When is a corneal patch graft or conjunctival flap considered in equine ulcers?

• A. For superficial ulcers
• B. For nonhealing or deep ulcers at high risk of perforation (e.g., descemetocele) or after debridement to preserve globe and promote healing
• C. For cosmetic effects
• D. For eyelid injuries

Answer: (B)

When a corneal patch graft or conjunctival flap is considered, the aim is to provide structural support and promote healing in ulcers that have thinned the cornea and threaten perforation. Superficial ulcers are typically managed with medical therapy alone and don’t require these tectonic procedures. In contrast, deep ulcers that are nonhealing or at high risk of perforation—such as those approaching a descemetocele—or ulcers that remain after debridement to remove necrotic tissue need coverage with vascularized tissue to stabilize the globe and encourage repair. A conjunctival flap brings a blood-supplied tissue over the ulcer, aiding healing and resisting further breakdown, while a corneal patch graft replaces missing corneal tissue to restore integrity. These approaches are about preserving the eye and promoting healing, not cosmetic improvements, and they’re not indications for eyelid injuries.