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Corneal Ulceration 209

to avoid complications from deep corneal PEARLS & CONSIDERATIONS SUGGESTED READING
defects. Comments Featherstone HM, et al: Feline corneal sequestra: a
VetBooks.ir initiation of prophylactic topical antibiotic Avoid topical corticosteroid use because this AUTHOR: Ellison Bentley, DVM, DACVO Diseases and Disorders
• At the time of sequestrum sloughing,
review of 64 cases (80 eyes) from 1993 to 2000.
Vet Ophthalmol 7:213-227, 2004.
treatment (see Acute General Treatment) is
may induce herpetic stromal keratitis if FHV-1
indicated, and referral for further evaluation
(with or without surgical treatment) should is an underlying cause. EDITOR: Diane V. H. Hendrix, DVM, DACVO
be considered. Technician Tips
• Surgical treatment: usually several rechecks Avoid pressure on globe when handling an
at 1- to 2-week intervals until defect is affected cat after the sequestrum sloughs.
epithelialized
Client Education
PROGNOSIS & OUTCOME Recurrence is possible, as is involvement of the
contralateral eye.
Good, but recurrence is possible

Corneal Ulceration Client Education
Sheet

BASIC INFORMATION • Ocular discharge, often serous
CONTAGION AND ZOONOSIS • Corneal edema, usually focal
Definition FHV-1 keratoconjunctivitis is contagious • Obvious defect in corneal epithelium
Loss of corneal epithelium with or without loss among cats. • Fluorescein dye retention in corneal stroma
of varying amounts of the underlying corneal Clinical Presentation • Miotic (small) pupil (reflex uveitis [p. 1023])
stroma. A common condition, there are three • Aqueous flare
main categories: DISEASE FORMS/SUBTYPES Complex corneal ulcer: any or all of the above
• Simple corneal ulcer: an acute loss of epi- Three main categories of corneal ulceration: and one or more of the following:
thelial layers of the cornea due to trauma; • Simple corneal ulcer • Mucopurulent ocular discharge
usually not infected • Complex corneal ulcer • Diffuse corneal edema
• Complex corneal ulcer: an acute or chronic ○ Stromal ulcer (loss of varying amounts of • Corneal blood vessels (p. 212); indicative of
loss of epithelial and/or stromal layers the corneal stroma) chronicity
of the cornea due to trauma and/or ○ Keratomalacia/melting ulcer (softening • Corneal white-yellow cellular infiltrate
infection and necrosis of the cornea, often associated (inflammatory cells ± microorganisms)
• Indolent/refractory corneal ulcer: a superficial with infection) • Corneal stromal defect (i.e., crater appearance
ulcer resulting from failure of epithelial adhe- ○ Descemetocele (loss of all stromal layers to affected cornea)
sion to the corneal basement membrane and down to Descemet’s membrane [basement • Keratomalacia/melting (severe edema, a
stroma membrane of the corneal endothelium] soft gelatinous ± bulging appearance to the
and endothelium) affected stroma, and/or stromal loss)
Synonyms ○ Ruptured ulcer/iris prolapse (perforation • Hypopyon (p. 522)
Corneal abrasion/erosion, ulcerative keratitis, of the cornea) Descemetocele: any or all of the above and
keratomalacia, spontaneous chronic corneal • Indolent/refractory corneal ulcer the following:
epithelial defects (SCCED) • Fluorescein-negative clear center of a deep
HISTORY, CHIEF COMPLAINT stromal ulcer (Descemet’s membrane is
Epidemiology • Variable onset, from acute to insidious/ hydrophobic and does not retain fluid or
SPECIES, AGE, SEX chronic fluorescein stain)
• Simple/complex ulcers: dogs and cats of any • ± History of trauma Ruptured corneal ulcer: any or all of the above
age or sex • Ocular pain (squinting and/or rubbing at and one or more of the following:
• Indolent/refractory ulcers: middle-aged to eye) • Copious ocular discharge with fibrin and/
older dogs • Cloudiness to surface of eye or blood (p. 511) in the anterior chamber
• “Red eye” • Visible tan-brown-black iris prolapse (iris
GENETICS, BREED PREDISPOSITION • Ocular discharge (watery, mucoid, or filling the corneal defect) and/or tan-yellow
• Simple/complex ulcers: any breed; brachyce- mucopurulent) fibrin clot within ulcer
phalic breeds (dogs and cats) are predisposed • Occasionally, upper respiratory signs in cats • Shallow anterior chamber
• Indolent/refractory ulcers: dogs: any breed; (p. 1006) • Dyscoria (abnormal pupil shape)
boxers are predisposed • Visible anterior synechia (iris adhesion) to
PHYSICAL EXAM FINDINGS the ulcerated area
RISK FACTORS Simple and indolent corneal ulcers: any or all Indolent ulcer: any or all findings of a simple
• Keratoconjunctivitis sicca (KCS [p. 568]) of the following may be present: ulcer and the following:
• Brachycephalic conformation • Blepharospasm (squinting) • Rim of loose epithelium
• Eyelid conformational abnormalities (pp. • Conjunctival hyperemia (enlarged vessels) • Halo of fainter fluorescein uptake around
273 and 296) ± swelling stained ulcer
• Feline herpesvirus type 1 (FHV-1) (p. 464) • Third eyelid elevation • Minimal to moderate pain

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