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Client Library Article
CORNEAL LACERATIONS & ULCERS
| Lacerations & Ulcers of
the Corneal Surface of the Eye |
| The cornea is the thin clear convex shaped outer layer of
the eyeball or globe. A corneal laceration is simply a cut or
perforation of the cornea. A corneal ulcer is a painful erosion of one or
more layers comprising the cornea. Ulcers can be shallow, involving only one
or two layers, or deep involving almost all of the layers of the cornea.
With most ulcers, there is usually infection seen as a severe conjunctivitis
or reddening of the schlera or white portion of the eye. Both
lacerations and deep ulcers are medical emergencies and should be seen
by a veterinarian as soon as possible. All lacerations should be
checked for foreign bodies such as shards of glass or flecks of dirt or
gravel. Corneal ulcers are usually infected and if left untreated can
eventually erode all the way through the cornea to cause a rupture of the
eye. If not promptly treated, dogs with ruptured corneal ulcerations and
large corneal lacerations will almost certainly loose their vision and often
the eye as well. |
| Symptoms |
- Painful eye
- Excessive tearing (epiphora)
- Excessive blinking and holding eye closed (blepharospasm)
- Swollen eyelids (chemosis)
- Conjunctivitis (pink eye = white part of eye is red and blood shot)
- Surface of eye looks cloudy, red or blue tinged (corneal edema &
hemorrhage)
- Divot or visible ulcer on corneal surface
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| Diagnosis |
| The veterinarian will examine the eye carefully using
different lights and ophthalmic viewing instruments- paying close attention
to the integrity of the corneal surface, the lens, the retina (in the back
of the eye), and looking for blood and fibrin in the anterior chamber or
front of the eye. The eye should be stained with a special dye (fluorescein) which adheres to exposed corneal material and out
lines the area of the ulcer or laceration. If a deep ulcer is present, a
culture of the eye should be taken before any medications or stains are
applied. The eye should be checked carefully for any presence of a foreign
body. Most lacerations and corneal ulcers are fairly straight forward, but
if possible, it is advisable to have a veterinary ophthalmologist examine
the eye. |
| Medical Therapy-
indicated for corneal ulcers & after laceration repairs. |
- Topical medications- Applied every 2-6 hours depending on the
medication and the stage of the treatment include antibiotics, atropine to
dilate the eye, and topical non-steroidal antiinflammatory drugs to decrease the inflammation. A therapy that
works remarkable well for corneal ulcers is using the patients own serum in the eye – 1-2 drop
every 2 hours during the initial treatment. The serum has strong proteins
that block the breakdown of the cornea by bacteria.
- Systemic medications can include oral antibiotics and
antiinflammatories.
- Steroids should not be
used topically or systemically in patients with corneal lacerations or ulcers, or one will risk rupturing the
eye.
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| Surgical Therapy-
is indicated for very deep or ruptured corneal ulcers, and for corneal
lacerations. |
- Corneal lacerations should be sutured as soon as possible using
specialized instruments and very thin suture material. After the
edges of the cornea are apposed, the anterior chamber ( inner part of the
eye) is re-inflated with saline and a tiny air bubble. The veterinarian
may or may not elect to place a conjunctival or third eyelid
flap over the sutured cornea to add support to the eye and encourage faster
healing.
- Deep corneal ulcers are treated surgically by debriding the ulcer
(gently scraping away all of the dead and infected cornea material), and
then placing either a third eyelid flap, or a conjunctival flap over the
ulcer- again to add support to the eye and help speed healing.
- Both laceration and ulcers require intensive medical therapy after
surgery to encourage healing and prevent scarring that could lead to
permanent loss of vision.
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Prognosis
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| Fair to excellent depending on the severity of the ulcer or
laceration, and the duration of the lesion. The key to any eye problem
is to identify the lesion early on and start aggressive therapy
as soon as possible. Aggressive therapy means eye drops every 2-4
hours in the beginning for at least 2-3 days, and continuing medicating the
eye frequently for at least 7-10 days or longer. In some cases, even
with aggressive care, the eye can be lost. |
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