Topical ocular steroids and NSAIDs: the risk with corneal ulcers
5-year-old English Bulldog prescribed dexamethasone drops for a red eye without staining the cornea. One week later it has a deep ulcer with soft, gelatinous stroma.
Which statement about topical ocular anti-inflammatories is correct?
chevron_right Show answer and explanation
A. Topical NSAIDs are safe in ulcers because they do not affect healing
Topical NSAIDs can also delay re-epithelialisation and have been associated with corneal melting; use them with caution if there is an ulcer.
B. Before prescribing a topical corticosteroid you must stain with fluorescein: with an ulcer they are contraindicated because they enhance proteases, delay healing and promote infection
Correct. Treating a red eye with a corticosteroid without ruling out an ulcer is a common and serious mistake. The corticosteroid can turn a superficial erosion into a deep or perforated ulcer.
C. Antibiotic–corticosteroid combinations are safe in superficial ulcers because the antibiotic offsets the risk
The antibiotic does not counteract the corticosteroid's effect on healing and protease activity; these combinations should not be used with an ulcer.
D. Topical dexamethasone does not reach the stroma, so it does not influence how the ulcer progresses
Dexamethasone penetrates the cornea well, especially when the epithelium is damaged, and acts precisely in the stroma.
lightbulb Key takeaway
Stain every red or painful eye with fluorescein before prescribing a topical anti-inflammatory. If you need to treat uveitis with an ulcer, use systemic anti-inflammatories and topical atropine, and save the topical corticosteroid for when the cornea has healed.
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Updated: October 31, 2026 · Educational content for veterinary professionals. It does not replace current clinical guidelines or the judgement of the attending veterinarian.