A bit like having a piece of sand in your eye, scratches or ulcers on the cornea hurt. In dogs and cats, corneal ulcers will generally heal with 7 to 10 days of treatment with antibiotic and tear replacement drops. There are however cases where the wound persists despite prolonged treatment; we call these, indolent ulcers. The term indolent means lazy or slow to heal. In these cases, new cells at the edges of the ulcer are unable to adhere to the ulcerated surface. Much like a wet bandaid, they just don’t stick so healing cannot occur.
Last week I saw Kobe, a handsome spirited Collie mix. Kobe had a corneal ulcer that refused to heal with drops alone, and I found myself thinking that a better term for this condition would be, insolent ulcer. Maybe it was because I’d been dealing with a bit of an unruly teenager for a few days, but really when you think about it, the term ‘insolent’ is actually very appropriate. I mean these corneas have no respect for the body’s attempt to heal itself!
So, how do we get these bad tempered corneas back to optimal health?
We perform a procedure called a striate keratotomy. Loose flaps of healing tissue at the edges of the ulcer are gently removed with a dry cotton swab. Then a small gauge needle is used to scratch a grid pattern over the surface of the ulcer. This stimulates healing and creates openings through the unhealthy corneal tissue which allows new cells to stick and ultimately fill in the defect. Striate keratotomies are effective in 60-70% of cases. If this procedure is not successful, referral to a veterinary ophthalmologist is required for a superficial keratectomy. In this procedure, a thin layer of cornea is completely removed (including the ulcerated area) leaving behind only healthy tissue. No matter the treatment used, patients always have to wear an Elizabethan collar (aka e collar or lampshade) which prevents them from rubbing the eye and causing further damage.
Managing insolent eyeballs requires patience and persistence, and in Kobe’s case, he seems to be well on his way to feeling better!