Author: Marc Bordelon, DVM, MBA

Overview

A corneal ulcer (aka ulcerative keratitis) is in the simplest of terms, an open sore on the outermost surface of the eye, the corneal epithelium. Corneal ulcers are seen clinically in both human and veterinary medicine. In the field of veterinary medicine, all animals could potentially be affected by an ulcer, however, certain species like dogs, cats and horses are more commonly affected because of infection, genetic anomalies, or trauma. Like a mouth ulcer, corneal ulcers are typically very painful so a prompt diagnosis is critical for the welfare of the patient as it may mean the difference between continued vision and blindness.  

Diagnosis

Corneal ulcers can be classified as superficial or deep, simple or complex, and may also be described based on their underlying cause. Common signs include increased tear production, abnormal or colored discharge, rubbing or pawing at the affected eye, swelling, and changes in the clarity or appearance of the cornea. To diagnose a corneal ulcer, veterinarians use several methods, including an ophthalmic examination, a Schirmer tear test to measure tear production, and the use of a dye (fluorescein stain) to highlight any defects to the corneal surface. In more complicated cases, additional tests such as cytology or microbial culture may be performed to check for infection.

Treatment

Treatment decisions will vary among veterinarians depending on clinical experience, drug availability, and how complicated the ulcer is to heal.  Common approaches to treatment include pain and infection control, control of inflammation, and frequent rechecks to assess progress and ensure owner compliance.  All ulcers have the potential to get worse, so additional medications, referral to a veterinary ophthalmologist, or surgical techniques may be considered in complicated, non-healing ulcers.  

Regenerative Medicine in Ophthalmology

Regenerative medicine is a broad term encompassing different therapies such as stem cell therapy, platelet rich plasma (PRP), and newer options like amnion-based therapies.  These approaches utilize naturally occurring components in the body, such as cytokines, growth factors, exosomes, and tissue inhibitors of metalloproteinases (TIMPs), to help support healing and decrease inflammation. 

The application of regenerative medicine in both human and animal ophthalmology is not new. Research into stem cells for human eye conditions began as early as 1989, quickly followed by veterinary studies in the 1990’s. While regenerative medicine options for eye care in the veterinary clinic were long limited to autologous serum (serum produced by the patient’s own blood), significant advances over the last three decades have introduced more convenient options. Today, modern advances have introduced shelf-stable, bioengineered amnion preparations available as ocular drops and amniotic membranes.

Next Generation: Amniotic Bioscaffold Use in Eye Conditions

Amnion-based therapies offer several benefits when treating corneal ulcers. The protein components in amnion products aid in decreasing inflammation, provide structural support for healing through cellular bioscaffolding, and inhibit enzymes that can cause further tissue damage. While many superficial ulcers are treated successfully in clinic, some corneal ulcers present as or progress into deep, complex, or slow-to-heal wounds. The availability of ready-to-use amnion products allows veterinarians to respond quickly, improving clinical outcomes for eye conditions while bettering the lives of their patients.

Key Takeaways

• Eye ulcers are a common, but often painful, eye condition affecting both small animals and horses.
• While many ulcers heal well with basic treatment, some complex ulcers require more intensive care, including specialty referral and surgery.
• Advances in regenerative medicine have expanded treatment options for both human doctors and veterinarians.
• Readily available shelf-stable, amnion-based products allow veterinarians to quickly treat eye conditions, improving patient outcomes and quality of life.