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CLINICAL APPROACH TO THE CANINE RED EYE | 8 9A 9B Figure 8. Deep stromal ulcer with a central descemetocele secondary to corneal malacia and stromal loss; 360° superficial corneal neovascularization is also present. Figure 9. Foreign body posterior to the third eyelid (A); note hyperemia and chemosis of palpebral, bulbar, and third eyelid conjunctiva. Presence of superficial corneal ulcer following removal of foreign body and fluorescein staining (B). 10 11 12 Figure 10. Episcleral injection and conjunctival hyperemia, chemosis, mydriasis, and diffuse corneal edema associated with primary glaucoma. Figure 11. Anterior uveitis with diffuse corneal edema and secondary glaucoma; note 360° deep perilimbal deep neovascularization, diffuse edema, and slight mydriasis Figure 12. Iris neovascularization (rubeosis iridis), episcleral injection, and miosis secondary to anterior uveitis. » As outlined for uncomplicated ulcers » Do not use atropine in patients with KCS Management of SCCEDs associated with primary corneal disease: • Medical management as outlined for uncomplicated ulcers • Debridement of ulcer with a cotton tip applicator • Contact lenses to provide comfort during the healing process, if needed • Grid keratotomy or diamond burr debridement if ulcer fails to heal (see Diamond Burr Debridement) Treatment of deep and melting ulcers consists of: • Topical atropine 2 to 3 times daily until dilation; do not use atropine in patients with KCS • Topical broad-spectrum antibiotic Q 1 to 4 H; fluoroquinolones, such as ofloxacin, have good broad-spectrum efficacy » Corneal ulcers should be carefully evaluated with cytology to guide initial antibiotic therapy » Culture and sensitivity are indicated to confirm antibiotic choice • Compounded 50 mg/mL cefazolin is indicated if grampositive organisms are present; only used in conjunction with other antibiotics » Cefazolin eye drops can be compounded by reconstituting a 1-g vial of injectable cefazolin with 2.5 mL of sterile water; shake the mixture until dissolved and add it to a 15-mL bottle of artificial tears. » Keep refrigerated and discard after 10 days5 • Topical protease inhibitors, such as autologous serum, N-acetyl-cysteine, or EDTA, are applied Q 2 H until corneal malacia and stromal loss are controlled. Serum can be obtained in private practice via venipuncture and centrifugation, with sterile preparation and storage. Oral doxycycline (10 mg/kg Q 24 H) also acts as a proteolytic inhibitor9-12 • Oral NSAID for additional comfort. Patients should be re-evaluated within 24 hours for signs of improvement. Signs of improvement include:4 • Increased pupil dilation • Smoothing of the epithelial margin • Reduction of: » Corneal and episcleral/conjunctival blood vessel perfusion DIAMOND BURR DEBRIDEMENT (DBD) is a relatively new treatment modality that: • ProvidessafeandeffectivetherapyforSCEDDs(no needforgridkeratotomy)6,7 • Hasalowriskofinjurytothedeepercorneallayers8 • Doesnotrequireextensivespecializedtraining • Isanaffordabletreatmentsolution. However,onlyusegridkeratotomyandDBDfor superficial ulcerations without stromal loss and makesureno infectious processispresentpriorto performingeitherprocedure. May/June 2013 Today's Veterinary Practice 15