Indolent ulcer

Indolent ulcer-what you have to know
Indolent ulcer

What is the cornea?
The cornea is the outermost, transparent layer of the eye, only about 0.6 mm thick. It consists of several layers:

  • The outermost layer: the corneal epithelium
  • Beneath it: the stroma, which is the thickest layer
  • The innermost layer: the endothelium, which is only a single cell layer thick

What is a corneal ulcer?
A corneal ulcer occurs when the corneal epithelium detaches. Superficial ulcers usually heal quickly, within 7–10 days. In these cases, cells migrate from the edge of the corneal wound and cover the affected area.

How do I know if my dog has a corneal ulcer?
The cornea is extremely sensitive and full of nerve endings, so an ulcer causes significant pain. In these cases, dogs:

  • Squint
  • Avoid light
  • Tear excessively
  • Scratch/paw at the affected eye

What does it mean that an ulcer is indolent?
Indolent ulcers do not heal within the usual 7–10 days, so they cause ongoing pain to the animal.

Why don't indolent ulcers heal?
In indolent ulcers, the epithelial cells are unable to attach to the underlying layer (the stroma). The reasons for this are:

  • The epithelial cells are immature
  • A membrane forms on the surface of the stroma that prevents the epithelial cells from attaching

When do indolent ulcers occur?
Indolent ulcers usually occur in middle-aged and older dogs, and generally develop following injuries to the ocular surface.

How can an indolent ulcer be treated?
Indolent ulcers cannot be treated with eye drops alone. It is necessary to remove the affected area of the cornea and "refresh" the wound. This treatment is usually performed under local anesthesia.
After the procedure, I place a soft contact lens, which acts as a "wound dressing," protecting the ocular surface and reducing post-procedure pain. With this treatment, the chance of healing is 80%.

What home care is needed?
At home, daily:

  • Eye ointment or eye drops must be applied 3 times
  • A pain-relief tablet or solution must be given once
  • An Elizabethan collar must be worn for the duration of healing (about 2 weeks)

Do I need to come back for a check-up, or can my referring veterinarian examine my dog?
A follow-up check is recommended in any case, because:

  • The contact lens needs to be removed
  • In about 20% of cases, the indolent ulcer does not heal after the first procedure, so further treatment may be needed