Feline Corneal Sequestration

Rhea V. Morgan, DVM, DACVIM (Small Animal), DACVO

BASIC INFORMATION
Description
A corneal sequestrum is an area of dead tissue that arises following
some sort of injury or irritation of the cornea. The reasons why a focal
area of the cornea dies and becomes discolored are not well understood. The sequestrum appears as a dark brown, almost black spot.
Corneal sequestra can occur in any age of cat, but they usually
develop in adult cats (average age, 5.5 years). Persian, Himalayan,
British colorpoint, Burmese, Siamese, and American domestic
shorthair cats appear to be predisposed. The lesion can occur in
one (most commonly) or both eyes. Corneal sequestration has also
been called corneal nigrum, corneal mummification, and necrotizing keratitis.

Causes
Numerous sources of irritation may result in a sequestrum, including prior corneal ulceration, entropion (in-rolling of the eyelids),
abnormal eyelashes or hair rubbing on the eyes, chronic conjunctivitis, chronic exposure of the cornea, and dry eye from poor tear
production. Feline herpesvirus (FHV) infection has also been
incriminated as a contributing factor in this disease.

Clinical Signs
A round to oval, black spot develops in the cornea, often near the
center. The spot looks very out of place and can be mistaken for a
foreign body. The surrounding cornea may be red and cloudy. In
some cats, the sequestrum causes no pain. If corneal ulceration is
present, the eye may be painful, and the animal may exhibit squinting, tearing, and redness. Although they are rare, severe ulceration
and corneal perforation may occur.

Diagnostic Tests
Diagnosis can usually be made by close examination of the cornea, sometimes with magnification. A complete ocular examination often involves tear testing, fluorescein staining of the cornea,
and a thorough search for underlying causes. In some cases, cell
samples may be submitted for FHV testing. Other causes of dark
spots in the cornea, such as foreign bodies and melanoma tumors,
must be ruled out.

TREATMENT AND FOLLOW-UP

Treatment Options
For the corneal sequestrum, two main treatment options exist:

Medical therapy may be tried in cats that do not exhibit pain,

especially if the sequestrum is close to the surface of the cornea. Over time, the cornea attempts to reject this dead tissue, and the sequestrum may fall off on its own. This process
can be quite slow and may take many months (average, 11
months). The medications used include topical antibiotics,
protective lubricants, and sometimes topical or oral antiviral
agents.
Surgery to remove the sequestrum is often chosen for cats that
are in pain. Several techniques are available, depending on the
size and depth of the lesion. Most involve removal of a portion
of the cornea (keratectomy). Because some of these surgical
procedures require magnification, such as an operating microscope, your cat may be referred to a veterinary ophthalmologist
for the procedure. Healing after simple keratectomy is usually
rapid (7-21 days), but it may take a few weeks if a grafting procedure was needed. Postoperative medications may include
topical antibiotics, lubricants, pain medications, and antiviral
agents.
Any underlying problems must also be addressed. Medications
may be started to treat dry eye, FHV infection, or corneal ulcerations. Surgery may be needed to correct entropion or other eyelid
problems.

Follow-up Care
Recheck examinations are often performed every 3-4 weeks if
medical therapy is tried. Rechecks may be scheduled more frequently if the cornea is ulcerated and inflamed. Examinations
often involve fluorescein staining of the cornea and monitoring of
the opposite eye.
When surgery is performed, postoperative examinations are
usually done every 7-14 days until the cornea is healed. If the
sequestrum was quite deep and corneal grafting was required after
its removal, then recheck visits may be needed for several weeks.

Prognosis
Corneal sequestra recur in 10-20% of affected eyes and can
develop at a later date in the opposite eye. The reasons for recurrence are not well defined but may include failure to adequately
address contributing factors; inability to remove the entire sequestrum (too deep), or poor healing responses on the part of the cornea. In most cases, successful treatment is possible and the affected
cornea may be left with only mild scarring. Good vision is maintained in most eyes.

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Copyright 2011 by Saunders, an imprint of Elsevier Inc. All rights reserved.