Joshua Broadwater, DVM, DACVO, explains why some ulcers stubbornly persist and his approach to dealing with them
Nonhealing corneal ulcers can turn even routine cases into weeks‑long frustrations for practitioners and pet owners alike. In this brief preview of his Fetch Charlotte lecture, Joshua Broadwater, DVM, DACVO, explains why some ulcers refuse to heal and how targeted procedures can finally get them back on track.
Joshua Broadwater, DVM, DACVO: Non‑healing ulcers are a huge part of what we do. That’s part of our bread and butter, because those cases come to us. I’m sure it’s very frustrating for a lot of general practitioners, because these dogs walk in your door and you diagnose a very simple, superficial ulcer. You start on these drops and, for all intents and purposes, it should be healed in a week—but it’s not.
You change medications and they come back, and it’s still not healed. These cases are frustrating for the general vet and for the owner as well, because they see their pet in pain 2 or 3 weeks beyond when healing should have occurred. My goal in this talk is to shed some light on why these ulcers don’t heal. What exactly is the process? Why are they developing in the first place, and why aren’t they resolving with standard therapy? Then, what can we do—or what can general vets do procedurally—to get these ulcers to close?
It also involves proper case selection. A superficial, non‑healing ulcer—what we would term an “indolent” or “refractory” ulcer—is very different from a deep, stromal, infected corneal ulcer. Those have different causes and require different treatments. We need to make sure we select the right cases before considering any procedures designed to stimulate superficial ulcers to heal.
There’s always a lot of controversy around true indolent ulcers—sometimes called “Boxer ulcers” or “refractory ulcers.” Which is the correct way to get these things to heal? A grid keratotomy has long been the gold standard, and I still perform it frequently. My goal with this lecture is to offer more insight on how to perform the procedure correctly.
But there are alternatives. Many clinicians have begun using a diamond burr keratotomy, and we’ll cover that as well. We’ll also talk about feline patients, because cats aren’t just small dogs—they’re practically aliens in how they heal or fail to heal. We’ll discuss which procedures used for dogs are appropriate for cats—and which aren’t—so you can choose the best approach for every patient.
Fetch On-Demand delivers expert-led veterinary continuing education on your schedule. With CE on your own terms, you can access top-tier sessions anytime, anywhere—whether at home, in the clinic, or on the go. Ready to earn CE credits? Watch this session and more on Fetch On-Demand, available now on dvm360 Flex.