Canine Corneal Ulcer Treatment Protocol

Excellent, let's walk through this case. A Shih Tzu with an acute ulcer is a classic presentation, and your description is clear.

Based on your findings—a superficial, fluorescein-positive defect with no evidence of stromal loss or cellular infiltrate—this currently fits the description of an uncomplicated superficial ulcer. The key word here is "uncomplicated." Our job is to keep it that way, especially in a brachycephalic breed prone to exposure keratitis and KCS.

Here is my recommended protocol:

Initial Diagnostics (Confirm/Add): I trust you've done a full exam, but I always want to be certain a Schirmer Tear Test (STT) was performed before the fluorescein stain. A low STT is a very common underlying cause in this breed and would change our long-term management. If not done, perform it at the first recheck. Normal is ≥15 mm/min.

Medical Therapy:

* Topical Antibiotic: A broad-spectrum triple antibiotic ointment (NeoPolyBac) applied every 6-8 hours (TID-QID) is an excellent first choice. The ointment base provides lubrication, which is beneficial for potential lagophthalmos in a Shih Tzu.
* Cycloplegia/Pain Control: Atropine 1% ophthalmic ointment or solution is appropriate to control the pain from ciliary body spasm. Apply one drop/small strip to effect (until the pupil is dilated), then reduce to every 12-24 hours. Be mindful that atropine can decrease tear production, another reason to have that baseline STT value.
* Systemic Pain Management: Consider a short course of a systemic NSAID (e.g., carprofen, meloxicam) for 2-3 days to improve comfort, assuming no systemic contraindications.
* Mechanical Protection: An E-collar is absolutely non-negotiable. Self-trauma is the number one reason simple ulcers become complicated. It must be worn 24/7 until the ulcer is fully healed.

Recheck Schedule:

* First Recheck: 5-7 days. At this point, a simple ulcer should be significantly smaller or completely resolved. Re-stain the cornea to confirm. If healing, you can typically discontinue the atropine and continue the antibiotic for another 2-3 days.
* If Not Healed: If the ulcer is the same size, larger, or deeper at the 5-7 day recheck, it has declared itself complicated. We need to find out why. Look for an underlying cause: KCS, entropion, ectopic cilia, or early signs of infection. If no obvious cause is found, it may be developing into an indolent ulcer (SCCED), though this is less common at 3 years old.

Referral Triggers:

* Immediate Referral (Emergency): If you see any signs of melting (keratomalacia), which appears as a gelatinous or "dissolving" cornea, or if it deepens rapidly into a descemetocele (a clear "pit" that doesn't take up stain at its base).
* Urgent Referral (within 24-48 hours): If the ulcer is not healing after 7-10 days despite appropriate therapy. At this point, we need to consider debridement for a possible indolent ulcer, a conjunctival graft if it has become deep, or more advanced diagnostics.

In summary, you are on the right track. Treat it as a simple ulcer, but maintain a high index of suspicion due to the breed. The E-collar and a definitive plan for the 7-day recheck are the most critical components for success.