what is the stepwise treatment protocol for a superficial corneal ulcer in a dog that is not healing?

Question

Accepted Answer

For a non-healing superficial corneal ulcer in a dog, the stepwise approach begins with confirming the diagnosis of a spontaneous chronic corneal epithelial defect (SCCED), then escalating through mechanical debridement procedures until healing is achieved. First, confirm the SCCED diagnosis. SCCEDs are characterized by a loose, non-adherent rim or sheet of epithelium, a superficial ulcer with no stromal involvement, and absence of a causative infectious agent.4 Before proceeding with SCCED-specific treatment, rule out concurrent conditions that perpetuate non-healing: keratoconjunctivitis sicca (KCS), corneal endothelial degeneration (CED), calcific corneal degeneration (CCD), and mechanical irritants such as a reopened conjunctival incision or corneal foreign body.468 A case of apparent SCCED that recurred within one week of healing was ultimately caused by a reopened conjunctival scar from prior cherry eye surgery — partial third eyelid resection resolved the ulcer with no recurrence over 12 months.6 Treating the underlying cause is prerequisite to any debridement procedure. Step 1: Cotton-tipped applicator (CTA) debridement alone. CTA debridement removes the loosely adherent epithelium and disrupts the hyalinized acellular zone (HAZ) to promote adhesion of new epithelium.4 This is the least invasive first step; however, debridement alone achieves healing in approximately 50% of cases.1 Step 2: CTA debridement followed by anterior stromal puncture (ASP) or grid keratotomy. When debridement alone fails, adding a stromal manipulation procedure substantially improves outcomes. Debridement followed by ASP achieves healing in approximately 80% of cases.1 Grid keratotomy outcomes after a single procedure are more variable, with reported healing rates of 10–79% depending on the study and time point assessed.1 Step 3: Diamond burr debridement (DBD). DBD is the current standard of care for refractory SCCEDs and is effective in both general and specialty practice settings.