In canine ophthalmology, how do you differentiate keratitis from corneal ulcer and what is the initial management?

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Distinguishing these conditions relies on the integrity of the corneal surface. Keratitis is inflammation of the cornea without a significant epithelial defect. A corneal ulcer, on the other hand, is an epithelial defect with underlying stromal involvement and thinning. You can assess this with fluorescein staining: a true ulcer shows a clear epithelial defect with dye uptake and may reveal thinning or stromal edema, whereas keratitis alone often presents with surface haze or punctate staining but no discrete epithelial break.

Initial management should address infection risk, pain, and comfort, and provide support to the cornea. Start topical broad-spectrum antibiotics to cover potential bacterial infection, provide pain relief, and use a cycloplegic to reduce ciliary spasm and prevent synechiae. Protect the eye as needed. If the ulcer is deep or there is significant thinning, consider surgical repair or a conjunctival graft to maintain globe integrity. Steroids are generally avoided initially if infection is a possibility and should only be used after infection is controlled and epithelial healing is underway.