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TOP TEN | In almost all cases, the hair is in the center of the upper lid (Figure 5). To find the hair, flip the Figure 5. Ectopic cilium in typical location of central upper eyelid upper lid and, with good mag- nification, locate the hair pro- truding from the conjunctiva. The hair is often surrounded by pigment, making it easier to spot; however, putting a drop of phenylephrine 2.5%, which blanches the redness often associated with the condition, allows the hair to be seen more clearly. 6 Is the Corneal Ulcer Superficial or Deep? Proper treatment for a corneal ulcer is very dependent on whether the ulcer is superficial or deep. How do we differentiate between the 2 of them? UÊ Magnification: Examine the cornea with magnification to deter- mine how much tissue is missing. If the ulcer has a ‘ragged edge’ (simi- lar to how an onion with the skin peeled off looks), then it’s superficial (Figure 6); if the ulcer has a ‘crater’ look with sloping edges, it is missing Figure 6. Superficial corneal erosion with ragged epithelial edges stroma and rather deep (Figure 7). UÊ Fluorescein stain: Fluorescein stain works by turning stromal tis- sue green—the epithelium has to be disrupted for the stain to infiltrate the stroma. Once an ulcer has the last layer of cornea bulging through the stroma (ie, a desce- metocele), fluores- cein stain often can- Treating…Corneal Ulcers Treatment greatly depends on the type of ulcer: r " TJNQMF TVQFSGJDJBM PS TMPXMZ healing indolent ulcer is treated by encouraging the epithelium to adhere to the underlying stroma. Techniques, such as epithelial debridement, bandage DPOUBDU MFOTFT HSJE LFSBUPUPNZ BOE TPNF OFXFS USJBM NFEJDBUJPOT JF "EFRVBO BSF VTFE UP TQFFE IFBMJOH Figure 7. Melting cor- neal ulcer with sloping stromal sides r %FFQ VMDFST BSF NVDI NPSF DSJUJDBM BOE DBO SFTVMU JO rapid perforation of the globe, requiring enucleation. %FQFOEJOH PO MFTJPO EFQUI QBSUJDVMBS TLJMMT PG UIF clinician, and a host of other factors, treatment ranges from medical support with anticollagenase drugs, such as acetylcysteine or serum, to conjunctival grafts. 8 Refer a Patient with a Unilateral or Early Cataract Since the development of safer cataract surgery, it is best to have a patient referred for cataract eval- uation sooner rather than later (eg, unilateral cata- ract patient or soon after a diabetic or pure-breed patient starts developing bilateral cataracts). This reduces the risk that a patient will develop lens- induced uveitis if the cata- ract remains in the eye. If severe adhesions develop between the iris and lens (Figure 9) or secondary glaucoma or retinal detach- ment occur, it is too late to save the eye. Figure 9. Cataract- induced uveitis with associated posterior synechiae and corneal degeneration July/August 2011 Today’s Veterinary Practice 65 UÊDetermining Depth: If you have a piece of examination equipment with a slit-beam, the degree that the light beam bends helps facili- tate determination of ulcer depth. not be retained by the cornea because all/most of the stroma is missing. 7 Entropion Diagnosis: The “Cookie” Test Patients can present with extremely squinty lids for a number of reasons: one of those is entropion. Suspicions are high when the patient is a shar-pei or chow chow, but what about other breeds that can have entropion, such as rottweilers, retrievers, and various giant breeds? Most of these patients are young (around 2 years old) and one lower lid is affected. Many of these dogs are hard to examine and hold still. One very easy way to evaluate a difficult patient is to apply a couple of drops of topical pro- paracaine, which allows the patient to relax the lids; then have it sit for a treat (aka “cookie”). Most of these patients will sit at attention once you say the word “cookie”! While the patient is sitting still without being held, keep the treat in your closed hand by your chin and look at the patient straight on, comparing each eye’s lid margins. If true anatomi- cal entropion is present, the lid (usually the lower) is rolled in on the eye (Figure 8). Figure 8. Lower eyelid entropion; the eyelid mar- gin is turned inward and, therefore, not visible 5FO 5JQT UP *NQSPWF :PVS 0QIUIBMNPMPHZ 4LJMMT