CORNEAL ULCER :

CORNEAL ULCER PRESENTED BY: P. MAHALINGAM BVM 06066

Definition :
Definition Corneal ulcer or ulcerative keratitis: Is an inflammatory condition of cornea Involving loss of its outer layer.

Corneal anatomy of the dog and cat :

Corneal anatomy of the dog and cat Outer layer 1 mm thick Trigeminal nerve supplies to cornea via the long ciliary nerves. Pain receptors Pressure receptors as deeper.

Cont., :
Cont., Four important layers: Outer layer - epithelium. Epithelium sticks to the basement membrane. Descemet's membrane. corneal endothelium.

Corneal healing :
Corneal healing By two methods: Migration - mitosis (dividing) -introduction of blood vessels from the conjunctiva. Superficial ulcers heal rapidly by the first method. Larger or deeper ulcers often require the presence of blood vessels to supply inflammatory cells. White blood cells and fibroblasts granulation tissue - scar tissue-healing the cornea.

Superficial and deep corneal ulcers :

Superficial and deep corneal ulcers Causes? Trauma Detergent burns Infections. Other conditions Entropion, Distichiae, Corneal dystrophy, Keratoconjunctivitis(dry eye).

Cont., :
Cont., Superficial ulcers involves a loss of part of the epithelium- severe scarring corneal perforation. Descemetoceles stroma Perforation.

Location :
Location Central Inferior nasal cornea Peripheral Border

Symptoms :
Symptoms Corneal ulcers are painful - nerve exposure- cause tearing, squinting, pawing at the eye. anterior uveitis miosis (contract pupil), aqueous flare (protein in the aqueous humour) redness of the eye.

Diagnosis :
Diagnosis Fluorescein stain. Schirmer's test.

Fluorescein Staining :
-Ve Staining +Ve staining Fluorescein Staining

Treatment :
Treatment Topical antibiotic . Pain medications. Topical atropine . Superficial ulcers usually heal in less than a week. Deep ulcers and descemetoceles may require corneal suturing, conjunctival grafts or conjunctival flaps, soft contact lenses, or corneal transplant. Topical corticosteroids and anesthetics should not be used on any type of corneal ulcer.

conjunctival grafts :
conjunctival grafts

Bridge or bipedicle conjunctival graft :

Bridge or bipedicle conjunctival graft

Pedicle conjunctival graft :

Pedicle conjunctival graft

After healing :
After healing

Conjunctival island graft :

Conjunctival island graft

Refractory corneal ulcers :

Refractory corneal ulcers superficial ulcers heal poorly tend to recur. Also known as indolent ulcers or Boxer ulcers. Defect in the basement membrane and a lack of hemidesmosomal attachments.

Treatment :
Treatment Refractory corneal ulcers - long time to heal. Topical antibiotics - prevent infection. Loose epithelium is removed with a dry cotton swab under topical anesthesia. keratotomy There are two main types used in dogs: Multiple punctate keratotomy (MPK) Grid keratotomy (GK).

Loose epithelium is remove :

Loose epithelium is remove

Cont., :
Cont., MPK involves making small superficial punctures into the cornea with a needle.

Cont., :
Cont., GK is more commonly used and involves making parallel and perpendicular scratches in the corneal surface.

Topical treatment :
Topical treatment Glycosaminoglycans such as sodium hyaluronate and chondroitin sulfate, aminocaproic acid, acetylcysteine.

Melting ulcers :
Melting ulcers Progressive loss of stroma - Pseudomonas infection - other types of bacteria or fungi - produce proteases and collagenases- break down the corneal stroma - Complete loss within 24 hours. Treatment includes antibiotics and collagenase inhibitors such as acetylcysteine and blood serum. Surgery may be necessary.

Cont., :
Cont.,

Slide 26:
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