November 10th, 2023

Brachycephalic Ocular Syndrome – Why do Pugs keep getting Ulcers?

By Fiorella Castro

This Webinar is sponsored by TVM and given by Dr Neil Geddes. It is focused on ocular diseases of brachycephalic breeds of dogs and cats.  

The Learning Objectives are:  

  • Brachycephalic Anatomy 

  • Detail Disease Process 

  • Detail Clinical Signs 

  • Detail Treatment 

  • Detail Prevention 

Brachycephalic ocular syndrome is a syndrome that occurs in breeds of dogs and cats with a flat face. These breeds present with many anatomical complications such as macro palpebral fissure, lagophthalmic, reduced corneal sensation, medial entropion, and poor tear films, which do not give sufficient protection to the eye hence why this syndrome usually appears.  

The webinar begins with an anatomical review, discussing canine tear film and its three phases, the canine cornea emphasising that it is avascular and difficult to heal when subjected to trauma. 

The corneal epithelium is normally damaged regularly and its healing lasts approximately 7 days. The stromal healing lasts longer and as it is a balance between protease and anti-protease enzymes, what happens in brachycephalic breeds is that this balance is lost and there is no one to control the over digestion of cells. 

Dr Neil explains that ulcers in dogs are usually caused by trauma, while in cats, the main cause is feline herpes virus 1, killing the epithelium of the cornea and conjunctiva. An an exposure of the underlying corneal stroma in brachycephalic dogs can also play a part.

To diagnose an ulcer Dr Neil recommends fluorescein and the use of blue light. 

Usually in brachycephalic breeds we find deep/melting ulcers, which are the result of an imbalance between protease and anti-protease, resulting in corneal ‘melting’ which is a keratomalacia. Dr Neil explains it in depth and explains the causes, with pseudomonas aeruginosa being one of the most common. 


For the treatment of these ulcers, it is necessary to be very assertive when it comes to antibiotics, as Pseudomonas are resistant to first line of antibiotics. Dr Neil gives a list of antibiotics that can be used, and details when and why each should be used. Non antibiotics drugs are also mentioned and the steps to take with a patient presenting with this condition, such as hospitalisation. Anti-protease treatment is also discussed. 

There are risk factors for melting that are mentioned and explained in the webinar. 

The signs that we are having success with our treatment are; the eye is less painful, the ulcer is shrinking, and its edges appear smooth, the cornea is usually more stable and when fluorescein is applied the area it paints is becoming smaller. Dr Neil points out that 50% of cases require surgery. He also mentions in when emergency surgery should be performed. 

The Webinar discusses corneal perforation, its clinical signs, its treatment, and the different surgical procedures that can be performed.  

This webinar is full of unbelievably valuable information, explained well, full of pictures and examples. I highly recommend it. 

Why Do Pugs Keep Getting Ulcers?

Find Out Here