Information on Eye Diseases
Vision Loss in Dogs
Vision loss in your pet can be an emotional time for all family members. Therefore it is important that you are all aware of the problem and give yourselves and your pet time to adjust. The emotions that you may all go through are quite normal but you need to be aware that there is something you can do for your pet. Being blind is not a death sentence. It is just a new learning experience for the whole family. In fact you may get a lot of pleasure out of re-training your dog to cope with his/her blindness. It will be challenging but here are some tips to help you and your pet develop your relationship on a new level:
Cataracts in Dogs
What is a cataract?
A cataract is an opacity of a structure inside the eye called the lens. The lens is usually clear and transparent, and helps to focus an image onto the retina, at the back of the eye. The same process happens inside a camera, with the lens focusing an image onto the film in the back of the camera. Having a camera with a foggy lens is somewhat similar to having a cataract—both produce very poor images! In humans, cataracts are one of the most common causes of blindness, especially in
What causes cataracts?
Many things can cause cataracts, and often we cannot be 100% certain of the cause in each and every case. Most cataracts seen in dogs are caused by genes inherited from their parents, but diabetes, injuries, inflammation, drugs and nutrition may also be to blame.
What are signs of cataracts?
Owners of dogs with cataracts usually report a deterioration in their pet’s eyesight. Poor eyesight may be noticed as an increase in ‘clumsiness’, a change in personality (lethargy or aggression), or a reluctance to go into the dark, among other things. Sometimes our clients notice a white area in their dog’s pupil (the black circle in the middle of the eye), or their referring veterinarian notices the problem during a routine physical examination.
What can we do for cataracts?
In the past, people have tried all sorts of medications to clear cataracts. With our current medical knowledge, we know that surgery is the only cure. This doesn't mean that your pet must have cataract surgery, as some cataracts do not affect vision enough to warrant the procedure.
You can discuss your pet’s suitability for surgery with one of our team members.
Why is cataract surgery recommended earlier rather than later?
Assessment and treatment of cataracts before they become too advanced is important for two reasons:
We need to assess the retina (the light sensitive membrane at the back of the eye), to ensure it is normal. This can be done more easily when the cataracts are not too dense, enabling us to see the retina with specialised diagnostic examination instruments.
If the cataracts are too dense we may need to do more specialised tests, such as ultrasound or electroretinography (ERG), to evaluate the structure and function of the back of the eye to ensure a successful outcome. These tests are often done on the same day that we intend to do the cataract surgery. If your pet fails either of these tests, then we may recommend that surgery not be performed as it will not improve vision for your pet.
If left in place for too long, a cataract can cause inflammation inside the eye. Sometimes medication can control the inflammation, and help control the associated pain. In the long term, however, the inflammation within the eye may become so severe that glaucoma (increased pressure in the eye) and uncontrollable pain may occur. In these cases, cataract surgery will not be an option for improving vision.
Also, cataracts which have been present for some time can develop other problems such as opacity in the normally clear capsule surrounding the lens, or breakdown of the lens zonules which hold the lens in place. These secondary changes can reduce the chances of achieving the best outcome. Even if you decide not to have cataract surgery, regular rechecking by one of our eye specialists would be recommended to monitor the progression of the cataract, and the associated problems in your dog.
What does cataract surgery involve?
The surgical techniques used to remove cataracts in your pet are almost identical to those used in humans. The technique most widely used is called phacofragmentation, and uses ultrasound energy to break the lens into tiny pieces which are then sucked out of the eye. Most cataracts are removed through a small ‘key-hole’ incision 3-4mm wide in the top of the eye! Removal does not involve the use of a laser, as some people mistakenly believe.
In most cases, after the lens is removed, the capsule surrounding the lens is left intact so that an artificial lens (IOL) can be inserted to correct the close distance vision back to normal. Not all dogs are candidates for an artificial lens. The decision to place an artificial lens depends on various factors, and is usually made by the surgeon during the procedure. Modern implants are made of a foldable plastic, and can be inserted through the same small 3mm incision.
How successful is cataract surgery?
The success rate for cataract surgery in dogs has markedly increased over the last 10-15 years, mainly as a result of new research and improved surgical techniques. In general, our patients achieve good, long-term vision the majority of the time. As with all surgery however, it is impossible to give an unqualified 100% guarantee of success with no complications.
What are the most common complications?
The three most common reasons for a poor result after cataract surgery are:
ongoing inflammation in the eye
retinal detachments, and
spontaneous bleeding within the eye,
opacities in the lens capsule,
It is very important to understand that some of these complications can result in blindness and/or loss of the eye due to uncontrollable discomfort. Usually the problems are not predictable and sometimes they do not occur immediately after surgery, often arising months or even years later. For this reason we recommend regular follow up visits after cataract surgery to try to identify these complications before they cause a poor outcome. These complications are similar to those seen after human cataract surgery.
Are there risks in having a general anaesthetic?
Although modern anaesthetics are generally very safe, very rarely complications and deaths can occur, and owners must accept this risk albeit very small. To minimise the chances of an anaesthetic complication, a detailed history of your dog’s previous and current medical problems is taken before surgery, and the patient is evaluated clinically for any possible risk factors. For animals over 7 years old, we recommend that your veterinarian perform preoperative blood tests. For dogs with heart or lung problems, a referral to a specialist may be recommended to assess the relative risk of anaesthesia. Modern anaesthetic agents and techniques are used during the cataract surgery, and the patient is constantly monitored during both the procedure and the recovery phase of the anaesthetic.
What happens after cataract surgery?
Usually your pet will be discharged from hospital on the afternoon of surgery. It is important to keep your dog quiet for the first two weeks afterwards, and limit exercise to strict leash walks, preferably with a chest harness (throat collars can increase the pressure in the eyes). Your dog should be not allowed to play with toys or balls, romp with other dogs, or travel with its head out of a car window. At first, you may be using topical medications up to 4 times daily. Over time the frequency of medication required decreases.
When we do send your dog home, it is essential that you use the medications as prescribed. Failure to do so, even for as little as a day or two, can result in uncontrolled inflammation and even glaucoma or other problems inside the eye.
The first rechecks are usually at one and three weeks after surgery. Subsequent revisits will depend on the progress of the case, but are usually at 6-12 monthly intervals.
When will my pet see after surgery?
If all goes well, your pet may have vision as early as the day after surgery. Some dogs may, however, take a few weeks to fully regain their vision due to the amount of post-operative inflammation present in the eye.
What is the cost of surgery?
The prices charged for cataract surgery reflect the costs of the highly specialised equipment used and the level of expertise required on the part of the surgeon. The disposable items and prosthetic lenses used during surgery can be expensive, and sometimes have to be imported from overseas. However, we are constantly striving to keep these costs within reasonable limits so that your pet can enjoy a better quality of life by being able to see again.
Our veterinary eye specialists will endeavour to give you as accurate an estimate of costs as possible before surgery. Please understand however that this is an estimate only and the final cost may vary slightly depending on circumstances at the time of surgery.
The estimated fee includes pre-operative tests where necessary, anaesthesia, theatre fees, surgical fees, disposable theatre items, drugs, and hospitalisation. The first two rechecks after cataract surgery are included in the estimate. After this time, a standard minimal revisit fee will usually apply. Further drugs prescribed at rechecks after surgery will also be at additional cost. In the unusual event of complications, we will always attempt to keep any associated additional costs as low as possible.
Please feel free to discuss any further questions you may have about cataract surgery with Animal Eye Services.
Progressive Retinal Atrophy
What is Progressive Retinal Atrophy?
Progressive Retinal Atrophy (PRA) is a common term used for a group of inherited diseases that cause loss of vision due to degeneration of the retina. It is seen in many breeds of dogs, but most commonly in Cocker Spaniels, Poodles, Australian Cattle Dogs, Silky Terriers and Labradors.
The disease causes gradual blindness, first affecting vision in dim light (night vision) and eventually, resulting in complete blindness many months or years later. Towards the end of the disease the affected eyes develop cataracts.
The first sign noticed by owners of pets is poor vision in dim light. Their dog may be reluctant to go outside in poor light, may seek out brighter light and may actually bump into things at night. Some dogs may show an increased green reflection of their eyes in artificial light.
With time the day vision begins to deteriorate and cataracts start to develop. These are seen as a white opacity in the centre of the pupil. The cataracts exacerbate the loss of vision because they prevent light passing through the eye to the retina.
Since the vision loss is so gradual, most owners don't notice a problem until the blindness has progressed to a severe end stage.
Treatment of PRA
Sadly, there is no known treatment for PRA at this time.
The cataracts that often also develop in association with PRA are usually not treated as their removal will not result in an improvement in vision. Eventually the cataracts, visible as white opacities in the centre of each eye, can cause other conditions such as uveitis (inflammation of the iris) and even glaucoma (high pressure in the eye) Usually treatment of the earlier stages of the inflammation with cortisone drops will prevent the development of later glaucoma.
Diagnosis of PRA
Depending on the stage and severity of the disease a combination of clinical exam, Chromatic PLR testing and/or electroretinogram (ERG) can be used.
Prevention of PRA
Genetics play a vital role in the disease and therefore, individuals related to an affected dog should also be examined for PRA with an eye examination. PRA is generally but not always inherited as an auto somal recessive trait. This means that the condition is passed on from both parents.
Since the mid 1990s DNA blood tests have become available to detect affected dogs and parents who may be genetic carriers of the condition.
The lens is held in its normal position behind the iris and pupil by tiny strands called "zonules". Disruption of the zonules can cause the lens to move out of its normal position (luxate). When a lens is only partially held by some zonules, it is referred to as a subluxated lens. When a lens is no longer held by any zonules, it is called a luxated lens.
Two general categories of lens luxation are defined according to whether or not the luxation was the first eye problem (primary lens luxation) or whether it was caused by another eye condition (secondary lens luxation). Primary lens luxation is seen more commonly in certain breeds (e.g. Jack Russell Terriers, Miniature Fox Terriers, Tenterfield Terriers and Cattle Dogs) where the defective lens zonules weaken and break over time. Trauma to the eye or head can also cause lens luxation, although it is not usually the primary cause. Trauma severe enough to cause lens luxation usually also causes other obvious eye problems.
Lens luxation can be secondary to other eye diseases such as glaucomaor uveitis. Elevated pressure inside the eye (glaucoma) or inflammation inside the eye (uveitis) can cause the zonules to weaken and the lens breaks free. Interestingly, a luxated lens can also causeglaucoma. Sometimes when we see a patient with multiple eye problems for the first time, it is difficult to tell which problem came first: the luxated lens or another eye condition!
Treatment of a luxated lens depends on the general health of the eye, the position of the lens, and whether or not the patient can still see out of the affected eye. If the lens is loose but is still behind the iris, we sometimes use medications which constrict the pupil in order to trap the lens in its proper position. If the lens has moved in front of the iris, then surgery may be recommended to remove the lens. Occasionally we will be able to “couch” the lens back behind the iris if conditions within the eye allow this. The lens can then be trapped behind the iris where it is less likely to cause complications. This is done by constricting the pupil with special prescription eye drops. These drops need to be used FOREVER though, missing a single dose could allow the pupil to dilate and the lens to slip back into the front chamber of the eye again.
Lens removal or “lensectomy” is done under general anaesthesia with the use of an operating microscope. An incision is made in the edge of the eye and the lens is removed using a small spoon shaped device called a lens loop, or a probe with a frozen tip is inserted into the eye to capture the lens. The lens adheres to the end of the probe in the same way your tongue would stick to a frozen lamp post in the winter! The surgeon then pulls out the lens in one piece. The corneal incision is sutured closed. Without a lens, the patient is still expected to be visual. Their ”up close” vision is rather fuzzy, though, as they cannot accommodate to nearby objects.
Sadly, despite everyone’s best intentions and efforts, a fair proportion of eyes affected by lens luxation will end up blind and/or have to be removed due to uncontrollable pain. This can be the case even when emergency surgery is performed.
Glaucoma is "an increase in pressure in the eye with a loss of vision". The disease is quite painful in most cases, especially when the eye pressure is very elevated.
The signs of glaucoma include:
- cloudy eye
- loss of vision
- an enlarged eyeball
- unusual aggressiveness
- loss of appetite
The normal physiology of the fluid in the eye calls for the fluid to be made in one structure behind the pupil (ciliary body), travel through the pupil, and exit out the space between the cornea and the iris. When the fluid cannot properly drain from the eye, the pressure in the eye is increased. An analogy would be a kitchen sink -- if the drain is open and the water is running, there is no problem. However, if a plug is placed in the drain and the water keeps coming, then the sink fills up with water and overflows! Some patients have primary glaucoma where there is no concurrent disease but some secondary causes of glaucoma include: inflammation, trauma, and tumours. All of these factors can obstruct the drainage of fluid from the eye.
Glaucoma is an ophthalmic emergency and must be treated immediately. If the pressure remains elevated for even a few hours, permanent vision loss occurs. The disease is difficult to treat but several options are available depending on whether the patient still has vision, the specifics of the patient, financial considerations, etc. Some of the options include: medical management with drugs, laser surgery, surgically placed drainage tubes, removal of an end stage blind painful eye or replacement with a cosmetic prosthesis. There are pros and cons to each of these treatments, and the options will be discussed with the client after initial examination, consideration of the possible duration and severity of the glaucoma and the chances of getting vision back again.
Uveitis refers to inflammation of a structure inside the eye called the uveal tract. The uveal tract lines the inside of the eye. It is the only structure within the eye containing blood vessels. At the front of the eye it is called the iris, at the back of the eye it forms a structure under the retina called the choroid. A specialised part between the front and back is called the ciliary body and produces fluid inside the eye.
When the uveal tract become inflamed, blood cells and debris leak out into the internal fluid filled chambers of the eye, resulting in cloudiness and loss of vision in severe cases. Clinical signs of uveitis include cloudiness of the cornea, redness around the edge of the eye, tearing, squinting, bleeding into the eye, and loss of vision.
Severe uveitis can result in vision threatening complications such as cataractformation, adhesions of the iris to the lens or cornea, retinal disease, and glaucoma. Treatment for uveitis is aimed at reducing the inflammation and preventing the complications. The treatment protocol will vary for each patient.
A healthy cornea and conjunctiva at the front of the eye is highly dependent on the presence of a healthy tear film. The normal tear film is made up of three layers:
The outer lipid layer produced by the Meibomian glands within the eyelids.
The aqueous (watery) layer. This represents over 95% of total corneal thickness, The watery component of the tear film is produced by lacrimal gland, a small gland which is found deep in the tissues behind the outer upper eyelid.
The mucous layer. This layer enables the tear film to “stick down” to the surface corneal cells.
There are many causes of dry eye including congenital disorders (puppies), infections (canine distemper virus), drug-induced (sulfa antibiotics), and removal of the tear gland of the third eyelid ("cherry eye"). The most common cause is thought to be autoimmune destruction of the lacrimal gland by immune system cells: the immune system inappropriately attacks the cells in the gland which produce the watery component of the tear film. The disease is seen very commonly in certain breeds such as the Cocker Spaniel, Shih Tzu, Lhasa Apso, Bulldog, Schnauzer, and West highland White Terrier.
The clinical signs of dry eye include:
heavy mucus production
rubbing at eyes
Many dogs have a history of having been treated for recurrent “conjunctivitis” with various anti inflammatory/antibiotic ointments or drops. After an extended period of dryness, the surface of the eye (cornea) begins to accumulate dark scar tissue and blood vessels – unfortunately to the point of blindness in many patients.
Our treatment goals for dry eye include stimulation of tears, lubrication, and decreasing the scar tissue. Cyclosporine or Tacrolimus are the preferred drugs for inhibiting the immune attack on the glands as well as stimulating natural tear production. It is important to understand that if you skip a dose or run out of the medication, they dry eye signs will immediately recur. In addition, it is crucial that you have your dog checked as directed to monitor treatment success.
Prolapsed Gland of the Third Eyelid "cherry eye"
When the tear gland of the third eyelid pops out of position, it protrudes from behind the eyelid as a reddish mass. This prolapsed tear gland condition is commonly referred to as "cherry eye". The problem is seen primarily in young dogs, and often in certain breeds such as the Cocker Spaniel, Lhasa Apso, Shih-Tzu, Poodle, and Bulldog.
Despite its appearance, cherry eye itself is seldom a painful condition. However, the longer the tear gland is exposed, the more likely it will come irritated and inflamed. If your dog rubs at the eye, it could cause the gland to bleed or become infected. Furthermore, the function of the tear gland could become compromised if the gland is exposed for long periods of time.
To correct cherry eye, surgical replacement of the gland is necessary. This treatment is superior to a somewhat older technique of surgically removing the gland. The gland of the third eyelid plays an important role in maintaining normal tear production. We now know that dogs who have had the tear gland removed are predisposed to developing Dry Eye Syndromelater in life. Dry Eye Syndrome is uncomfortable for the patient, and requires the owner to administer topical medications several times a day for the remainder of the patient's life. To avoid this condition, it is preferable to tuck the tear gland back inside the third eyelid, where it can continue to function normally.
The procedure used to correct cherry eye is called a "pocket technique". In this procedure the gland is pushed back into a small pocket on the back surface of the third eyelid, and the pocket is sutured closed.
In many cases there is an element of cartilaginous deformation associated with the third eyelid anatomy. In severely affected animals it can be almost impossible to achieve a 100% normal looking alignment of tissue after surgery.
Entropion is an inward rolling of the eyelid. The problem is most common in the Shar Pei, Chow Chow, Bulldog, Retrievers, Rottweiler, and Mastiffs. Although the exact genetic pattern is usually not known, the problem is most likely caused by many genes that are responsible for the overall head and face conformation. Therefore, we recommend that you do not breed animals affected by entropion since the problem can be passed to the offspring.
When the eyelids roll in, the hair on the outside of the lid rub on the surface of the eye and cause corneal irritation. In some patients, entropion leads to corneal ulceration.
Common symptoms associated with entropion include squinting, tearing, and rubbing.
The treatment for entropion is surgery to remove some skin and muscle along the eyelid margin. This is cosmetic surgery and after reconstructing the eyelid, the lids should look normal. The incision is closed with tiny absorbable sutures and you shouldn't be able to see a scar at all.
The permanent surgery is usually performed after the age of 10 months. Usually only one surgery is required but since the problem occurs in growing patients, we might have to perform further surgery when the affected dog is an adult. Fortunately, about 95% of patients require only one surgery. After the surgery, your dog should not be shown or bred since the problem is considered inherited in most breeds.
Disorders in Brachycephalic Dogs
Flat nosed dogs such as Pugs, Pekingese, Shi-Tzus are commonly seen at Animal Eye Services. These dogs get numerous eye problems because their eyes tend to sit on the front of the skull without the benefit of protection by a deep boney socket as seen in other breeds with longer skulls.
There are several problems which arise from this conformation:
- Many have medial lower eyelid entropion which results in chronic irritation of the cornea by hairs from the eyelid and the development of a pigmented film over the cornea.
- Often their eyelid circumference is much larger than corneal circumference resulting in exposure of the tissues around the edge of the eye. These dogs can have a greater tendency to globe proptosis i.e. traumatic prolapse of the eyeball out between the eyelids and this can have catastrophic consequences for the eye i.e. tearing of the muscles around the outside resulting in inability to move the eyeball, and tearing of the optic nerve at the back of the eye resulting in permanent blindness.
- Often the exposure of the eyeball can result in failure to close the eyelids properly over the cornea, especially whilst the dog is sleeping resulting in dryness and secondary corneal disease.
The best treatment for preventing the long term problems associated with the brachycephalic conformation is a procedure known as a permanent medial canthorrhaphy. This procedure involves removing a small section of the upper and lower eyelids at the inside corner of the eyes and resuturing the eyelids together again resulting in a smaller eyelid margin circumference and correction of the medial lower lid entropion.
Hypertense Retinopathy in Old Cats
Hypertensive retinopathy is a condition where high systemic blood pressure (hypertension) causes secondary retinal detachments or retinal haemorrhages. The problem tends to occur most frequently in elderly cats, and results in sudden blindness.
The retina normally lies flat against the back of the eye and contains cells (called rods and cones) which detect light, converting light stimuli into electrical impulses which are then transmitted to the brain for visual processing. When the retinas detach from their normal position, they cease to function and the patient becomes blind. Although immediate reattachment of the retinas can sometimes restore vision, cats' retinas degenerate quickly so in many cases by the time the diagnosis is made, the prognosis for vision is poor. Often retinal haemorrhages i.e. bleeding from small blood vessels in the retina can occur as well.
Since the hypertension caused the retinas to detach, treatment and control of the hypertension can help to achieve at least partial reattachment of the retinas. Unlike humans, high blood pressure in cats and dogs is not caused by poor diet. Instead, hypertension in animals is usually secondary to another problem such as kidney disease, heart disease, cushing's disease or thyroid disease. Treatment for hypertensive retinopathy usually involves an investigation into the possible underlying diseases responsible for the hypertension as well as medications to control the high blood pressure.
Corneal Endothelial Disease
CORNEAL ENDOTHELIAL DISEASE IN DOGS
Endothelial disease causes oedema or excess fluid in the cornea. To understand what is
going on a microscopic level it is important to understand the normal microscopic anatomy
and function of the cornea.
The cornea consists of three layers:
* EPITHELIUM: the outer layer of the cornea represents approximately 10% of the total
thicknesss. It consists of three layers of cells and is the outer protecting coat for the cornea.
* STROMA: the middle and thickest of the three layers forms around 90% of total thickness.
It is composed of hundreds of layers of collagen laid down in very regular sheets. Between
the collagen fibres is a ground substance (water and chemical compounds called GAGS)
which is osmotically active, ie water from inside the eye can be"sucked" into the corneal
stroma where concentration of these chemicals is higher.
* ENDOTHELIUM: is a single layer of cells on the inside of the cornea. The cells are laid
down in a very regular array like a mosaic of hexagonal shaped tiles. The endothelial cells
have little pumps in their membranes which normally move water out of the corneal stroma
back into the front chamber of the eye. Endothelial cells cannot regenerate - the cells present at birth remain throughout life but may degenerate with age.
The endothelium will continue to function normally until the density of the cells on the
endothelial surface gets below a certain critical level. The overall effect of this is a net
movement of water into the cornea. The water gets between the collagen layers in the stroma causing abnormal bending of light and a whitish blue opacity will appears as the stromal oedema develops. When the problem gets advanced, water can break out through the corneal epithelium, the outer layer causing painful chronic superficial ulcers.
The endothelium can lose its normal function in a number of ways
* natural loss of endothelial cells and decline in density with age.
* some breeds of dogs eg Boston terriers, Chihuahuas, Springer Spaniels seem to have a
natural breed-related dystrophy which results in abnormal function at an earlier age than
* damage by inflammation: when the interior of the eye becomes inflamed, inflammatory
cells and proteins deposit on the endothelial surface and damage it causing loss of normal
water pumping function and oedema
* glaucoma: very high pressure inside the eye can damage the endothelium
Endothelial disease is a very difficult disease to treat in dogs as there are no simple solutions
to replace the abnormally functioning endothelial surface. Endothelial grafts are an emerging field in veterinary medicine, not yet widely available. There are few drugs which can help to reduce the oedema: at best these drugs will stabilise the problem. If the disease becomes end stage then two alternative procedures can be tried, but these never return the cornea to normal clarity:
* thermal keratoplasty: applying tiny multiple burns to the outer layers of the stroma to
create scars or adhesions between the collagen layers and reduce their water holding
* Gundersen flap: a very thin layer of conjunctiva is dissected from the edge of the eye and
pulled across the corneal surface. The blood vessels in the conjunctiva help to improve the
egress of water from the water from the cornea. The veterinary ophthalmologist will discuss
the appropriateness of each of these procedures in your dog's case.
SCCED (Spontaneous Chronical Corneal Endothelial Defects)
AKA. Indolent ulcer, Boxer ulcer, Non healing ulcer
A SCCED is a non healing defect in the outer layer of the cornea, known as the epithelium. The normal corneal epithelium is around 10-12 cell layers thick and is constantly being turned over. The epithelial cells have their origin at the edge of the cornea and move towards the centre and outwards towards the surface before they are shed as dead cells into the tear film. The epithelium sits on a membrane called the basement membrane.
A superficial ulcer is defined as a defect where only the epithelium is missing but the
basement membrane is intact. Normally there is strong adhesion between the cells at the
base of the epithelium (basal cells) and the basement membrane. In a normal healthy cornea
with the normal healing mechanisms present, even large superficial defects should heal
rapidly, commonly within 2 weeks. These defects normally heal by the basal cells "sliding"
across and sticking down firmly to the basement membrane.
Unfortunately in some breeds, most commonly the Boxer, Samoyed, Welsh Corgi and the
Staffordshire Bull Terrier (although they can be seen in almost any dog) these superficial
ulcers fail to heal or show protracted poor healing over long periods of time. Sometimes they
can appear to have healed then suddenly appear as a new ulcer again. In these breeds we
know that there is a defect in the way the epithelium sticks down to the basement membrane at a microscopic level. Unfortunately simple medication with antibiotic ointments will not heal these defects as the problem is not due to bacterial infection. Procedures such as simple debridement (rubbing the loose epithelium off) third eyelid flaps or sewing of the eyelids together to protect the surface seem to be ineffective in most cases.
To get these ulcers to heal we need to do something which mechanically interferes with or
damages the basement membrane at a microscopic level so that the migrating epithelium can be induced to stick down to the basement membrane. We will discuss various options with you ranging from simple outpatient type procedures such as basement membrane burring to more involved procedures requiring a general anaesthetic such as grid keratotomy and superficial keratectomy, with the goal of achieving rapid resolution of this very frustrating
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