Frequency of application can vary from q1h to q8h, depending on both the severity of the lesion, and the formulation used (ointment vs. drops). Much of the pain associated with corneal ulceration is due to the secondary uveitis and miosis, and effective relief can often be gained with topical atropine(1%), leading to mydriasis. Dosing is generally q4h initially, and then as required to maintain dilation. Mydriasis is also important to avoid some of the complications associated with uveitis, such as synechiae formation and glaucoma. Pain is also associated with inflammatory response occurring in the adjacent sclera and conjunctiva, and systemic analgesia in the form of NSAIDs is usually indicated, for example, flunixin meglumin 1.1 mg/kg, BID. Topical NSAIDs are available (diclofenac, flurbiprofen) and effective, but have been shown to increase corneal healing time. In horses that are difficult to treat, or in cases that require very frequent treatment, then placement of a sub-palpebral lavage system can be very useful. As an adjunct to therapy, physical protection of the eye may be required, in the form of a mask. Some horses will rub their eyes in response to pain, and this can cause further corneal damage. Box rest is also vital, as over-exertion has been linked to intra-ocular haemorrhage and increased severity of uveitis. Success in your therapeutic regime can be judged by a reduction in pain, and a decrease in size of the ulcer. Healing generally occurs rapidly at first, followed by a slowing after 5–7 days.
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.