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A grid keratotomy is a minimally invasive surgical procedure involving the epithelium (outer layer) and stroma (thickest layer) of the cornea. It is used to treat chronic ulcers on the surface of the eye. These ulcers are painful to the dog, and often change in both size and shape. Performing a grid keratotomy can encourage the damaged epithelium to attach to the eye and heal.
Generally, these ulcers begin from physical trauma to the eye. Topical and oral therapies may be attempted before a grid keratotomy is recommended. Dogs suffering from eye ulcers may experience constant discharge and tearing from the affected eye. The eye may appear swollen and red, with the pupil exhibiting a blue color. A veterinarian will need to perform the grid keratotomy, preferably one with optical experience.
A grid keratotomy does not require the use of general anesthesia, and can be performed during a regular veterinary visit. The dog will be sedated and a topical anesthesia will be applied to the eyes via drops to begin the process. An eyelid speculum will be used to prevent the eyelids from moving. Before a grid keratotomy can be performed, all loose epithelium tissue must be removed. This is done using a sterile cotton swab against the eye's surface.
A veterinary technician will have to restrict the dog's movement during the grid keratotomy. A 20 gauge needle is then used to prick the eye. Multiple pricks or scratches are made right through to the stroma of the eye. This stimulates the epithelium to heal by making it easier to attach to the stroma.
A grid keratotomy carries a very high success rate, with up to 95% of dogs relieved of their ulcers following this procedure. A contact lens is often bandaged to the eye for approximately one week to ease healing. The use of epithelium debridement and a bandaged lens alone yields only a 50% success rate. Diamond burring using a small rotary tool has also been found to successfully treat SCCEDs in dogs, however it requires special equipment to be completed.
Chronic eye ulcerations can take several weeks to heal even with treatment. An Elizabethan collar is recommended during this time, especially if the dog's eye has been bandaged. The collar can prevent the dog from scratching at its damaged eye. It is possible for new ulcers to develop during the healing process. A prescription will be given for topical and oral medication, including steroids, NSAIDs and antibiotics. Pain relief is also given to help ease the irritation of the ulcer. On average, five to seven appointments will be needed to re-administer treatment and to assess how the eye is healing. Medication doses will be adjusted at these appointments.
As no general anesthesia is needed for this procedure, it is not as expensive as many surgical treatments. The price for a grid keratotomy can range from $500 up to $1,000. Keep in mind that the overall price may increase, as it is not uncommon for multiple procedures to be needed. Diamond burring is only offered at certain veterinary clinics and may cost more than grid keratotomy to offset the cost of equipment. Medical treatment may be needed for several weeks or more.
A grid keratotomy is not associated with many risks and is minimally invasive, however SCCED can be a very stubborn disease. If the ulcers are recurring after multiple keratotomies, a keratectomy may be required. This procedure involves the use of general anesthesia. A conjunctival graft may also be recommended to treat severe cases. If a dog suffers from dry eyes, the healing process may be delayed.
SCCED is a genetically inherited issue that occurs due to a dog's anatomy. Boxers and other breeds who have bulging eye are especially susceptible to the issue. The dog's failure to fully blink leads to complications with the healing of the eye. It is always a good idea to enquire about your dog's family health history when obtaining the animal. This can help you prepare to certain issue before they develop. Treating the ulcers before they are large in size may be easier than dealing with excessive damage.
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Staffordshire Bull Terrier
1 found helpful
My dog was diagnosed with a superficial corneal ulcer on her right eye, using the fluorescent test. I think she may have developed this going through long grass. She had a small wart on her lower eyelid near the site of the ulcer, which she had had for around 3 years. The vet advised that this may delay the healing of the ulcer and so she had the wart removed under general anaesthetic, at which time debridement and gridding was performed. I have since been administering Isathal ointment and Remend drops 2 and 3 times a day respectively. This evening, Thursday 11 days after surgery she went for her 2nd post operative check up and the dye shows the ulcer is still very large. She is still squinting, closing the eye and it is blue and cloudy. I have another appointment booked for Monday to review the situation, but am concerned about what to do next if there is still no improvement. Are you able to offer me any advice please.
June 14, 2018
Some ulcers can be stubborn even with grid keratotomy, topical treatment should continued until your next appointment; if there is still not a satisfactory improvement another thorough examination should be performed to ensure that there are no other underlying issues and in severe cases the procedure may need to be repeated or for a superficial keratectomy surgery to be performed. Regards Dr Callum Turner DVM http://vetmed.illinois.edu/refractory-corneal-ulcer-management-dogs/
June 15, 2018
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