Bullous Keratopathy in a dog treated with Third Eyelid Flap and Autologous Serum Eye Drops

Abstract

Background: Bullous Keratopathy (BK) is characterized by decompensation of the corneal stroma resulting in visual impairment by corneal opacity, discomfort, excessive tearing, blepharospasm and pain. The aim of this study was to report a case of BK in a dog and the complete recovery of the ocular structure and visual function, with a third eyelid flap associated with the use of autologous blood serum topically.Case: A 2-year-old Shih Tzu male dog, weighing 4.3 kg, with recurrent bilateral eye discomfort was brought to Ophthalmologist Veterinarian Assistance. The patient had already been seen by other veterinarians, but the signs returned in a short period of time after the prescription was suspended. During physical examination it was observed moderate blepharospasm in the right eye, epiphora in the left eye, and in both eyes was noted exophthalmos, medial corneal entropion, caruncle trichiasis and ectopic cilia in the upper and lower eyelids. Fluorescein test was positive in both eyes, and a large bullous, opaque and gelatinous lesion with irregular appearance was observed occupying a large part of the cornea of the right eye. Superficial corneal ulcer was diagnosed in left eye and BK in right eye, both probably in consequence of ectopic cilia presence. Surgical intervention was made, with the cauterization and excision of the ectopic cilia and third eyelid flap in the right eye. The cauterization of caruncle trichiasis was not authorized by the owner. Moxifloxacin eye drops in the dose of one drop four times a day in both eyes, lubricant based on hyaluronic acid in the dose of one drop four times a day in both eyes, and autogenous blood serum, obtained from the centrifugation of a blood sample of the dog itself, in the dose of one drop every hour in the right eye for 24 hours, and meloxicam in the dose of 0.1 mg/kg every 24 h for 3 days were prescribed. Elizabethan collar was recommended until removal of the third eye flap. During the surgery, a sample of eye secretion was collected and sent for culture and antibiogram and did not show growth of microorganisms. After seven days of the procedure, the animal did not show eye discomfort and corneal ulcer in the left eye was healed. The third eye flap remained stable until the return of 28 days and after removal of the capton, adhesions were identified, which were removed with Castroviejo scissors after application of topical anesthetic proxymetacaine hydrochloride eye drops. A fluorescein test was performed and the absence of corneal keratitis was confirmed. Discrete corneal scars (macula) were identified.Discussion: The patient in this report had several changes in ocular morphology that favored the formation of recurrent injuries which contributed to the formation of BK. The use of topical medications as unique treatment was not performed due to the severity of the lesion and the presence of alterations such as medial entropion, caruncle trichiasis and ectopic cilia that needed surgical corrections to resolve the causes of the lesions. In order to protect the cornea and provide compression of its epithelium, a third eyelid flap was performed, a low-invasive procedure that is quick and easy to perform. Ectopic cilia were cauterized to eliminate one of the causes of the corneal injuries, however, the other changes could not be corrected because they were not authorized by the owner. The adjuvant uses of ocular lubricant based on hyaluronic acid, a broad-spectrum topical antibiotic and mainly autogenous blood serum favored the epithelial reconstruction of the cornea by providing protection, vitamins, growth factors, immunoglobulins, anti-collagenolytic and bacteriostatic substances. The protocol used it enabled a rapid reduction in patient discomfort, reversal of injuries and recovery of visual function.