dog cat eye disease cornea
Ulcers of the cornea may be shallow or deep. They result from everything from pawing to bee stings, the scratch of a thorn or an infectious bacteria. Once the outermost layer of the cornea has been torn the area becomes irritated and painful causing the pet to squint and tear. We call this reflex blepharospasm.
Corneal ulcers are quite painful and itch. In response, dogs and cats will rub the affected eye causing the condition to become worse. A discharge may accumulate in the corner of the eye nearest the nose (medial canthus) and the vesicles of the white of the eye (sclera) fill with blood. If the damaging object is no longer in the eye and the scratch is not deep it will rapidly heal. However if an infection is present it may progress to affect the deeper layers of the cornea. Once much of the cornea has been eroded away a bulge may form similar to a sidewall blowout on a tire. Such a bulge is called a descemetocele. If a descemetocele bursts, the anterior portion of the eye will collapse and the contents will spill out destroying the eye. This is why all corneal ulcers need to be observed closely and frequently.
Corneal abrasion (scraping) causes the entire cornea to swell (edema) and the cornea to turn white in color. If the eye is normal, within a few days tiny blood vessels will form in the cornea to aid in the healing process.
corneal ulcer dog cat eye disease cornea
Corneal ulcers are graded according to their depth. If only the outer layer is lost the lesion is called a superficial corneal ulcer. When more than one half the thickness of the cornea is lost it is called a deep corneal ulcer. Superficial ulcers in health eyes heal in a matter of days. Deep ulcers may take several weeks to heal. Deep ulcers require new blood vesicles to penetrate the area. They may also leave a corneal scar. When there are underlying causes for the ulcer some refuse to heal or heal only to re-ulcerate again.
Diagnosis of corneal ulcers:
Fluorescein dye strips are used to detect and demonstrate that there is a tear or abrasion on the surface of the cornea. First the eye is anesthetized with a drop of topical anesthetic (lidocaine). Then the strips are moistened with saline and the dye allowed to flow out over the cornea. The eye is then gently washed with saline to remove all excess dye. In a normal eye no dye remains on the cornea. Fluorescein dye attaches only to raw abraded areas where it can be seen when viewed with an ultraviolet light source through an ophthalmoscope.
A second test used to evaluate the eye is the Shirmer tear test. This test measures the amount of tears present in the eye. One predisposing cause of corneal ulcers is a lack of adequate tear flow.
If I suspect that the pressure in the eye is too high (glaucoma) and that this increased pressure and distortion of the shape of the eye is the underlying cause of the ulceration I perform another test. For this test I use a Schiotts tenometer, an instrument that measures pressure within the eye. Ulcers due to increased intraoccular pressure require a different course of treatment.
Corneal ulcers due to accidents:
Scraping and puncture wounds of the eye are the most common cause of corneal ulcers in dogs. Cats are less likely to poke their eyes with blunt or sharp objects or to damage the cornea with their claws while scratching. These ulcers are often linear or oblong in shape. If they are not deep they tend to heal quite rapidly.
Corneal ulcers due to eye conformation:
Dogs and cats with bulging eyes are more susceptible to corneal ulcers. This is because bulging eyes are more likely to be scraped and scratched. Misplaced eyelashes (dystrichiasis) and eyelids that curl inwardly (entropion) or outwardly (ectropion) can also cause corneal ulcers.
Corneal ulcers due to dry eye:
The film of tears over protruding eyes often does not reach the center. Dryness of the eye is sufficient to cause ulceration. Other pets are born with deficient tear production. Tear flow over the eye can be increased using cyclosporin ophthalmic drops or corrective surgery.
Corneal ulcers in cats due to herpesvirus-1 infection:
The rhinotracheitis or herpes-1 virus can form a carrier state in the eyes of cats causing periodic corneal ulcers. These ulcers come and go with stress. When inactive, the cornea is left with milky white rounded scars. If this disease is suspected and the signs are severe and persistant, the cat should recieve topical antiviral drugs such as diluted trifluridine(Viroptic,trifluorothymidine).
The amino acid, l-lysine, has been found to help many cases of rhinotracheitis conjunctivitis resolve. This amino acid reduces the amount of another amino acid, arginine, that is present in the cat's body. Arginine is thought to be necessary for herpesvirus to reproduce. The suggested lysine dose is 250-500 mg per day sprinkled on canned cat food. I would give this suplement until the acute flare-up has resolved. But many cat owners continue the suplement indefinitely. Lysine can be purchased at health food stores. Pick a brand that is propylene glycol-free.
Corneal dystrophy:
This rare condition is characterized by abnormal deposits within the cornea, which contain calcium and cholesterol. It is sometimes associated with hypothyroidism.
Breed-related problems:
Boston Terriers and Boxers have corneas that just do not seem to heal well. When these breeds develop corneal ulcers vitamin E solution may hasten healing.
Corneal ulcers due to bacterial or fungal infection:
Certain bacteria have an affinity for the eye causing redness and itching. Self-trauma in these cases can cause corneal ulcers. These cases need to be placed on antibiotic or antifungal eye drops.
Indolent ulcers:
Some corneal ulcers refuse to heal. These are called indolent ulcers. These occur when a ledge of dead corneal tissue surrounds the ulcer. These ulcers can be encouraged to heal if this dead tissue is scraped away. These long-standing ulcers also respond when the third eyelid is sutured across the defect in a procedure called tarsorrhapy.
Corneal ulcers that progress to a descemetocele:
Some corneal ulcers become so deep that the inner lining, Descemet's membrane, balloons out forming a descemetocele, which is similar to sidewall damage on a tire. If this structure ruptures, fluid from the anterior chamber of the eye leaks out over the cornea and the eye collapses. The iris in these eyes becomes sticky and will often stick to or protrude through the defect. When these eyes heal the normal anatomy of the eye does not recover. Distortions of the iris in these eyes often leads to glaucoma and loss of vision or the eye when the iridocorneal angle is changed (see diagram).
Treatment of corneal Ulcers:
The treatment I prescribes for dogs and cats with corneal ulcers depends on the severity of the ulcer, how long it has been present and what I feel is the underlying cause of the problem. I focus on treating and preventing secondary infection, controlling inflammation and pain , preventing additional corneal damage, and minimizing damage to the cornea by limiting scar formation.
Pets with corneal ulcers are in considerable discomfort and pain. These animals squint or keep their eye tightly shut. They may be sensitive to bright light. I often dispense the drug atropine, which dilates the pupil, and helps relieve this pain. This is the same medicine that ophthalmologists use to dilate your eyes. These pets are also more comfortable if they are kept out of bright light. Topical anesthetic eye drops are good during initial examinations but retard healing and therefore can not be dispensed for long term use.
I place all pets with corneal ulcers on antibiotic ointment or salves applied frequently to the affected eye. Corticosteroid-containing medicines should never be used with corneal ulcers because they retard the healing process. If the pet is pawing at the eye it may need to be placed in an Elizabethan collar or have its paws bandaged.
Corneal tissue heals very rapidly so uncomplicated superficial ulcers take only a few days to heal. I usually recheck eyes in four days when I perform another fluorescein dye test.
Cats with persistent viral-induced corneal ulcers receive anti-viral ointments or drops.
Deep corneal ulcers need more complicated treatment. Since these cases can be medical emergencies I usually hospitalize these pets. If Descemet's membrane is bulging through the ulcer I anesthetize these pets. As much tissue as possible is replaced through the ulcer. I will often reinforce the area of the ulcer with very fine suture material and then sew a patch composed of an attached slice (flap) of the third eyelid over the ulcer to shield it and bring it a blood supply. When I am through with this surgery I suture the lower lid over the eye to protect it. After three weeks these ulcers have usually healed sufficiently for the patch to be removed. If Descemet's membrane has burst and the eye has already leaked its contents, the outcome of this surgery is less successful. Some of these eyes cannot be saved. Short-faced (bracheocephalic) breeds of dogs such as Pekingese and Lhasa Apsos are particularly prone to this condition.
Superficial ulcers that are slow to heal (indolent) sometimes need to be scraped clean of dead tissue, especially around the margins of the ulcer, in order for new tissue to spread over the defect. This is carefully done under general anesthesia with a small scalpel blade. Tissue adhesives, which are forms of super glue, can be used to provide protection while these ulcers heal.
Ointments and drops need to be applied very frequently to affected eyes. I generally suggest every two to four hours in newly treated eyes. During this time the pet must be observed closely so that it does not rub or scratch the eye.
If the pet developed an ulcer because of insufficient tears (keratoconjunctivitis sicca) or a bulging eye I often place them on cyclophosphomide eye drops or artificial tears. An alternative to this is surgical transplantation of the duct of the salivary gland.
It is important that your veterinarian check the eye after four or five days of treatment. Most ulcers will have healed in this time but some will require additional time. If the ulcer has not healed in two weeks, treatment needs to be reevaluated and other procedures such as scraping (debridment) or a corneal patch may be required.
Recently, an article reported that 58% of cats with uveitis or inflammation of the anterior portion of the eye,51% of cats with conjunctivitis and 86% of cats with chorioretinitis (inflammation of the retina) as well as 75% and 58% respectively of cats with keratitis and corneal ulcers respectively, were positive for Bartonella. This would make Bartonella one of the most common causes of eye inflammation in the United States. This condition responded well to treatment with Doxycycline (5mg/pound twice a day for 6 weeks) azithromycin (5mg/pound once a day for 21 days) or rifampin (5mg/pound once a day for 21 days). When using doxycycline capsules one must follow the capsule administration with a considerable amount of water to keep the capsule from lodging in the esophagus. Azithromycin is the prefered drug for treatment because it is also effective against mycoplasma which may be present.
