22 Deep corneal ulcer
CLINICAL EXAMINATION
The ophthalmic examination should include measuring aqueous tear production. If the eye is very painful, or the ulcer is very deep and you are concerned about corneal rupture, then perform the Schirmer tear test on the fellow eye only. Acute keratoconjunctivitis sicca is an under-recognized cause of sudden onset, deep corneal ulceration in the dog (see Case example 16.2). The eye is assessed for vision, and the pupil should be checked – often some miosis is present representing a reflex uveitis and this should be addressed when formulating a treatment plan. A frank uveitis with aqueous flare or even hypopyon can be present in conjunction with deep corneal ulceration, especially if bacterial infection is present. Careful evaluation of the conjunctival sac, including behind the third eyelid, should be undertaken since foreign bodies can be retained here. Intrinsic factors causing the ulcer, such as ectopic cilia or entropion, should also be looked for (Figure 22.1).