Indolent Ulcers - Dogs
An indolent ulcer is a superficial corneal ulcer that fails to heal despite no apparent underlying cause. Authors differ on the time before an ulcer is classified as indolent, with some saying an ulcer is indolent after 7 days with no healing, others after 14 days. Indolent ulcers are also known as Superficial Chronic Corneal Epithelial Defects, Recurrent Epithelial Erosions or Boxer Ulcers.
Signalment
Indolent ulcers are seen in Boxer dogs of any age, and middle aged or older dogs of any breed.
Clinical Signs
A superficial ulcer failing to heal within 7 or 14 days. The ulcer is normally surrounded by a lip of non-adherent epithelium which flourescein dye applied will run under, staining the stroma of the cornea beyond the edges of the ulcer. There is usually no infection and the eye is only moderately painful at worst.
Treatment
There are several techniques used to treat indolent ulcers.
Debridement
Under topical anaesthesia a cotton bud is used to remove any loosely adherent epithelium. The debridement may need to be repeated multiple times for healing to occur. In a retrospective study, 84% of cases treated with debridement alone healed, with a median healing time of 21 days.[1]
Grid Keratectomy
Following debridement, a 25 gauge needle may be used to create a grid of linear striations extending across the ulcer. This often requires sedation or general anaesthesia. In a retrospective study all ulcers healed after grid keratectomy was performed, though 13% of cases required a second grid keratectomy. Median healing time was 11 days.[1]
Superfical Keratectomy
In a retrospective study all cases healed after a single procedure. [1] General Anaesthesia and magnification is required for this procedure, and consideration should be given to referral to an ophthalmolgist.
Control
There is little evidence on how to prevent recurrence. Some authors suggest applying ocular lubricants may be benefical.
References
Maggs, D et al (2007) Slatter's Fundamentals Of Veterinary Ophthalmology (Fourth Edition) Saunders
Peiffer, Robert J, and Petersen-Jones, Simon M (2008) Small Animal Ophthalmology (Fourth Edition) Saunders
Riis, Ronald C (2002) Small Animal Ophthalmology Secrets Hanley and Belfus, Inc