SAEVA Congress 2018 Proceedings | 12-15 February 2018 | ATKV Goudini Spa
Treatment : Medical treatment is designed to eliminate the stromal infection and manage the intraocular inflammatory process . o If the lesion appears white then antimicrobials moxifloxacin [ Vigamox ] or tobramycin [ Tobrex ], 4-6x / day but if yellow and deep appearing then antifungal , voriconazole [ VFend ]. Penetration can be improved by frequent drug medications and removal of the epithelial layer . Intracorneal voriconazole may also be performed [ see details later ]
o Mydriatics / cycloplegics : Atropine drops 1-2x / day cause paralysis of the iris and ciliary body muscle , alleviating uveal muscle spasm and pain . Gut motility needs to be monitored .
o Anti-inflammatories : Flunixin [ Finadyne ] 1.1 mg / kg every 12 hours IV or PO until the anterior segment inflammation is resolving , subsequently decreasing and tapering the dose to effect . It is recommended , however , that a patient be kept on low-dose systemic NSAIDs throughout the treatment period . The patient should be monitored for systemic toxicity , in particular renal and alimentary effects , and gut protectants may be required .
o Subpalpebral lavage systems may be used in cases where the patient is difficult to handle or where management is unable to medicate frequently .
Corneal vascularisation should be encouraged and its presence is a good thing . The cyclooxygenase and lipoxygenase pathways are important for promoting corneal vascularisation but unfortunately these are inhibited by Flunixin [ Finadyne ]. As healing of the SA progresses one will see the yellow-white colour of the abscess be replaced by a grey coloured corneal fibrous tissue and the uveitis should be improving . When a stromal abscess is very deep and is projecting into the anterior chamber , there usually is less vascularisation and the uveitis is more severe which results in a poorer outcome . These are mainly fungal in nature . If there is no significant improvement within 48-72 hrs on aggressive medical management , then a surgical option should be considered . Surgery is aimed at removing the sequestered organisms and the surrounding necrotic tissue thus allowing the cornea to heal faster . The tissue that is removed can be submitted for culture which improves the diagnosis and potentially can allow for more targeted antimicrobial treatment
Infected Melting Ulcers : It is not unusual for the equine practitioner to encounter an infected corneal ulcer . This type of ulcer progressively deteriorates over hours to days in spite of medications . They generally have a white to yellow colour as a result of cellular infiltrates , have a soft or melting jelly-like appearance and corneal oedema is present . This type of ulcer is usually infected with Pseudomonas or Streptococcus bacteria species . The stromal collagenolysis , as a result of activation of proteolytic enzymes from bacteria , leukocytes and corneal epithelial cells , needs to be suppressed . Treatment is aimed at reducing the bacterial and fungal growth , the tear film protease activity must be reduced and finally uveitis must be managed . Corneal
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