Melting ulcer as the term suggests, describes a situation where the cornea literally liquifies and changes from a solid structure to more of a gel. The image on the right shows how this case presented at referral.
Melting ulcer on day 1
The cornea as you can see, has stabilised and ruptured has been prevented.
The initiating cause of this condition can be trauma, followed by bacterial infection, viral infection or may result from chemical damage when an irritant inadvertently comes in contact with the cornea.
A careful evaluation of the eye including an ultrasound scan, determined that the innermost layer of the cornea, descemet’s membrane was exposed but not penetrated. Swabs were submitted for bacterial culture and broad spectrum antibiotic cover was instigated. Serum was collected from the pony and used as a topical treatment to provide anti-inflammatory and growth factors to help stabilise the cornea. The eye was lavaged with saline and a mini-tipped swab was used to debride the loose tissue. An in-dwelling subpalpebral lavage system was considered but the patient was very compliant and possible further irritation to the cornea was a risk. The image to the left is two weeks after the start of treatment.
The stabilised cornea is vulnerable to secondary bacterial or fungal infection so preventative medication is still necessary. A further two weeks of treatment were given by which time the healing process was well underway. You will see from the follow-up pictures taken at three weeks and six weeks from the picture above that there is a profound vascularisation from the corneal margins which is essential for healing to take place.
Three weeks after corneal stabilisation
Three weeks after the image above
The eye is now nearly healed but will probably be left with a small scar.