How to treat an indolent ulcer and perform temporary eyelid tacking in a dog | VETgirl Veterinary Continuing Education Videos
In this VETgirl veterinary continuing education video, we review treatment of an indolent ulcer in the dog. In this video, we review two procedures: diamond burr corneal debridement for indolent corneal ulcers and temporary eyelid tacking for entropion. In this video, we have an 9-year-old Labrador that presented with a history of chronic squinting and a non-healing corneal ulcer in the left eye. The eye exam revealed lower lateral eyelid entropion and an indolent corneal ulcer in the same region. The entropion was suspected to be spastic, secondary to the chronic corneal pain. Indolent ulcers can be recognized by their typical clinical appearance: a superficial ulcer with a non-adherent epithelial border.
Fluorescein stain can be seen diffusing under this loose lip of epithelial cells and appears as a less intense ring of stain uptake. Indolent ulcers are most often located in the central or para-central cornea, and develop neovascularization approximately 60% of the time. Without proper treatment, indolent ulcers may persistent for months, with an average time to referral of 7.5 weeks. Treatment of non-healing corneal ulcers requires both medical therapies along with some form of corneal debridement. The foundation and crucial first step in all successful corneal debridement modalities is epithelial debridement. Using numerous, dry, sterile cotton-tipped applicators, removal of the loose epithelium can be safely performed after application of topical anesthetic. Normal epithelium is well attached and will not be removed with debridement. Be sure to use dry cotton-tipped applicators for the best grip – you may use 5-6 swabs per eye. It is not uncommon for a much larger area of ulceration to be present after epithelial debridement. Epithelial debridement on its own has a reported healing rate of about 50%.
Diamond burr debridement (DBD) is the most recently described technique. DBD is performed using a handheld, battery powered polishing burr which removes the abnormal membrane and non-adherent epithelial cells, but does not penetrate into normal stroma. The average success rate of the DBD is 92.5%. After corneal debridement, medical treatment of indolent corneal ulcers should include prophylactic topical antibiotics (every 8-12 hours), and oral non-steroidal anti-inflammatories or additional pain medications such as tramadol. Tetracycline therapy (such as Terramycin ointment or oral Doxycycline) has been shown to improve the rate of healing in indolent ulcers.
In this patient, following the DBD, a temporary tacking procedure was performed to alleviate the entropion and allow the corneal ulcer to heal. A temporary eyelid tacking procedure is performed here using surgical staples, which works well in patients with mild entropion. In patients with significant entropion or very thick eyelids (like the SharPei or Bulldog), sutures are needed to achieve adequate tissue eversion. Entropion – or inversion of eyelid margins – can be seen temporarily in cases such as this due to discomfort as a result of the corneal ulcer. The goal is to break the pain cycle by everting the eyelid edges to alleviate the constant corneal irritation, which will allow the ulcer to heal and the comfort level to normalize.