RE: Boxer ?keratitis

Robert Lowe — Wed, 20 May 2020 19:47:11 GMT

Topical or oral tetracyclines are useful with stomal lysis but as this is not present then I don't think they make any difference from this point of view. This cornea is not going to be infected but if there is an ulcer I would provide basic broad spectrum antibiotic cover in line with the cascade so Ophtocycline or Isathal

RE: Boxer ?keratitis

joanne mcallister — Wed, 20 May 2020 12:40:46 GMT

Thank you so much for this Rob. Would there be any benefit in adding topical or oral tetracycline to treatment?

RE: Boxer ?keratitis

joanne mcallister — Wed, 20 May 2020 12:40:02 GMT

Thank you so much for this Rob. Would there be any benefit in adding topical or oral tetracycline to treatment?

RE: Boxer ?keratitis

Robert Lowe — Wed, 20 May 2020 06:35:52 GMT

Hi Joanne

Thank you for the thorough description and photos. The signalment of being a 10 year old boxer with a non healing ulcer points very much at this being a spontaneous chronic corneal epithelial deficit (SCCED). Most of my advice will be based on this as the underlying diagnosis.

Debridement of the loose epithelial edges will remove non-adherent epithelium but does not treat the underlying pathology of a hyalinised anterior stromal surface. In an otherwise uncomplicated case the epithelium will spread back over the stroma in an attempt to heal. It moves as an entire sheet rather than dividing at the leading edge. Sometimes it will achieve its ambition and meet successfully with epithelium migrating from the other side and form a seal. However it may not always reform an effective junction with the abnormal stroma. Neovascularisation occurs within the stroma (epithelium does not routinely vascularise) in response to the ulceration and can be quite spectacular. If the epithelium remains poorly adherent then this can continue to promote vascularisation.

So I wonder if we have some poorly adherent epithelium that is fluorescein negative but isn’t actually properly adherent to the stroma. If this is the case then you would be able to debride or move the epithelium easily with a cotton bud under local anaesthesia. If it moves it needs removing. At this stage I would then consider treatment of the underlying pathology with Alger Brush burring.

If the epithelium is intact then continue topical steroids for another two weeks.

I would also advise the client that this dog may get the same type of ulceration in the right eye at some point but that once effectively treated an eye would be unlikely to ulcerate in the same way again.

Finally I would want to be certain that this is not something else if there is no further response to the above treatment and would think about looking for a corneal foreign body or consider a keratectomy with histopathology which would rule out any bizarre neoplasia but would be the ultimate treatment for SCCED anyway. I reckon about 1:100 of our SCCEDS end up having keratectomy as a curative treatment but we never find anything else on histopathology.

Hope this helps

Rob