A Helping Hand (Corneal Ulcers)

Dr Mc Blog

May 14, 2014
“As I was saying, my daughter says that there’s something wrong with her eye. You see it’s kind of mattering and she keeps it closed pretty tight. My daughter gave me some medicine to put in it, but it’s not better, so she said maybe I should see you.”

“Ah”, I said, a trifle overcome. As I gazed at the little cocker spaniel quivering on the exam table I could only be grateful that at last they had sought professional help. She was a pretty little dog but today her head hung low, the eyelids of her right eye neatly pasted together. It looked painful. I had to place eye drops infiltrated with a local anesthetic into her eye before she would let me examine it.

And what an eye! The entire cornea, or outer clear layer that covers the eyeball, was fuzzy blue, a sign of swelling and fluid accumulation (corneal edema) between the thin corneal layers. At the center of the eye a small pit could be seen. This was an ulcer, a hole punctured in the eye by a sharp object – shrubs, cats, foxtails, a bit of trash caught by a face hanging out the car window? It was obvious, too, that the body had tried to heal itself : a fine network of thin vessels traced their way to the edge of the ulcer, to increase circulation and carry off infection cells. (This is why products like Visine are a no-no – constricting the blood vessels prolongs irritation, though the eye will look more clear). Fortunately the ulcer, though severe, was not very deep. A very deep ulcer that has almost pierced the eye will have a deep blue-black appearance and is called a descemetocoele, named for the last of the last ten thin corneal layers that prevent a dog’s eyeball from leaking all over his face. A descemetocoele ulcer often requires corneal surgery.

I applied a small amount of an orange stain containing fluorescein dye to the cornea and watched it turn green over the ulcerated area, outlining the extent of the ulcer nicely. An intact cornea will not take the dye.

I turned to the couple to discuss treatment, now satisfied that I knew the extent of the problem. As I opened my mouth the elderly gentleman hurried to fill me in on my options. “Now don’t you be suggesting surgery. My daughter warned me about those. Said she had a dog done once where they sewed the eyelid up and she could hardly get the medicine in.” Helplessly I asked, “But did it get better?” “Oh yeah, but my daughter didn’t like it.” “But”, I protested, “sewing the third eyelid (inner eyelid – dogs and cats have them, people don’t) up and over the ulcer protects it from further injury and keeps it from drying out. For a small ulcer it isn’t necessary but this has been going on for some time.” “No, ma’am”, the man held firm. “My daughter told me not to do it.”

Well, you do the best you can. The little cocker was given some antibiotic eye drops and some other eye medications, with strict instructions to return within 5 days. That eye took more than twice as long as most to heal, until it would no longer take up the fluorescein stain, and she would always bear a scar. The little dog felt much better, but the client had his own views. On our last visit he surveyed the eye with deep satisfaction. “Yep”, he said, “My daughter told me it was healing up just fine. I only brought her in cuz I knew you’d want to learn from this.”

Christine B. McFadden, DVM


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