Medical and Surgical Management of Melting Corneal Ulcers Exhibiting Hyperproteinase Activity in the Horse

Corneal ulcerations are very common in horses; most of them are uncomplicated noninfected ulcers that heal quickly without complications, but some can present various levels of corneal liquefaction or “melting.” Because melting corneal ulcers can progress rapidly and be sight threatening, the crucial steps of their diagnosis and clinical management are stressed in this paper. The treatment of melting corneal ulcers in horses should eradicate the infection, reduce or stop the corneal destruction, support the corneal integrity, control the uveal reaction and the pain associated with it, and minimize corneal scarring. Medical therapy including antiproteolytic drugs is discussed as well as adjunctive surgical options, including keratectomy, conjunctival grafts, and amniotic membrane and other biomaterial grafts. The prognosis depends on the stage and the severity of the corneal ulceration, the etiology of the condition, and the therapeutic choice.