History: Dog presented with a recent history of ocular pain (pawing at right-side of face), squinting and mild ocular discharge. Dog had been at groomer's approximately 7 hours prior to arrival at clinic; mild symptoms were noted when owners picked dog up from grooming salon and then worsened over the following 5 hours.
Clinical Exam: Patient nervous but bright and alert; vitals within normal limits; dog holding right eye shut and occasionally pawing at face.
Diagnostic Findings: (+) Fluorescein stain uptake to right (OD) corneal surface.
Diagnosis: Superficial corneal abrasion (OD).
Treatment: Atropine applied to eye to provide relief, triple antibiotic eye ointment applied to eye for next several day, repeat fluorescein stain of eye in 3 days to ensure proper healing.
Patient Recommendations: Because the eye is painful and the dog is pawing at/rubbing her face, there is a high risk of self-trauma to the eye/face. An Elizabethan (or Buster) collar should be kept on the dog at all times until a negative fluorescein stain and the dog no longer is pawing at/rubbing her face. If an increase in ocular discharge or a discolored discharge is noted, or continued pain is noted, the eye should be rechecked immediately.
Additional photos: corneal ulcer in a 3-year-old female Puggle.
Probable cause: scratch from nail of canine housemate while playing.
Note the circled area. The green area is the ulcer highlighted by the corneal dye. The dye allows us to appreciate the severity of the corneal ulcer.
The arrow is pointing to the same area of dye uptake; this is the corneal ulcer.
Client Education:
Corneal Ulcer: One of the classical eye problems veterinarians must address is THE RED EYE. The red eye may or may not be obviously painful but when it is, the pet can be observed squinting or even rubbing at his/her face. The conjunctiva (the pink moist tissue lining the inner surfaces of the eyelids) becomes an angry red and can even swell or puff up around the eye (a condition called chemosis). In short, it is clear when the eye suddenly hurts and that veterinary attention is needed.
There are several causes of acutely red and painful eyes and one of the most common causes is a wound or scrape to the surface of the eye. The clear surface of the eye is called the cornea and because it is the outermost layer of the eye, it is prone to scrapes and tears. Common causes of corneal erosions include:
Rough contact with plants, thorns, or bushes
Scratches from another animal (note: the cat scratch wound can be especially serious as the wound quickly heals over, sealing infection within the eye.)
Self trauma (rubbing or scratching at a painful ear or even at the eye due to some other eye problem can lead to an inadvertent scratch to the eye.)
Chemical irritation (such as getting shampoo in the eye during a bath.)
Foreign body injury (plant material can get stuck under an eyelid and can scrape the cornea.)
A special fluorescent stain is used to confirm the presence of the ulcer or erosion. Normally, water will run smoothly off the surface of the cornea, like rain washing off a windshield. If the cornea is damaged, the stain will stick to the damaged area and show bright green under a fluorescent lamp.
A routine corneal ulcer or erosion should heal easily. Since the damaged cornea is at risk for becoming infected (or may even already be infected, as demonstrated by a purulent discharge), a topical antibiotic is needed and ideally should be used four times a day or more. Since it is a rare pet owner that can accommodate any medication administration four times a day, we usually have to make do with three times a day but to properly sterilize the eye surface, the antibiotic should be used four times a day. Either drops or ointment can be used, depending on the owner’s preference. The second part of treatment is pain relief: Atropine 1% drops or ointment. The atropine acts by temporarily paralyzing the pupil’s ability to constrict (the main source of pain is when the pupil spasms from the ulcer). Pupillary dilation is expected when this medication is used, and the pet may be reluctant to experience bright sunlight while under the influence of this medication. Because the tear duct system is connected to the nose and mouth, the patient will also taste the above medications and atropine is famous for its bitter taste. Dogs do not seem to mind this unduly but cats will drool shortly after the medication is given in an effort to get the taste out of their mouths. This is a normal reaction to the Atropine as is the dilated pupil.
A collar called an Elizabethan collar may be needed to prevent self-trauma of the eye. If you think your pet will rub the eye, it is important to have the pet wear this collar until the erosion is healed. Be sure to request one if you think your pet needs it, and if you are given one be sure the pet wears it for the entire course of treatment.