![Page 1: SASH : Allyson Groth - A simple systematic approach to canine corneal ulcer](https://reader030.vdocument.in/reader030/viewer/2022033108/58a983961a28ab412d8b4b23/html5/thumbnails/1.jpg)
A simple, systematic approach to canine corneal
ulcersAllyson D. Groth
BVSc(hons), MANZCVS, DACVOSpecialist in Veterinary Ophthalmology
![Page 2: SASH : Allyson Groth - A simple systematic approach to canine corneal ulcer](https://reader030.vdocument.in/reader030/viewer/2022033108/58a983961a28ab412d8b4b23/html5/thumbnails/2.jpg)
Diagnosis Classification What’s known What to do Cases
Outline
![Page 3: SASH : Allyson Groth - A simple systematic approach to canine corneal ulcer](https://reader030.vdocument.in/reader030/viewer/2022033108/58a983961a28ab412d8b4b23/html5/thumbnails/3.jpg)
Pain Redness Discharge Cloudiness
Diagnosis: Symptoms
![Page 4: SASH : Allyson Groth - A simple systematic approach to canine corneal ulcer](https://reader030.vdocument.in/reader030/viewer/2022033108/58a983961a28ab412d8b4b23/html5/thumbnails/4.jpg)
Topical anaesthetic always OK – exam ONLY Corneal defect Fluorescein stain retention** Miosis Anterior chamber reaction
** Care with descemetoceles & “indolent” ulcers
Diagnosis: Examination
![Page 5: SASH : Allyson Groth - A simple systematic approach to canine corneal ulcer](https://reader030.vdocument.in/reader030/viewer/2022033108/58a983961a28ab412d8b4b23/html5/thumbnails/5.jpg)
Classification
Uncomplicated Complicated
![Page 6: SASH : Allyson Groth - A simple systematic approach to canine corneal ulcer](https://reader030.vdocument.in/reader030/viewer/2022033108/58a983961a28ab412d8b4b23/html5/thumbnails/6.jpg)
History◦ <7 days duration
No vascularisation No change in stromal character:
◦ No malacia◦ No cellular infiltrate◦ No stromal loss (divot)
Uncomplicated
![Page 7: SASH : Allyson Groth - A simple systematic approach to canine corneal ulcer](https://reader030.vdocument.in/reader030/viewer/2022033108/58a983961a28ab412d8b4b23/html5/thumbnails/7.jpg)
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”
Uncomplicated
![Page 8: SASH : Allyson Groth - A simple systematic approach to canine corneal ulcer](https://reader030.vdocument.in/reader030/viewer/2022033108/58a983961a28ab412d8b4b23/html5/thumbnails/8.jpg)
Classification
Uncomplicated Complicated
![Page 9: SASH : Allyson Groth - A simple systematic approach to canine corneal ulcer](https://reader030.vdocument.in/reader030/viewer/2022033108/58a983961a28ab412d8b4b23/html5/thumbnails/9.jpg)
Complicated
![Page 10: SASH : Allyson Groth - A simple systematic approach to canine corneal ulcer](https://reader030.vdocument.in/reader030/viewer/2022033108/58a983961a28ab412d8b4b23/html5/thumbnails/10.jpg)
Signalment: brachycephalic History: previous medications, ocular
disease/surgery Change in stromal character:
◦ Malacia◦ Loss (depth/divot)◦ Cellular infiltrate – colour change
Anterior chamber reaction
Infection
![Page 11: SASH : Allyson Groth - A simple systematic approach to canine corneal ulcer](https://reader030.vdocument.in/reader030/viewer/2022033108/58a983961a28ab412d8b4b23/html5/thumbnails/11.jpg)
![Page 12: SASH : Allyson Groth - A simple systematic approach to canine corneal ulcer](https://reader030.vdocument.in/reader030/viewer/2022033108/58a983961a28ab412d8b4b23/html5/thumbnails/12.jpg)
Cytology predicted culture result in 50/71 cases (70%)
19%: -ve cytology, +ve culture 11%: +ve cytology (PMN’s or bacteria), -ve
culture
Infection
![Page 13: SASH : Allyson Groth - A simple systematic approach to canine corneal ulcer](https://reader030.vdocument.in/reader030/viewer/2022033108/58a983961a28ab412d8b4b23/html5/thumbnails/13.jpg)
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
Infection
![Page 14: SASH : Allyson Groth - A simple systematic approach to canine corneal ulcer](https://reader030.vdocument.in/reader030/viewer/2022033108/58a983961a28ab412d8b4b23/html5/thumbnails/14.jpg)
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
Infection
![Page 15: SASH : Allyson Groth - A simple systematic approach to canine corneal ulcer](https://reader030.vdocument.in/reader030/viewer/2022033108/58a983961a28ab412d8b4b23/html5/thumbnails/15.jpg)
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
Infection
![Page 16: SASH : Allyson Groth - A simple systematic approach to canine corneal ulcer](https://reader030.vdocument.in/reader030/viewer/2022033108/58a983961a28ab412d8b4b23/html5/thumbnails/16.jpg)
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
Infection
![Page 17: SASH : Allyson Groth - A simple systematic approach to canine corneal ulcer](https://reader030.vdocument.in/reader030/viewer/2022033108/58a983961a28ab412d8b4b23/html5/thumbnails/17.jpg)
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
Infection
![Page 18: SASH : Allyson Groth - A simple systematic approach to canine corneal ulcer](https://reader030.vdocument.in/reader030/viewer/2022033108/58a983961a28ab412d8b4b23/html5/thumbnails/18.jpg)
Complicated
![Page 19: SASH : Allyson Groth - A simple systematic approach to canine corneal ulcer](https://reader030.vdocument.in/reader030/viewer/2022033108/58a983961a28ab412d8b4b23/html5/thumbnails/19.jpg)
Foreign body - acute Trichiasis
◦ Entropion: primary/conformational, secondary/spastic◦ Periocular, nasal fold◦ Distichia, ectopic cilia – young dogs
Ongoing irritation
![Page 20: SASH : Allyson Groth - A simple systematic approach to canine corneal ulcer](https://reader030.vdocument.in/reader030/viewer/2022033108/58a983961a28ab412d8b4b23/html5/thumbnails/20.jpg)
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
Ongoing irritation
![Page 21: SASH : Allyson Groth - A simple systematic approach to canine corneal ulcer](https://reader030.vdocument.in/reader030/viewer/2022033108/58a983961a28ab412d8b4b23/html5/thumbnails/21.jpg)
![Page 22: SASH : Allyson Groth - A simple systematic approach to canine corneal ulcer](https://reader030.vdocument.in/reader030/viewer/2022033108/58a983961a28ab412d8b4b23/html5/thumbnails/22.jpg)
Complicated
![Page 23: SASH : Allyson Groth - A simple systematic approach to canine corneal ulcer](https://reader030.vdocument.in/reader030/viewer/2022033108/58a983961a28ab412d8b4b23/html5/thumbnails/23.jpg)
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)
“Indolent”
![Page 24: SASH : Allyson Groth - A simple systematic approach to canine corneal ulcer](https://reader030.vdocument.in/reader030/viewer/2022033108/58a983961a28ab412d8b4b23/html5/thumbnails/24.jpg)
![Page 25: SASH : Allyson Groth - A simple systematic approach to canine corneal ulcer](https://reader030.vdocument.in/reader030/viewer/2022033108/58a983961a28ab412d8b4b23/html5/thumbnails/25.jpg)
![Page 26: SASH : Allyson Groth - A simple systematic approach to canine corneal ulcer](https://reader030.vdocument.in/reader030/viewer/2022033108/58a983961a28ab412d8b4b23/html5/thumbnails/26.jpg)
![Page 27: SASH : Allyson Groth - A simple systematic approach to canine corneal ulcer](https://reader030.vdocument.in/reader030/viewer/2022033108/58a983961a28ab412d8b4b23/html5/thumbnails/27.jpg)
![Page 28: SASH : Allyson Groth - A simple systematic approach to canine corneal ulcer](https://reader030.vdocument.in/reader030/viewer/2022033108/58a983961a28ab412d8b4b23/html5/thumbnails/28.jpg)
![Page 29: SASH : Allyson Groth - A simple systematic approach to canine corneal ulcer](https://reader030.vdocument.in/reader030/viewer/2022033108/58a983961a28ab412d8b4b23/html5/thumbnails/29.jpg)
Cotton bud debridement: ~50% healed Grid/multifocal punctate keratotomy: ~80% healed Superficial keratectomy: 100% healed
![Page 30: SASH : Allyson Groth - A simple systematic approach to canine corneal ulcer](https://reader030.vdocument.in/reader030/viewer/2022033108/58a983961a28ab412d8b4b23/html5/thumbnails/30.jpg)
![Page 31: SASH : Allyson Groth - A simple systematic approach to canine corneal ulcer](https://reader030.vdocument.in/reader030/viewer/2022033108/58a983961a28ab412d8b4b23/html5/thumbnails/31.jpg)
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
![Page 32: SASH : Allyson Groth - A simple systematic approach to canine corneal ulcer](https://reader030.vdocument.in/reader030/viewer/2022033108/58a983961a28ab412d8b4b23/html5/thumbnails/32.jpg)
![Page 33: SASH : Allyson Groth - A simple systematic approach to canine corneal ulcer](https://reader030.vdocument.in/reader030/viewer/2022033108/58a983961a28ab412d8b4b23/html5/thumbnails/33.jpg)
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”
![Page 34: SASH : Allyson Groth - A simple systematic approach to canine corneal ulcer](https://reader030.vdocument.in/reader030/viewer/2022033108/58a983961a28ab412d8b4b23/html5/thumbnails/34.jpg)
Uncomplicated Complicated
![Page 35: SASH : Allyson Groth - A simple systematic approach to canine corneal ulcer](https://reader030.vdocument.in/reader030/viewer/2022033108/58a983961a28ab412d8b4b23/html5/thumbnails/35.jpg)
![Page 36: SASH : Allyson Groth - A simple systematic approach to canine corneal ulcer](https://reader030.vdocument.in/reader030/viewer/2022033108/58a983961a28ab412d8b4b23/html5/thumbnails/36.jpg)
http://davidlwilliams.org.uk/
![Page 37: SASH : Allyson Groth - A simple systematic approach to canine corneal ulcer](https://reader030.vdocument.in/reader030/viewer/2022033108/58a983961a28ab412d8b4b23/html5/thumbnails/37.jpg)
![Page 38: SASH : Allyson Groth - A simple systematic approach to canine corneal ulcer](https://reader030.vdocument.in/reader030/viewer/2022033108/58a983961a28ab412d8b4b23/html5/thumbnails/38.jpg)
![Page 39: SASH : Allyson Groth - A simple systematic approach to canine corneal ulcer](https://reader030.vdocument.in/reader030/viewer/2022033108/58a983961a28ab412d8b4b23/html5/thumbnails/39.jpg)
![Page 40: SASH : Allyson Groth - A simple systematic approach to canine corneal ulcer](https://reader030.vdocument.in/reader030/viewer/2022033108/58a983961a28ab412d8b4b23/html5/thumbnails/40.jpg)
![Page 41: SASH : Allyson Groth - A simple systematic approach to canine corneal ulcer](https://reader030.vdocument.in/reader030/viewer/2022033108/58a983961a28ab412d8b4b23/html5/thumbnails/41.jpg)
![Page 42: SASH : Allyson Groth - A simple systematic approach to canine corneal ulcer](https://reader030.vdocument.in/reader030/viewer/2022033108/58a983961a28ab412d8b4b23/html5/thumbnails/42.jpg)
![Page 43: SASH : Allyson Groth - A simple systematic approach to canine corneal ulcer](https://reader030.vdocument.in/reader030/viewer/2022033108/58a983961a28ab412d8b4b23/html5/thumbnails/43.jpg)
![Page 44: SASH : Allyson Groth - A simple systematic approach to canine corneal ulcer](https://reader030.vdocument.in/reader030/viewer/2022033108/58a983961a28ab412d8b4b23/html5/thumbnails/44.jpg)
![Page 45: SASH : Allyson Groth - A simple systematic approach to canine corneal ulcer](https://reader030.vdocument.in/reader030/viewer/2022033108/58a983961a28ab412d8b4b23/html5/thumbnails/45.jpg)
www.cliniciansbrief.com
![Page 46: SASH : Allyson Groth - A simple systematic approach to canine corneal ulcer](https://reader030.vdocument.in/reader030/viewer/2022033108/58a983961a28ab412d8b4b23/html5/thumbnails/46.jpg)
![Page 47: SASH : Allyson Groth - A simple systematic approach to canine corneal ulcer](https://reader030.vdocument.in/reader030/viewer/2022033108/58a983961a28ab412d8b4b23/html5/thumbnails/47.jpg)
![Page 48: SASH : Allyson Groth - A simple systematic approach to canine corneal ulcer](https://reader030.vdocument.in/reader030/viewer/2022033108/58a983961a28ab412d8b4b23/html5/thumbnails/48.jpg)