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These are the pits: non-healing corneal ulcers and how to deal with them

image of These are the pits: non-healing corneal ulcers and how to deal with them
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Abstract

: Superficial corneal ulcers that fail to heal in the expected time are a common problem. Identifying the cause, however, can be a challenge. This presentation looks at examples of two conditions: spontaneous chronic corneal epithelial defects (SCCEDs) and corneal endothelial failure.

: Superficial non-healing ulcers are not as common a problem in the cat as they are in the dog. However, when they do occur, they can be a real challenge to treat. Getting these ulcers to heal is difficult and the key is to understand the cause and treat that too. Interventions such as keratotomies (grid, punctate, diamond burr and phenol) cannot be used in the cat, as they predispose to the development of corneal sequestra. Brachycephalic cats are at particular risk due to corneal exposure; this, combined with poor corneal sensitivity and evaporative tear film loss, is the perfect recipe for poor healing. The other main consideration is the role of Feline Herpes Virus (FHV) in these cases. Once the diagnosis of ‘indolent ulcer’ is established then debridement of the loose epithelial edges is recommended, this can be combined with the use of a contact lens. Topical prophylactic antibiotics and tear replacement should be given and in cases where FHV is involved, topical or systemic antivirals should also be used. The debridement can be repeated several times but if the ulcer sill fails to heal then a superficial keratectomy is recommended. These cases are at risk of developing a corneal sequestrum in the ulcer bed, and if this does occur will definitely need a keratectomy to bring about healing.

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