Corneal ulcer – this can affect the eye

Corneal ulcer, also known as corneal ulceration, is one of the most common eye diseases in horses. It is not a growth, but rather a tissue defect that does not heal chronically and can vary in severity. The treatment of a corneal ulcer can be very frustrating, and untreated or incorrectly treated corneal ulcers can lead to serious visual impairment or even loss of the eye.

INHALT
Anatomy Cause Symptoms Diagnosis Treatment Forecast Prophylaxis
Anatomy

The cornea, medically known as the cornea, is the outermost transparent layer of the horse's eyeball and is involved in refracting light rays. Together with the lens, it forms the optical system of the eye. The cornea is approximately 1 mm thick in horses and has no blood supply of its own. The cornea is supplied with nutrients via the inner eye, the adjacent sclera (the white part of the eye) and the tear fluid, which ensures that the surface of the cornea is always moist and clean. A branched network of sensitive nerve fibers runs through the entire cornea, which explains why injuries cause severe pain.

The cornea is made up of several layers. At the top, directly below the protective tear film, is the constantly renewing epithelial layer, which is bordered by the stroma. This is the thickest but also the most pain-sensitive layer of the cornea. The stroma is followed by the Descemet's membrane and the sensitive endothelium membrane underneath. The Descemet's membrane is extremely resistant and protects the eye from leakage, even if the epithelial layer and stroma are already damaged.

Corneal ulcers that only affect the epithelial layer are called superficial ulcers. Deep corneal ulcers are ulcers that involve both the epithelial layer and the stroma. The danger of deep ulcers is the increasing (sometimes very rapid) melting of stromal tissue and potential perforation of the Descemet's membrane, which in the worst case can lead to leakage of the eye and detachment of the retina.

Cause

The causes of a corneal ulcer can be very diverse. Relatively common triggers are injuries or foreign bodies that the horse picks up in the stable or pasture, but infections of the eye with viruses, fungi, parasites, or bacteria can also cause a corneal ulcer. Furthermore, abnormalities of the eyelids or eyelashes, as well as functional disorders such as insufficient tear fluid, can lead to severe mechanical irritation, resulting in a corneal ulcer. A corneal ulcer can also occur in connection with diseases of the inner eye or due to chemical irritation (fly spray).

Symptoms

The signs of the disease can vary depending on the cause and extent of the corneal ulcer. The first symptoms noticeable to the owner are often increased sensitivity to light and increased blinking, painful squinting, increased tearing, or even mucous discharge and reddened conjunctiva. In cases where the condition has been present for some time, a milky-white, dull spot on the eyeball and blood vessels sprouting into the cornea may be visible to the naked eye. If the cornea or conjunctiva is additionally colonized by bacteria, the discharge may also be yellowish and purulent.

If you notice any suspicious symptoms in your horse's eyes, do not hesitate to call a veterinarian, even if the changes appear harmless, as you cannot tell how deep a potential ulcer has already penetrated the layers of the cornea.

Diagnosis

The veterinarian will perform a thorough general examination and a special eye examination. For a detailed examination of the eye, he has several modern devices at his disposal with which he can examine both the cornea and the inside of the eye in detail. Another useful tool is staining the cornea with fluorescein. This is particularly helpful in cases of minimal lesions that are difficult to see otherwise. If the cornea is intact, the dye cannot adhere to it. If the epithelial layer is defective, the fluorescein accumulates in the exposed water-containing stroma.

If an infectious change is suspected, swab samples are taken from the eye and examined in the laboratory for microbes so that the correct preparation for treatment can be selected.

Corneal ulcer in horses
Fluorescein can be used to make corneal defects visible
Treatment

The type of treatment depends primarily on the cause of the ulcer. If the trigger or underlying disease is known, it should be eliminated or the disease treated. Corneal ulcers are usually treated with medication first. Depending on the cause, different active ingredients are used, which are administered locally into the eye. These include pain-relieving, anti-inflammatory, antifungal, or antibiotic preparations.

IMPORTANT: Please do not use eye ointments or drops on your horse's eye without consulting the attending veterinarian, especially if they have already been opened! In particular, eye ointments containing cortisone must not be administered under any circumstances if there is a corneal defect, as this can lead to dramatic complications during the healing process.

In cases of advanced disease or if medication is ineffective, surgery is the treatment of choice. Minor defects of the epithelium and stroma can be filled by the veterinarian with a special tissue adhesive that dissolves during the healing process. In the case of more extensive, superficial defects, healing can be accelerated with the help of a conjunctival flap. This involves temporarily suturing part of the conjunctiva to the cornea so that the cornea in this area is supplied by the vessels of the conjunctiva. In the case of deeper defects, a corneal transplant may be the only promising treatment option. This involves transplanting healthy cornea from a deceased horse into the affected horse. Experience with this surgical method has been very good, with very few cases of tissue rejection and vision being preserved. However, the cost of the operation is very high.

When using pupil-dilating medication, care must be taken to ensure that the affected eye is reliably protected from sunlight in the following days. A darkened stall and a fly mask offer good protection for horses with eye diseases.

Forecast

The prognosis for healing a superficial corneal ulcer is good with timely and consistent treatment. The defects usually heal completely within 3 to 7 days. With deeper ulcers, the prognosis can vary greatly depending on the extent and severity of the disease. The timing of treatment and potential complications such as secondary infections (infections with an additional pathogen) are also decisive for the prognosis. If the inside of the eye has already become infected, there is little chance of saving the eye. After a deep ulcer has healed, whitish opacities may remain on the cornea, which can impair vision depending on their size.

Prophylaxis

A good stable environment and early treatment of potential eye diseases are the best preventive measures to reduce the risk of corneal ulcers. Check your horse's stable and pasture for potential hazards (sharp objects) and remove them.