Clinical Connections  –  Summer 2020

Canine Corneal Ulcer Case and Flat Faced Dog Susceptibility to Eye Damage
Short-nosed dogs are frequent patients at the RVC Ophthamology service as their large, prominent eyes can easily be traumatised, and they often have a poor tear production contributing to an unhealthy surface of the eye. RVC research in 2017 revealed that almost 1 in every 100 dogs from the overall dog population will be affected with a corneal ulcer each year. The study also reported almost one in five needed surgery.
One of the biggest findings relates to the types of breeds that are most affected by corneal ulceration. Brachycephalic (flatfaced) breeds had over 11 times the risk compared with non-brachycephalics.

Canine Corneal Ulcer Infection Case Study

Nesto, a six year old Cavalier King Charles Spaniel, presented to the QMHA as an emergency due to an infected corneal ulcer with secondary uveitis and lipid aqueous in his right eye. Nesto was noticed to have intermittent blepharospasm in his right eye for the past 2-3 days and slight cloudiness had quickly progressed over the course of the day to cover the entire surface of the eye such that the edges of the iris could not be seen on presentation. His owners flagged up several possible causes, including that a fence hole he liked to poke his head, that the other dog in the house likes to lick his eyes and potential infections from local foxes. Nesto was otherwise healthy. As a puppy, he used to sleep with his eyes slightly opened, and three years ago possibly developed a corneal ulcer (owners are unsure about the diagnosis), which was treated with eyedrops
Menace responses were reduced in the right eye and present in the left eye. Dazzle reflexes were present bilaterally. Pupillary light reflexes were absent in the right eye due to the recent administration of atropine and were present in the left eye. Schirmer tear test readings were 15/30s and 20/min, and intraocular pressures were 16mmHg and 15mmHg in the right and left eyes, respectively. Examination of the right eye revealed moderate blepharospasm. There was marked conjunctival and episcleral hyperaemia. There was an axial corneal ulcer with white/cream coloured stromal infiltrate. There was marked (3+) aqueous flare, and the aqueous was white due to influx of lipid. The pupil was
mid-dilated. Further examination of the intraocular structures and fundus was not possible. Examination of the left eye was unremarkable except for a axial oval-shaped superficial stromal crystalline deposits within the cornea.
Atropine, ofloxacin eye drops alongside serum as eye drops from one of our RVC pet blood donors.
The aim of using the serum was to help halt the corneal melting process and stabilise the cornea.
By preventing this ulcer deepening, we could avoid surgery.
Oral medications: Metacam and Doxycycline
Alongside antibiotics treatment, the infection was controlled and Nesto’s cornea healed within one week. A month later Nesto’s vision was back to normal, and his eye was completely healed, only a small scar was left.
Pictures : Nesto before the treatment at the QMH ophthalmology department. A month later Nesto’s vision was back to normal, and his eye was completely healed, only a small scar was left.
Nesto 4 weeks after the treatment at the QMH ophthalmology department using serum in form of eye drops as well as antibiotic and anti-inflammatory drugs.
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Research References: 
O’Neill DG, Lee MM, Brodbelt DC, Church DB, Sanchez RF. Corneal ulcerative disease in dogs under primary veterinary care in England: epidemiology and clinical management. Canine Genetics and Epidemiology, 2017

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