Ulcerative keratitis

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Sections available in full article Introduction, Presenting signs, Age predisposition, Sex predisposition, Breed predisposition, Cost considerations, Pathogenesis, Etiology, Predisposing factors, Pathophysiology, Timecourse (incubation, duration), Diagnosis, Presenting problems, Client history, Clinical signs, Diagnostic investigation, Confirmation of diagnosis, Histopathology findings, Differential diagnosis, Treatment, Initial symptomatic treatment, Standard treatment, Monitoring, Subsequent management, Sequelae, Prognosis, Expected response to treatment, Reasons for treatment failure, Sources, Publications, Vetstream contributor(s),
Contributors Dr Dennis E Brooks DVM PhD DipACVO
Dr David L Williams MA VetMB PhD CertVOphthal FRCVS

Introduction

  • Important ocular disease characterized by loss of corneal epithelium plus variable amounts of stroma.
  • Cause : complex; trauma, collagenase activity and bacterial/viral infections should be considered.
  • Mycotic infection is more common in dogs than cats in the USA.
  • Diagnosis : relatively straightforward; use of fluorescein is strongly advised.
  • Treatment : remove causative agent(s) and create an environment suitable for healing.
  • Prognosis : corneal rupture is a possibility in cases of deep ulceration.

Diagnosis

Clinical signs

  • Ocular discharge.
  • Ocular pain (blephrospasm, photophobia).
  • Indolent ulcers have an epithelial lip.
  • Deep ulcers appear as a crater-like defect.
  • Miosis.
  • Conjunctivitis Conjunctivitis.
  • Corneal edema.
  • Direct visualization of ulceration.
  • Hypopyon.

Diagnosis

Differential diagnosis

  • Keratoconjunctivitis sicca (KCS) Keratoconjunctivitis sicca.
  • Uveitis Uveitis.
  • Glaucoma Glaucoma.
  • Physical irritation:
    • Distichiasis Distichiasis.
    • Entropion Entropion.

Sequelae

Prognosis

  • Deep ulcers may epithelialize leaving a corneal defect (facet).

Expected response to treatment

  • Rapid healing of superficial ulcers.
  • Corneal clarity and vision.
  • Absence of pain.

Reasons for treatment failure

  • Untreated bacterial infection.
  • Continued trauma.
  • Untreated KCS or uveitis.
  • Severe corneal scarring.
  • Topical steroid use with an ulcer can cause melting.

Sources

Publications

Refereed papers

  • Kern T J (1990) Ulcerative keratitis. Vet Clin North Am Small Anim Pract 20 , 643-666.

Other sources of information

  • Gelatt K N (ed) (1999) Veterinary Ophthalmology. 3rd edn. Lippincott, Williams & Wilkins. ISBN 0683300768.

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