Corticosteroid-type ointments are generally contraindicated for corneal ulcers in veterinary patients.

Corneal ulcers pose a tricky challenge. They’re painful, can blur sight, and demand careful decisions from the moment you step in the exam room or the clinic. When it comes to medications, corticosteroid-type ointments are one of those temptations that sound soothing but can backfire big time. So, is it acceptable to use them in patients with corneal ulcers? The short answer is no—generally not. Let me explain why, and what we usually do instead.

Why the quick answer is no (the real reasons behind it)

Corticosteroids are powerful anti-inflammatories. They can tamp down swelling and redness, which sounds helpful, right? In the context of a corneal ulcer, though, that suppression comes at a price. Here’s what actually happens:

• Healing slows down. The cornea needs to rebuild its layers after an ulcer. Corticosteroids can blunt the cellular activity required for those healing steps, delaying re-epithelialization. That means the protective surface lags, leaving the eye vulnerable longer.

• Infection may worsen. An ulcer is often an infection or a reaction to injury. The immune system is part of the defense team. If you dampen that defense too early, bacteria, fungi, or other pathogens can gain the upper hand and spread.

• Risk of pressure problems. Corticosteroids can raise intraocular pressure in some patients. Elevated IOP isn’t something to ignore; it can damage the optic nerve or lead to other complications.

• Perforation is a danger. With slower healing and ongoing infection, the cornea becomes thinner over time. In severe cases, that thinning can progress to perforation, a sight-threatening emergency.

Put simply: steroids can turn a manageable ulcer into a more serious problem. Because of these risks, they’re generally contraindicated in the early, active phase of corneal ulcers.

What usually works instead

Careful, targeted treatment is the name of the game. The goal is to control the infection, support healing, and reduce pain while keeping an eye on the tissue’s ability to renew itself. Here are the mainstays you’ll typically see in practice:

• Antimicrobial coverage. The frontline is topical antibiotics (and sometimes antifungals, if a fungus is suspected). The exact choice depends on the suspected organism, the ulcer’s location, and whether the animal is a dog, cat, horse, or other species. Broad-spectrum options are common initial choices, and clinicians tailor therapy once culture results or clinical response guide them.

• Pain relief and comfort. Pain control matters, not just for the animal’s well-being but to prevent reflex rubbing that can aggravate the ulcer. Short-acting analgesics and, when appropriate, cycloplegics (drugs that paralyze the eye’s focusing muscles) can help by reducing pain and preventing pupil constriction.

• Lubrication and protection. Artificial tears or lubricant gels can keep the ocular surface slippery, which aids comfort and healing. In some cases, temporary moisture-retaining methods or protective measures are used to shield the ulcer while it mends.

• Debridement and surface care. In certain ulcers, removing loose corneal tissue or applying temporary dressings helps the surface heal more cleanly and quickly. This is a technique that requires precision and should only be done when indicated.

• Monitoring and culture. Regular rechecks are essential. Fluorescein staining reveals how the ulcer is changing, and culture or cytology can identify the organism if the infection isn’t clearing. Close observation helps ensure that therapy is doing its job and not letting trouble simmer beneath the surface.

• Addressing underlying factors. Sometimes ulcers are worsened or triggered by dry eye, eyelid abnormalities, foreign bodies, or other issues. Finding and correcting these can be critical to recovery.

The nuance that matters: steroids in specific, controlled circumstances

There are rare situations where a veterinarian might consider using a corticosteroid after infection control and surface healing are underway. In such cases, steroids are used with extreme caution, and only under strict veterinary supervision. The logic is to minimize scarring and inflammation that could impair vision, but this step comes after the risk of infection has been managed, not during the active ulcer phase.

In those scenarios, you’ll often see steroid therapy layered in with continued antibiotics and careful monitoring of intraocular pressure and corneal integrity. It’s not a free pass to use steroids in ulcers; it’s a tightly controlled, balance-seeking approach that aims to protect vision while safeguarding healing tissue.

A closer look at what to watch for

If you’re evaluating an ulcer in a patient, here are practical notes that often guide decision-making:

• Signs of infection. Purulence, corneal thinning, endothelial plaques, or progressive corneal involvement signal that infection control should stay front and center.

• Location and depth. Central ulcers or those that threaten the corneal thickness demand more aggressive monitoring and a careful antibiotic plan.

• Corneal clarity and scarring. As the tissue heals, scarring can affect vision. Some clinicians weigh the long-term visual impact when deciding how aggressively to treat inflammation versus infection.

• Patient-specific factors. Species differences matter. For example, horses can have different healing dynamics than small animals; breed-related glaucoma risk can influence how you manage any therapy that affects IOP.

What students (and clinicians) tend to forget—and what to remember

It’s easy to think, “If the eye is swollen and uncomfortable, a steroid might calm things down fast.” But fast relief isn’t always good relief when the surface is damaged and an infection may be present. A few memorable takeaways:

• The safest default: avoid corticosteroid-type ointments during active corneal ulcers.

• The real performers: antibiotics or antifungal agents that target the infectious agent, paired with lubrication and pain management.

• The monitoring must-happen: regular checks with staining and possibly cultures to confirm healing and rule out hidden infection.

• Steroids aren’t banned forever. They can be part of the later healing phase, but only after careful assessment and clear signs that the infection is controlled.

A quick, real-world snapshot

Imagine a dog with a shallow, central corneal ulcer. The vet starts with a careful exam, punctal plug or eyelid position assessed, and a plan: broad-spectrum topical antibiotic drops several times a day, an eye lubricant, and a mild cycloplegic to reduce pain and spasm. The owner is instructed to prevent rubbing, monitor discharge, and bring the dog back for a recheck in 24 to 48 hours.

By the second visit, the fluorescein stain shows improvement, the surface looks re-epithelialized in the central area, and there are no signs of secondary infection. Only then does the clinician consider whether any anti-inflammatory medication is appropriate, and even then, it’s a measured, stepwise decision, not a blanket prescription. In this way, the patient’s eye is given the best chance to heal with minimal scarring and a lower risk of complications.

A few practical tips for you to keep in mind

• When you’re learning about corneal ulcers, think in phases: infection control first, then healing, then inflammation management if needed.

• Always pair anti-inflammatory decisions with antimicrobial coverage during ulcers. You don’t want to let inflammation mask an underlying infection.

• Use diagnostic tests as your compass. Fluorescein staining, tonometry (to check IOP), and culture results help keep the plan on track.

• Don’t rush to steroids. If a patient improves with antibiotics alone, that’s a clear sign to stay the course rather than add more risk.

• If you’re ever unsure, consult or observe. In ophthalmology, a second professional opinion can save an eye.

Bringing it together

Corticosteroid-type ointments have earned a reputation for being powerful, quick-acting anti-inflammatories. In the case of corneal ulcers, that power can work against healing and safety. The standard approach is to prioritize infection control, comfort, and a careful progression toward healing. Steroids aren’t a routine first move here; they’re a rare, tightly supervised option that’s only considered after the clear signals that healing is underway.

If you’re studying veterinary pharmacology and want to feel confident in scenarios like this, practice with a few thought experiments. Picture the ulcer’s stage, the likely organism, and the patient’s overall health. Then map out a plan that emphasizes safety, healing, and preservation of vision. That’s the core of sound decision-making in ophthalmic care—and it’s the kind of reasoning that helps you stand out in real-world clinical settings.

A final thought

Learning about drugs for the eye isn’t just about memorizing a list. It’s about understanding how they affect tissue, how fast healing happens, and what can go wrong when we push too hard too soon. The cornea doesn’t forgive impatience. When in doubt, choose a plan that respects the healing pace of the tissue, protects the eye’s structure, and uses antibiotics as the primary shield against infection. With that approach, you’re building not just knowledge, but clinical judgment you can rely on.

If you want a quick mental check, remember this simple rule: active corneal ulcers—no routine corticosteroid ointments. Inflammation and healing have their moments to shine, but infection and tissue integrity come first. Keep that framework in your pocket, and you’ll navigate these cases with a steady hand and a clear eye.