This eye exhibits diffuse corneal edema without other signs of inflammation (conjunctival, scleral vascular congestion, aqueous flare). The pupil is dilated (but responsive). The lens also exhibits nuclear sclerosis which contributes to the cloudiness. Differentials for corneal edema include:

• Glaucoma
• Uveitis
• Corneal endothelial degeneration

Measurement of intraocular pressure is essential to rule out glaucoma but once that is established to be normal, these clinical signs are most suggestive of corneal endothelial degeneration. This is a condition seen sporadically in older dogs of all breeds but is inherited in Boston terriers, Chihuahuas, and Dachshunds. In these breeds, the age of onset may be as young as 3-4 years with progressive corneal edema leading to bullous keratopathy ("blisters" which form between the stromal lamellae). Rupture of these bullae results in corneal ulceration which can result in chronic discomfort and progressive corneal fibrosis. Visual impairment occurs as a result of the dense corneal edema and opacification associated with these later stages.

In the early stages, corneal endothelial degeneration is treatment medically with topical hyperosmotics to reduce the corneal edema and anti-inflammatory medications to manage the secondary keratitis. During episodes of ulceration, topical antibiotics are indicated. Recurrent ulceration is an indication for more aggressive management which may include a thermokeratoplasty.
 

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