Superficial ulcers usually heal in less than a week. Deep ulcers and descemetoceles may require corneal suturing, conjunctival grafts or conjunctival flaps, soft contact lenses, or corneal transplant. Topical corticosteroids and anesthetics should not be used on any type of corneal ulcer because they prevent healing and will often make them worse. Bioscaffold
A new bioscaffold developed by TR BioSurgical is being evaluated for refractory corneal ulcers in dogs. The study is being conducted by board certified veterinary ophthalmologists and has shown promise in healing refractory ulcers that have failed conventional treatment . Refractory corneal ulcers
Refractory corneal ulcers are superficial ulcers that heal poorly and tend to recur. They are also known as indolent ulcers or Boxer ulcers. They are believed to be caused by a defect in the basement membrane and a lack of hemidesmosomal attachments. They are recognized by undermined epithelium that surrounds the ulcer and easily peels back. Refractory corneal ulcers are most commonly seen in middle aged or older dogs and often occur in the other eye later. They are similar to Cogans cystic dystrophy in humans. Commonly affected breeds
Alaskan Malamute
American Cocker Spaniel
Boston Terrier
Boxer
Brussels Griffon
Cairn Terrier
Chesapeake Bay Retriever
Chihuahua
Chinese Shar Pei
Dachshund
Bulldog
English Springer Spaniel
German Shepherd Dog
Golden Retriever
Irish Setter
Japanese Chin
Lhasa Apso
Maltese
Pekingese
Poodle
Pug
Rottweiler
Samoyed
Shih Tzu
Silky Terrier
Weimaraner
Welsh Corgi
Welsh Springer Spaniel
West Highland White Terrier
Wirehaired Fox Terrier

Treatment
Refractory corneal ulcers can take a long time to heal, sometimes months. Topical antibiotics are used continually to prevent infection. Pain medications are given as needed. Loose epithelium is removed with a dry cotton swab under topical anesthesia.
Bacterial and fungal infection occurs readily after the initial ulceration, as disruption of the corneal epithelium allows attachment and colonisation of the underlying tissues by normal corneal commensals. Commonly isolated bacteria include Staphylococcus, Streptococcus and Pseudomonas, and empirical anti-microbial therapy should be effective against these bacteria. Symptoms
Ocular Pain
Blepharospasm
Increased lacrimation
Photophobia
Corneal Oedema (1⁰/2⁰)
Scleral injection
Conjunctivitis

Diagnosis
Differential diagnoses for the painful equine eye:

Ulceration
Uveitis
Blepharitis
Conjunctivitis
Glaucoma
DachrocystitisA full ocular exam should be performed for every case of eye pain. Fluoroscein staining is usually diagnostic for corneal ulcers, although staining with Rose Bengal is also recommended as it can pick up early viral/fungal lesions, which will appear as multifocal disturbances to the tear film. Culture and sensitivity is recommended for rapidly progressive or deep corneal ulcers. Cotton swabbing is often inadequate, and corneal scraping, for example, with the blunt side of a scalpel blade is usually required. This can be greatly facilitated by the use of local nerve blocks and topical anaesthesia. There is almost invariably a secondary uveitis present with corneal ulceration, and signs of this may also be seen: miosis, corneal oedema, aqueous flare, hypopyon, IOP changes. Treatment
Medical therapy should be based upon the severity of disease initially, and then by the response to therapy. The aims of the initial therapy are:

Antibiosis
Analgesia
Anti-inflammatory
MydriaticThe initial choice of antibiotic depends upon personal choice, experience and availability, but could include chloramphenicol, chlortetracycline, bacitracin-neomycin-polymyxin (BNP), ciprofloxacin, ofloxacin and tobramycin. Topical gentamicin formulations are also available, but in the opinion of some, should be reserved for cases with stromal melting.