Indolent eye ulcer in dog

Re: Indolent eye ulcer in dog

Kate Richardson — Fri, 25 Jan 2013 14:53:08 GMT

Ta muchly

Re: Indolent eye ulcer in dog

Robert Lowe — Fri, 25 Jan 2013 14:30:01 GMT

[quote user="Kate Richardson"]

Rob,I've been told not to debride too frequently, ie leave it about 10 days between reviews and repeating debridement with a cotton tip if necessary- would that be about right?

[/quote]

7-10 days is what I use as time between based on 1mm or re-epithelialisation per day from each side of the ulcer meaning a 10mm wide ulcer should be healed in 5 days.

Re: Indolent eye ulcer in dog

nelu rudareanu — Fri, 25 Jan 2013 11:37:32 GMT

Thanks Rob,

Re: Indolent eye ulcer in dog

Kate Richardson — Fri, 25 Jan 2013 10:12:25 GMT

Rob,I've been told not to debride too frequently, ie leave it about 10 days between reviews and repeating debridement with a cotton tip if necessary- would that be about right?

Re: Indolent eye ulcer in dog

CatherineThomas — Fri, 25 Jan 2013 07:27:35 GMT

I've been told to use oral doxycycline in similar cases by an opthalmologist. I think he said it's not for the antibiotic action but it has some anti-inflammatory action in the cornea, or something like that. Anyway when I did use it the ulcer resolved, not sure if it was because of that or the other treatments I was using.

Re: Indolent eye ulcer in dog

Robert Lowe — Thu, 24 Jan 2013 21:45:46 GMT

[quote user="nelu rudareanu"]How often the keratatectomy with the cotton bud can be perform?[/quote]

I have probably done a keratotomy 5-6 times in some cases and much more with just debridement alone. Third eyelid flap is usually helpful if you are having no luck

Rob

Re: Indolent eye ulcer in dog

Virginia Campbell — Thu, 24 Jan 2013 21:35:19 GMT

[quote user="David Mills"]Gentamicin inhibits corneal healing, quite dramatically sometimes.[/quote]

I like vetsurgeon. There's another fact I didn't know but now I do :-)

Re: Indolent eye ulcer in dog

nelu rudareanu — Wed, 23 Jan 2013 15:20:42 GMT

The SG was normal at the bigining the ulcer was towars medial canthus but now has extendend in the center of the eye, i repeated today the keratectomy under local anesthetic using a cotton but.

How often the keratatectomy with the cotton bud can be perform?

I was thinking to perform third eyelid flap if is no improvment.

Thank,

nelu

Re: Indolent eye ulcer in dog

Utlendigur — Wed, 23 Jan 2013 13:38:39 GMT

Is the ulcer mid cornea or near the lid margin - eg any ectopic cilia/distichiasis etc?

Was the urine SG normal - just wondering about cushings?

Was there a loose rim of epithelium visible when the keratectomy was done? Sometimes it takes multiple debridements that can be quite extensive but can be done conscious or sedated using topical local and a cotton bud.

Re: Indolent eye ulcer in dog

Robert Lowe — Wed, 23 Jan 2013 12:44:12 GMT

Hi Nelu

Antibiotics don't make ulcer heal they just remove any infection and prevent any more infection occurring. If the ulcer isn't healing at this stage then its because there is an ongoing cause.

The most likely is a superficial chronic corneal epithelial deficit due to underlying anterior stromal pathology but I can't make a definitive diagnosis based on your description.

If it is then disruption of the anterior stroma using a grid or punctate keratotomy is one recognised treatment but it should only be done under supervision or by experienced hands.

An alternative would be to reduce the trauma of the eyelid on the loose epithelium by performing a third eyelid flap, temporary tarsoprrhapy or placement of a contact lens. Other treatments include phenol cautery and various topical medications / healing factors. None of the treatments has a 100% success rate.

These cases can takes multiple treatments to work and require pain relieve and topical covering antibiotics while they heal (Fucithalmic would be OK).

Rob

Re: Indolent eye ulcer in dog

nelu rudareanu — Wed, 23 Jan 2013 08:57:32 GMT

Hi Raj,

the ulcer is 0.7 cm iregular shape superficial in the cornea, The STT was 22 in 60 seconds I had it on fucithalmic for 2 weeks with no response.

Urine test in house normal ( we are looking for underlying problem like diabetes).

Do you think is worth to take a swab for C&S?

Thanks

Nelu

Re: Indolent eye ulcer in dog

Rajat — Tue, 22 Jan 2013 21:52:12 GMT

[quote user="Rajat"]

reatd etail

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1772389/

[/quote]

Sorry my post got garbled. Above was meant to read " see interesting (human) article with lots of details on this technique including preparation" followed by the link..!!

Re: Indolent eye ulcer in dog

David Mills — Tue, 22 Jan 2013 21:42:08 GMT

Also, swap the clinagel for something else. Gentamicin inhibits corneal healing, quite dramatically sometimes. Lubricate, lubricate, lubricate.

Serum drops, as rajat says, as usually used for meting ulcers as they inhibit protease (which is overexpressed in melting ulcers).

Re: Indolent eye ulcer in dog

Rajat — Tue, 22 Jan 2013 19:49:12 GMT

Hi Nela

It's simple- obtain blood, allow it to clot, spin it down to get serum (not so high a rpm as to cause hemolysis)

Store in aliquots which can be used within 1 day. The aliquots for future use can be frozen (-20c) and thawed + used on subsequent days. Alternatively you can prepare it on a every other day basis.reatd etail

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1772389/

Can you describe signalment and changes to ulcer appearance, and current status in bit more detail? i.e. is it getting smaller, is it melting or under run, is there uveitis or are there any identified underlying factors? Probably not needed while you're doing serum, but it may be worth adding tear replacement bid- tid too (such as viscotears)

Although the article states that serum drops help with ulcer healing amongst other corneal conditions, my understanding of their use is that it is primarily indicated for 'melting' ulcers.

I'm sure people with better knowledge of ophthalmology will be along to better advise as well.

Best of luck with your case

Raj