Corneal Ulcers

A dog being gently held with its head tilted to the side while another hand is dripping an orange dye into the dog's eye.

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In this episode of ‘Your Vet Wants You to Know’, Dr. Kristen Fischer, veterinary ophthalmologist discusses corneal ulcers in pets. Pet owners will learn what corneal ulcers are, how they are diagnosed and treated. Dr. Fischer gives valuable insights on what pet owners should watch for, healing times, and the importance of a rapid veterinary exam. This episode provides practical advice for pet owners on how to heal their pets’ eyes faster. Treatment options, including the use of topical antibiotics and the importance of the ‘cone of shame’ for prevention of further injury, are discussed. The “Scratching the Itch” segment concludes with an overview of other helpful (and adorable) protective eyeware.

Welcome Dr. Fischer!

Dr Fischer on a horse with her daughter on another horse

[00:01:05] Dr. Lancellotti: Welcome, everyone, to today’s episode of Your Vet Wants You To Know. Today, we’re going to be talking about corneal ulcers, and this is something that I see occasionally in my dermatology practice, but something that Dr. Kristen Fischer, an ophthalmologist, sees much more commonly. So she is here to talk to us, today, about what corneal ulcers are, how we test for them, and how to treat them. Welcome, Dr. Fischer.

[00:01:26] Dr. Fischer: Thanks. Thanks for having me. I’m excited to Educate people on what to look for and what these corneal ulcers are all about.

[00:01:33] Dr. Lancellotti: Yeah. I think this is going to be a really helpful episode. and I want our listeners to have a little bit of your background and kind of understand where your expertise is and how you got to where you are today as a veterinary ophthalmologist.

Dr. Fischer: So I grew up at East Tennessee and went to undergraduate, school at the University of Georgia and then I moved on to vet school in Tennessee after that. And then in my vet school career, I just decided that I wanted to be really good at one thing. So, uh, my dad was a surgeon while I was growing up (on people) and I really liked surgery. I thought that was cool and I also rode horses a lot when I was growing up, so the light bulb went off and I realized that in ophthalmology, I get to do surgery and I get to see horses and I get to be really good at one thing. I mean, the eyeball is just one little tiny organ. So, I decided to specialize in ophthalmology. I did my residency, at the University of Tennessee. And I have been a board certified veterinary ophthalmologist since 2012, and I practiced in South Carolina in the Charleston area.

VetHive and OphthoVet Consulting

Dr. Fischer: I also really love teaching. so I’m a, Guide, uh, with that online education community called Vet Hive. And then I also started a consulting business to help general veterinarians manage, eye cases in their own practice when referral to an ophthalmologist might not be, possible.

[00:02:55] Dr. Lancellotti: Yeah. VetHive has been a really amazing clinical support community for veterinary professionals. So if you are a veterinarian who’s listening to the episode today, definitely something to check out. VetHive has been really helpful, in collaborating on cases and there’s just some really supportive, professionals, on there who really want to just help everyone, um, in terms of making sure that, all the cases that need that helper are getting the support that they need. and Dr. Fisher, what is the name of your consulting, business?

[00:03:23] Dr. Fischer: So my consulting business is called OptoVet Consulting. And, it’s an online consulting, business where veterinarians can reach out to me for specific case by case help on their specific cases, to help them manage cases that they might not feel comfortable handling on a regular basis.

[00:03:42] Dr. Lancellotti: That’s excellent.

Mitzi, the corgi with a corneal ulcer.

[00:03:59] Dr. Lancellotti: Is there one particular patient that sticks out in your mind when you think of pets that you’ve treated with corneal ulcers?

[00:04:16] Dr. Fischer: Well, I see this probably 10 to 15 times a day in my general practice, so they all kind of run together. But specifically for this podcast episode,. I’m going to be talking about Mitzi, an 11 year old Corgi who has a history of having repeated corneal ulcers. An ulcer is an abrasion on the eye, and they usually happen because of trauma. She developed an ulcer in her left eye (about a year ago) that we ended up treating and it ended up healing, and then she recently developed an ulcer in her right eye. In certain breeds, it can take a little bit longer to heal, older dogs sometimes can have a harder time healing, and then certain types of ulcers can occur more commonly in more than one eye. So it’s not terribly uncommon, for a dog like Mitzi, who’s an 11 year old Corgi, to develop an ulcer, in the opposite eye at some point. We’ve gotten to know her pretty well and she decided to get some little protective goggles to protect her eyes moving forward. Hopefully, she won’t have to deal with that again

[00:05:23]Dr. Lancellotti: And I will just preface this by saying that there is an absolutely adorable picture of Mitzi that will be on the website if anybody wants to see, just how cute she is wearing her special protective goggles.

A corgi dog wearing goggles to protect her eyes

Deep Dive into Corneal Ulcers: A Serious Eye Scratch​

Dr. Lancellotti: So let’s talk about exactly what corneal ulcers are. How are they different from what’s happening in a normal eye?

[00:05:41] Dr. Fischer: On the surface of your eyeball (cornea, the windshield of the eyeball), there is a surface layer of cells called epithelial cells (which are like epithelial skin cells, just a different type) which are supposed to be completely intact, without any disruption. If you actually have a scratch, a scrape, or some type of trauma to the surface of the eye, and those cells are rubbed or scratched away, then that results in a corneal ulcer. It’s just a little abrasion, like a scrape or a scratch that you would get on the skin surface- not a deep cut or anything. But that’s what a superficial corneal ulcer is. There are certainly different types of ulcers. They’re not all created equal by any means.

[00:06:29] Dr. Lancellotti: Yeah. I imagine that it’s a little bit trickier when you have a scratch on the surface of your eye, compared to the scratch on the surface of your skin. Every time the animal blinks, it’s going to be rubbing against that scratch there.

[00:06:40] Dr. Fischer: For sure. Some are really painful, and some dogs and cats don’t seem to be bothered by them at all. Some are just on the surface and some go deeper into the cornea, and those are certainly more serious because the cornea is really only about the thickness of a dime, at its thickest. In some animals it’s even thinner than that, so if the ulcer starts to get down deeper into the cornea, then the eye can actually be really fragile and it can potentially even be vision threatening.

How Long Does it Take For a Corneal Ulcer to Heal?

[00:07:07] Dr. Lancellotti: In terms of healing time, I know you said they’re not all created equal, but what should owners expect if this does happen? How quickly can corneal ulcers heal?

[00:07:16] Dr. Fischer: Well, in the perfect world, you can heal an ulcer in about 48 to 72 hours, but there’s a lot of other factors that play into the healing in our pets. Most of them heal within about a week, but some of them can take months and months to heal. It really depends on what’s going on and if there’s an underlying problem. Again, most of them happen because of trauma, but we also can see ulcers happen for other reasons, and depending on the reason, if you don’t address that, it could take lot longer to heal.

Understanding Corneal Ulcers: Causes, Symptoms, and Treatment

[00:07:50] Dr. Lancellotti: Yeah, so let’s talk a little bit about some of those reasons. You mentioned trauma. Why else might corneal ulcers occur? Are there other problems that the pet owner might need to be concerned about if they do develop a corneal ulcer?

[00:08:02] Dr. Fischer: There are a lot of things that can cause ulceration, but that can be anything from you went to go pet your dog on the head and you accidentally poked it in the eye or they were rough-housing with the other pet in the house and just happened to get swatted in the face. It’s not always some kind of like major trauma.

We can also see confirmation issues. So if the eyelids don’t fit onto the skull properly, they can roll in, and the hair on the skin can rub on the eye.

We can also see abnormal eyelashes. Sometimes, dogs will develop a whole second set of eyelashes that point towards their eye instead of pointing away, and that can be really irritating.

An older dog will sometimes grow something like a little wart like growth or tumor on their eyelid. A lot of times, although those are benign and they’re not going to spread elsewhere, they certainly can be irritating if they’re growing on the eyelid.

As you mentioned, your eyelids are moving (the upper eyelid is blinking) and anything that is abnormal with those eyelids can actually lead to ulceration and can prevent ulcers from healing.

In cats, mainly, but we can see it in dogs too) there are actually some viral conditions and an infectious things that we think of that can cause corneal ulcers.

Figuring what’s causing it, or at least ruling some of those things out, is going to be your veterinarian’s goal, so that they can help your pet heal quickly as possible.

Allergies in Dogs Can Lead to Corneal Ulcers

[00:09:30] Dr. Lancellotti: You mentioned that trauma or just scratching that eye as one of the major reasons. As a dermatologist, the most common reason I see corneal ulcers in my patients is because their face is really itchy from allergies. They’re bringing their paw up to scratch at their face, or they’re rubbing their face aggressively on carpeting or something to try to relieve that itch and they wind up scratching their eye as well. So that’s certainly something to keep in mind; if your pet’s super itchy, we want to check those eyes to make sure that they haven’t damaged them.

Signs Your Pet May Have a Corneal Ulcer

Dr. Lancellotti: What might a pet owner notice at home if a pet does have a corneal ulcer?

[00:10:07] Dr. Fischer: Probably the most common symptom in any pet with a corneal ulcer is going to be squinting or holding that eye closed. Sometimes, they have it all the way closed. Other times, they just have it partially closed. That’s going to be your most common symptom, and that’s actually a sign of discomfort or pain. People ask me all the time, “How do I know if my dog’s eye is hurting?” Holding it closed is probably your first tip.

The other thing you might notice is more tearing (watering of the eye) or even a mucus-like discharge, and then also redness. So if you lift up the upper eyelid and look at the white part of the eye, the sclera, you may notice that it’s actually quite red. Most of the time, ulcers happen in one eye, so fortunately, most of the time, you actually have a normal eye that you can compare it to. So if one eye is more squinty than the other, more red, more cloudy on the surface, or there’s more drainage, those are all potential signs of an ulcer.

[00:11:05]Dr. Lancellotti: Perfect. So that would be a great time to make an appointment with your veterinarian or a veterinary ophthalmologist to get that checked out.

A list of common signs of corneal ulcers including pictures of a dog with excess tears and a dog squinting

What Tests Are Recommended for Corneal Ulcers?

Dr. Lancellotti: Once the pet goes into the vet’s office, if the veterinarian suspects that the pet has a corneal ulcer, what types of testing might they recommend?

[00:11:19] Dr. Fischer: So, again, we kind of talked about ruling out other causes. One of the causes that I didn’t actually touch on before is dry eye disease. We can see a lot of pets that develop dry eye issues, meaning they don’t have enough tears lubricating the surface of their eye, that can certainly lead to ulceration. Checking their tear production is probably a good place to start just to be sure that you’re not missing an underlying cause. We test the tears with something called a Schirmer tear test, where we put this little piece of paper kind of in the eyelid and it wicks out the tears. You can measure how many tears they’re actually making and determine if that’s normal.

If the tear test is normal, then the next test, and the test that tells you for sure whether you have an ulcer or not, is something called a fluorescein stain test. Fluorescein is a dye you put in the eye, and if the eye has a disruption in those epithelial cells, if those cells are missing, then that stain will cause the cornea in the area where the ulcer is to turn green. Your veterinarian will put this stain in there and then they may shine a little Cobalt blue light at the eye, it will fluoresce and it will kind of illuminate and you can really highlight That ulcer area.

[00:12:39] Dr. Lancellotti: Yeah, it’s pretty cool to see those ulcers light up under that fancy light we use. It’s really bright green where they do have that ulcer. This is an easy test that most general practice veterinarians, as well as veterinary ophthalmologists will be able to do very quickly and easily with most animals who are coming in.

Proper Eye Care and Treatments for Corneal Ulcers in Pets

Dr. Lancellotti: If there is a corneal ulcer, what are some options that pet owners have in terms of treatment and can you talk about what the benefits and risks are.

[00:13:09] Dr. Fischer: It depends a little bit on what’s causing the ulcer because I already mentioned that you may have to treat whatever that underlying problem is. So if there is a growth or something on the eyelid, that’s obviously going to need to be addressed.

The main thing that you need when there’s an ulcer is some type of topical antibiotic treatment. The antibiotic surface treatment for the eyes comes in either ointments, which is kind of like an eye drop. There’s normally bacteria present on the surface of the eye, but it doesn’t normally cause a problem. But whenever that epithelial cell layer is disrupted, bacteria really see that as an opportunity to try to show up and set up shop and cause an infection. Most ulcers are not infected, and most of them should heal really quickly. But if you do develop an infection on the surface of the eye, that can be actually really serious.

So the most important thing, is a topical antibiotic and which antibiotic a veterinarian chooses will probably depend on what they’re comfortable using and what they have in stock in their practice, because that’s always changing, and then potentially what type of ulcer is going on. Again, if there’s an underlying cause, they plan to identify that and then address that if needed.

[00:14:22] Dr. Lancellotti: Topical therapy seems to be one of the most important aspects of allowing this corneal ulcer to heal. And I know that some of my clients have expressed to me that they are having some difficulty in terms of putting eye medications in. I want to let listeners know that Dr. Fischer is going to be doing, another episode on how to apply eye medications and some tips and tricks for making that as easy as possible. Make sure you hit subscribe so that you are aware when that episode comes out and that’ll give you a little bit more information, on how to successfully do these treatments at home.

Dr. Lancellotti: Dr. Fischer, are there any other treatments that might not be topical, but maybe some oral medications that might be prescribed occasionally?

[00:15:04] Dr. Fischer: Yes, so I mentioned before that ulcers are painful and so oftentimes we’re going to use some type of pain medication, whether it is an oral anti-inflammatory or just an oral pain medication. Sometimes they were actually injections that can be given by your veterinarian in the office that might last a little bit longer for pain while we’re waiting on that ulcer to heal.

Then there’s the dreaded cone of shame. The hard plastic e-collar is going to be a really helpful tool here. Nobody likes it. Your pet’s going to hate it. It is absolutely helpful at preventing these types of ulcers from getting infected. Infections can cause ulcers to be really serious. Your pet will have a whole lot more bacteria on their skin than they do on their ocular surface and different types of bacteria. So, if they’re rubbing their eye and they have an ulcer, they’re going to be at risk for getting bacteria from their skin onto the surface of their eye, which could make a much worse situation. Wearing a hard plastic protective collar to  keep your pet from further traumatizing the area also keep them from introducing bacteria.

You mentioned that the episode on administering eye medications. We have to do a lot of education for owners on how to do that successfully. For some patients, it’s easier to do drops for ointment. You can definitely let your veterinarian know if you feel like one of those formulations may be easier, because most of the time, when they need topical antibiotic therapy, it’s going to need to go in there (at least) 3 times per day. Feeling confident in your ability to get that in is going to be key.

Does My Pet Need Eye Drops or Eye Ointment?

[00:16:41] Dr. Lancellotti: I wanted to ask, if you have an owner that says, “Oh yeah, I can do either drops or ointments,” do you have a preference, in terms of what you like, when you do antibiotics?

[00:16:50] Dr. Fischer: I tend to defer to the owner, if they feel like one is going to be easier than the other. I want them to be able to get the meds in. As an ophthalmologist, my decision is based on what type of bacteria I think are likely to be present. For just routine, non infected, superficial ulcers, I do use a lot of this antibiotic ointments, but ointments tend to be less potent, as far as antibacterial effects. I end up reaching a lot more for some of the more potent drops. If I have a really serious ulcer, or if certain breeds of dog tend to have a higher incidence of infection (smooshed-faced brachycephalic dogs), a lot of times, I’ll choose drops that were ointment for them.

Brachycephalic Breeds​ (short-nosed dogs) & Corneal Ulcers

Dr. Fischer: Certain breeds of dog tend to have a higher incidence of infection (smooshed-faced brachycephalic dogs), so a lot of times, I’ll choose drops over ointment for them.

[00:17:40] Dr. Lancellotti: Yeah. I was actually really surprised. Earlier this year, I went to a lecture where they were going over all sorts of different information on health issues with the brachycephalic breeds (French bulldogs, pugs, English bulldogs, boxers, etc) and they had mentioned that there’s actually a decrease in the sensation on the surface of the eyes, so they don’t actually feel when they’re traumatizing their eyes as much as a normal dog will. They’re more likely to cause worse ulcers because they have that decreased sensation there. Is that something that you’ve noticed with your patients?

[00:18:17] Dr. Fischer: For sure. It’s very interesting. And you’ll notice in your patient population, if you just look at their ocular surface, if a long-nosed dog has a tiny little hair on their eye, they’re squinting, rubbing or trying to get it out like we would, but sometimes I’ll see these Pekingese come in with all kinds of stuff stuck to their eyeball and they don’t seem to care. The other thing about that is that they don’t blink as often, so they have decreased sensation and don’t feel it when their cornea starts to dry out, and they won’t blink to disperse their tears. If you just sit there and watch a brachycephalic dog when they’re blinking, they can close their eyelids all the way, but sometimes they just barely close them. That also puts them at risk for more ocular damage and trauma. It doesn’t seem to bother them when they start to get an ulcer, so they don’t exhibit symptoms until the ulcer is already starting to get worse, just because of that lower corneal sensation. I certainly see that in my practice all the time.

[00:19:23] Dr. Lancellotti: That’s really interesting. It’s just another reason why these animals have higher health problems than our normal long-faced dogs.

Key Takeaways on Managing Corneal Ulcers

[00:19:36] Dr. Fischer: One of the things that I always tell clients is that eye issues can get bad really quickly, and you only have two eyeballs. I tell people all the time, “they get bad quickly, they get better slowly.” They can go south within hours or days, so it can be very serious if they get something like an infection.

The most important thing is to recognize that if your pet is exhibiting symptoms of ocular pain, squinting, tearing, discharge, redness, or cloudiness, I would relatively urgently try to get in to see your veterinarian. You don’t necessarily have to rush them to the emergency room at 3:00 in the morning, but I probably wouldn’t wait days. It’s important to recognize that you don’t really want to wait, when it comes to the eyes, to have your pet evaluated.

Also, understand that they should improve relatively quickly with corneal ulcer treatment, so if they’re not improving or if they are getting worse, they definitely need to go back in. I tell people, “that might not be all the way healed yet,” or that they need to be patient. As long as we’re seeing improvement and things aren’t getting worse, then we’ll stay the course, but we don’t want to go too far and not be able to make adjustments to our therapy.

Some of these ulcers can be really frustrating and some can take a long time to heal, but it’s just important to understand that the antibiotics that are prescribed are important. When we tell you that you need a cone to protect your pet’s eye, that’s also important because we’re just trying to prevent this from getting a lot worse, despite our treatment.

[00:21:14] Dr. Lancellotti: Yeah. It’s not that we just like to see how silly pets look in the cone. That cone is really helpful in getting them better as quickly as possible. But I think you highlighted a really important point there. Having an open conversation with your veterinarian about what you’re seeing, giving them updates, and making sure things are heading in the right direction are really important for something like this, especially when you’re dealing with the eye and you want to make sure that you’re protecting that animal’s vision on a long term basis.

Consulting with Dr. Fisher, veterinary ophthalmologist.

Dr. Lancellotti: Don’t hesitate to reach out to your family veterinarian, or if you’re interested in finding an ophthalmologist, there’s a link to the American College of Veterinary Ophthalmologists on the website under the resources section, so that you can see if there’s a specialist in your area. For those people who don’t have an ophthalmologist in their area, Dr. Fisher, can you talk a little bit about your consulting business and how their primary care veterinarian can consult with you?

[00:22:07] Dr. Fischer: Yes. I am happy to help your veterinarian manage your pet. If an ophthalmologist is either not logistically possible for you to get to because you don’t have one in your area, or if it’s financial, whatever the case may be, I’m happy to consult with your veterinarian. I have a website and your veterinarian would upload any photographs or case history, along with specific questions that they have about what they would like help with. Then, they would contact me for either an email or phone consultation, to come up with a plan for your specific pet about how to diagnose, treat, and how to follow up on the problem, along with what the prognosis is going to be. There are follow up options available, as well. So if your pet comes back in, down the road, and they need more advice on what to do, there’s certainly a way to do that.

Scratching the Itch

[00:23:24] Dr. Lancellotti: At the end of each one of the episodes, we have a section called Scratching The Itch. It’s a short segment that highlights something, whether it’s a human interest story, a product, a website, or something that just provides relief or makes you feel good. Hence, scratching the itch. Do you have a ‘scratching the itch’ for our listeners today?

[00:23:42] Dr. Fischer: Since we’re talking about ulcers, and we have such an amazing, adorable picture of our friend, Mitzi, I decided to talk about a product. You would not believe it, but everywhere I go, people find out what I do for a living and will ask me if I fit dogs and cats for glasses and contacts. The short answer is “No, not really.” But I live near the beach, and people who always take their dogs to the beach want to protect their eyes from sand (or if they’re like Mitzi and have had a previous ulceration). There are 2 types of protective eyewear (glasses or goggles) on the market that are the most popular brands, at least for pets. One of those is called Rex Specs. They’re similar to ski goggles. If you think about the broad ski goggles that kind of protect your eyes. The other type are called ‘doggles.’ Those are more like smaller swimmer goggles, and those are available online, as well. Certainly, they can be a fashion accessory or protective eyewear. These dogs look super cool in them.

Some of them actually have built-in UV protection, which can actually be very helpful for some specific eye conditions that are exacerbated by increased ultraviolet exposure. This is a potentially helpful product.

A lot of people also say, “I got these things and my dog won’t wear them” and that’s to be expected. Dogs are not used to wearing stuff like that, so it really probably depends on your pet compliance. You can certainly start with a lot of positive reinforcement, having them only wear them for a couple of seconds at a time- lots of “good boys” and “good girls,” positive energy, affection, and giving them treats and trying to get them used to it. But when they come in wearing cool glasses, they look really cool and it serves a purpose to keep their eyes protected.

There’s a picture of my ulcer patient, Mitzi, wearing her cool Rex Specs. Check them out on their social media because they’ve got some really cool pictures of working dogs doing cool things while wearing the Rex Specs.

[00:25:54] Dr. Lancellotti: These are absolutely adorable. And I said to you earlier, Mitzi looks like she belongs in the sidecar of a motorcycle wearing these Rex Specs. She is absolutely adorable. Very cool. Dr. Fisher, thank you so much for coming on today and for giving all this information about corneal ulcers. It’s such a common thing, for both family veterinarians and specialists to see, and I think this is so helpful for having pet owners understand a little bit more about what’s going on and how to treat their animal. I really appreciate your time. Thank you very much.

[00:26:28] Dr. Fischer: Yeah. Thank you so much for having me. I love it. I love teaching and I love helping people understand what’s going on, and drawing pictures, showing pictures and all of that, so I’m happy to be here and grateful to help.

[00:26:39] Dr. Lancellotti: And for everyone listening, I look forward to your next visit with Your Vet Wants You to Know.

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