Corneal ulcer gone wrong: a self-assessment

This self-assessment will consider a case of corneal ulceration to critically assess its progression over time, and understand how steps could have been performed differently to change the final outcome. I will provide the final outcome from the start: it is arguably easier to look at a case retrospectively, and by giving you the outcome, it will be possible to see if that changes your decision-making process as the case unfolds.

The patient required surgical correction of the ulcer via a conjunctival flap. At the follow-up, 1 week after surgery, a Schirmer tear test (STT) was performed in the affected eye, and revealed a reading of 8 mm/min, confirming a diagnosis of kerato-conjunctivitis sicca (KCS) in this eye.

You are presented with an 8-year-old, female spayed, West Highland white terrier. Close examination of the right eye showed a superficial stromal corneal ulcer, approximately 5 × 3 mm on the ventral half of the cornea (Figure 1). There were no signs of foreign bodies, or abnormal hairs abrading the corneal surface. There was moderate corneal vascularisation and bulbar conjunctival hyperaemia, and mild peri-ocular mucoid discharge. Treatment with fusidic acid ointment (Isathal^®, Dechra) was started twice daily to the affected eye, as well as oral meloxicam (Metacam^®, Boehringer Ingelheim Animal Health) once daily per os (PO), and amoxicillin/clavulanic acid (Synulox^®, Zoetis) twice daily PO.