Chronic Ulcer Surgery in Dogs

Chronic ulcer surgery is a surgical procedure used to treat indolent (corneal) ulcers in dogs. Although this surgical procedure can be performed by a veterinary surgeon, dog owners are often referred to a veterinary eye specialist to carry out the treatment. Chronic ulcer surgery, known as keratotomy in the veterinarian world, involves the removal of epithelial cells that no longer are attached to the stroma, or ulceration. This procedure can be carried out under general or topical anesthesia, depending on the size of the ulcer. 

Chronic ulcer surgery in dogs can be completed under general or local anesthetic, depending on the size of the ulcer and the patient. Keratotomy can be completed in a punctuate pattern or linear grid. The goal of this procedure is to first remove all of the epithelial cells that are unable to remain attached to the stroma. The surgeon will use a very fine needle to make a series of microgrooves or grids on the superficial corneal stroma. This patterned punctuate will help to disrupt the abnormal portion of the cornea, allowing new epithelial cells to anchor the new healthy cornea below the unhealthy zone. Following this initial treatment, the ulcer will heal, however, some refractory ulcers may require a repeat of the procedure or a more invasive surgical procedure. If this is the case, a surgical procedure termed superficial keratectomy may be performed. In this procedure, the outer layers of the cornea are surgically removed using a specialized corneal blade, peeling the unhealthy layer of corneal stroma off. 

Chronic ulcers surgery in dogs, carried out by a licensed veterinary eye surgeon specialist, generally carries a good prognosis for a dog with ulcers. The goal of this procedure is to first remove all of the epithelial cells that are unable to remain attached to the stroma.

Following surgery, a broad spectrum antibiotic will be dispensed in the canine’s eye three times a day to prevent infection. A pain medication, atropine, which works by widening the pupil to reduce pain, may be necessary. A bandage contact lens may be placed over the eye to cover exposed nerve endings. After a single treatment of debridement and cautery, more than 50% of chronic ulcers heal within one to two weeks. 

Chronic ulcers surgery in dogs can cost a pet owner $200 to $2,000 to have completed. The cost of surgery depends on the size of the ulceration and the anesthesia required. 

The main concern for veterinarians for dogs that have undergone a chronic ulcer surgery is the possibility of infection. Even with the use of a suitable broad spectrum antibiotic, infection can occur, deepening the ulceration. If infection does occur, urgent surgical care will be required, which is often very costly. Aside from the risk of anesthesia, any procedure involving the cornea can pose a risk for potential complications to arise. Potential complications associated with the surgery include, but are not limited to the following: 

• Luxation (Lens displacement to the front of the eye) 
• Epiphora (tearing) 
• Blindness 
• Hyphema (bleeding inside the eye)
• Ocular pain
• Retinal detachment
• Retinal degeneration 
• Glaucoma (high pressure within the eye) 
• Uveitis (inflammation) 
• Ocular rupture 
• Corneal mineralization, vascularization or scarring
• Infections internal or external 
• Wound dehiscence (breakdown of the wound) 
• Conjunctivitis (inflammation of tissue) 

Not all indolent ulcers require chronic ulcer surgery. Preventing your dog from experiencing trauma to the eyes is a well formed prevention method. Older dogs are commonly affected by corneal ulcerations, whereas other dog breeds are predisposed to developing the condition. West Highland White Terriers, Staffordshire Bull Terriers, Corgis and Boxers are most commonly affected.