Ophthalmic diseases
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Ophthalmic Diseases. Pupil IrisSclera Conjunctiva. Chapter 4 Common Diseases of Companion Animals. Conjunctivitis . Causes (in dogs, usually not caused by infectious agent) Allergy (atopy) Anatomic (ectropion, entropion) Bacterial infection (predisposed by): Injury

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Ophthalmic diseases

Ophthalmic Diseases

Pupil IrisSclera Conjunctiva

Chapter 4

Common Diseases of Companion Animals


Conjunctivitis

Conjunctivitis

  • Causes (in dogs, usually not caused by infectious agent)

    • Allergy (atopy)

    • Anatomic (ectropion, entropion)

    • Bacterial infection (predisposed by):

      • Injury

      • ↓Tear production

      • Foreign body

  • Causes(in cats, it is usually infectious)

    • Feline herpes virus (most common cause of bilateral conjunctivitis)

    • Calicivirus

    • Chlamydia psittaci bacteria

    • Mycoplasma


Conjunctivitis1

Conjunctivitis

  • Signs

    • Redness

    • Chemosis (swelling of conjunctiva)

    • Ocular discharge (tears, mucus)

  • Dx

    • Determine 1º disease, if any

    • r/o FB

    • r/o ‘dry eye’ in recurrent cases

      • Schirmer tear test

      • 1 min; tears show as blue dye


Conjunctivitis2

Conjunctivitis

  • Rx

    • Topical antibiotic ointment

      • neomycin/bacitracin/polymyxin B

      • Gentamicin ophthalmic ointment

      • Antibiotic w/ cortisone (if cornea is intact)

  • Client info

    • Do not allow dogs to ride with head out window

    • Keep medial canthus of eye clean (warm water, clip hair)

    • Vaccinate kittens to prevent URI

    • Do not touch eye with applicator

    • Discard unused medication


Epiphora

Epiphora

Excess tearing

  • Causes (2 causes)

    • Overproduction of tears

      • Ocular pain, irritation (from hair, etc)

    • Faulty drainage by lacrimal system

      • Blockage of duct (swelling, inflam)

      • Blockage of puncta (hair, debris)

      • Imperforate puncta (no opening)

        • Cockers

        • Poodles

      • Trauma


Epiphora1

Epiphora

  • Signs

    • Watering of eye

    • Discoloration of hair

  • Dx

    • Fluorescein dye test

      • Dye at nose shows duct is open

  • Rx

    • Treat 1º cause

      • Flush lacrimal ducts

      • Surgically open imperforate puncta

      • Topical antibiotic ointment

      • Keep hair trimmed around eyes

  • Client info

    • Hair acts as wick

    • Staining due to pigment in tears, not blood

    • Some dogs have life-long problem


Entropion

Entropion

Eye lids rub against cornea; common in dogs, not in cats

  • Causes

    • Congenital—large orbits w/ deep-set eyes (poor lid support)

      • Collies, G Dane, I Set, Dobe, G Ret, Rott, Weim

    • Poor ocular muscle development (also congenital)

      • Chesapeake, Labs, Chow, Sam

    • Trauma → scarring with distortion of lid

    • 2º to painful corneal lesion, conjunctiva inflammation (most common cause in cats)

  • Signs

    • Epiphora (tearing)

    • Chemosis (swelling of conjunctiva)

    • Conjunctivitis

    • Pain

    • Corneal ulceration (±)

    • Photophobia


Entropion1

Entropion

  • Rx

    • Surgical correction is TOC

      • Temporary mattress suture to evert eye (young animal)

      • Lateral canthoplasty (to shorten eye lid)

      • Remove elliptical piece of tissue from under eye


Ectropion

Ectropion

  • Causes

    • Congenital

      • Bassets, Blood, C Span, E Bull, St Bern

  • Signs

    • Conjunctivitis

    • Epiphora

    • Keratitis (corneal inflammation/scarring), usually from exposure

    • Purulent exudate

  • Rx

    • Surgery to shorten eye lid

    • Other procedures


Hypertrophy of nictitans gland cherry eye

Hypertrophy of Nictitans Gland (Cherry Eye)

Nictitating membrane is the 3rd eyelid; is a protective structure

Produces ~30% of tears

  • Cause is unknown

    • Bassets, Beagle, B Terr, C Span

  • Signs

    • Young dog (<2 y)

    • Epiphora

    • Usually no pain

  • Dx

    • r/o tumor

  • Rx

    • Sx remove gland

    • Stitch back in place


Glaucoma

Glaucoma

Aqueous humor provides nourishment to lens and cornea

Increased intraocular pressure; → Blindness

Normally, the amt of fluid produced = amt of fluid leaving eye

Normal: Dog/Cat—12-22 mm Hg

  • Causes

    • Inherited (C Span, Basset, Chow)

    • Secondary—obstruction of drainage angle

      • Neoplasia

      • Luxation of lens

      • Hemorrhage

      • Uveitis

  • Signs

    • Ocular pain

    • Episcleral injection

    • Corneal edema

    • Dilated pupil (unresponsive to light)

    • Blind (±)


Glaucoma1

Glaucoma

  • Dx

    • IOP>30 mm Hg

  • Rx

    • Acute (this is an emergency; prevent blindness)

      • Latanoprost (Xalatan 0.005%)

        • Facilitates aqueous outflow

      • Dichlorphenamide (Daranide)

        • Decreases aqueous production

      • Surgical

        • Cryosurgery or laser (destroys part of ciliary body)

          • Decreases aqueous production

    • Chronic

      • Enucleation to relieve pain

Schiotz Tonometer

Tono-Pen


Ulcerative keratitis corneal ulcers

Ulcerative Keratitis(Corneal Ulcers)

Ulcers usually heal within a few days

  • Causes

    • Trauma

    • Chemical burns

    • Foreign objects

    • KCS (Keratoconjunctivitis Sicca)

    • Conformational abnormalities

    • Herpes virus (cats)

  • Signs

    • Pain

    • Epiphora

    • Blepharospasm (eyelid spasm)

    • Hyperemia of conjunctiva

  • Dx—Fluorescein dye to cornea

Herpes virus


Ulcerative keratitis corneal ulcers1

Ulcerative Keratitis(Corneal Ulcers)

  • Rx

    • Topical atropine (1%) ointment (Debate over benefits and how long to use)

      • Decrease pain, blepharospasm

    • Topical broad-spectrum antibiotic ointment

    • Viral ointments or solutions (Viroptic)

    • Surgery

      • Eyelid flap, conjunctival flap

    • Serum (autologous)

      • Blocks proteases released from leukocytes and bacteria (helps prevent continued collagen loss)

        • keep in refrigerator (throw out after 72 hours)


Ulcerative keratitis corneal ulcers2

Ulcerative Keratitis(Corneal Ulcers)

  • Client info

    • Most ulcers heal quickly with treatment

    • Avoid using old medications

    • Rx with cortisone will retard healing of ulcer

    • Do not touch eye with ointment applicator


Chronic superficial keratitis pannus

Chronic Superficial Keratitis (Pannus)

Keratitis

Pannus

Pannus—superficial corneal vascularization/scar tissue

Progressive, bilateral, can result in blindness

  • Cause

    • Thought to be immune-mediated

      (Infiltration of cornea with lymphocytes, plasma cells)

    • Animals living above 5000 ft elevation most susceptible

    • Increased ultraviolet light increases incidence

  • Signs

    • Opaque lesions that begin at limbus and extend into cornea

      • Milky, pink, or tan


Chronic superficial keratitis pannus1

Chronic Superficial Keratitis (Pannus)

  • Breeds

    • G Shep, B Collie, greyhound, S Huskie

  • Dx

    • r/o KCS, corneal ulcers

  • Rx

    • Corticosteroids for life

  • Client info

    • No cure

    • If Rx is stopped, disease will return and progress

    • High altitudes and ↑sun predispose animals


Deep corneal ulcer

Deep Corneal Ulcer

  • Desmetocele – erosion to membrane


Keratoconjunctivitis sicca kcs

Keratoconjunctivitis Sicca (KCS)

Lack of tear production; tears clean, lubricate, nourish, ↓bacteria, aid in healing

Tears from 2 glands: 70%--Lacrimal gland; 30%--Nictitans gland

  • Signs

    • Recurrent conjunctivitis, corneal ulcers, keratitis

    • Dull, dry, irregular cornea, conjunctiva

    • Tenacious, mucoid ocular discharge

    • Blepharospasm

    • Crusty nares

  • Rx

    • Tear stimulation—cyclosporine, pilocarpine

    • Artificial tears

  • Client info

    • Px is guarded for resolution

    • Failure to treat → blindness


Cataracts

Cataracts

Opacity of lens that causes reduced vision; most common disease of lens

  • Cause

    • Genetic

    • 2º to:

      • Diabetes mellitus (bilat; within 1 y of disease; ↑glucose → ↑fluid in lens)

        • Most common cause

      • Trauma (unilateral; HBC, thorn penetration, shotgun pellet)

      • Lens luxation

      • Nutritional deficiency

      • Uveitis

      • Hypocalcemia

      • Electrical shock

  • Rx

    • Surgical removal of lens

    • Treat underlying cause (e.g., Diabetes)

  • Client info

    • Most cataracts are inherited, so don’t breed affected dogs

    • Dogs can live quality lives even with bilat cataracts


Cataracts1

Cataracts

  • Signs

    • Progressive loss of vision

    • Opaque pupillary opening

  • Dx

    • Must be distinguished from senile nuclear sclerosis

      • Normal old age change; graying of lens; bilat; usu does not affect sight


Progressive retinal atrophy

Progressive Retinal Atrophy

A group of hereditary disorders causing loss of rods, cones, and/or blood supply

  • Breeds

    • T/min Pood, G Ret, I Set, C Span, Schnauz, Collie, Sam, N Elk

      • Recessive gene isolated in some breeds

  • Signs—slow onset of blindness

    • Loss of night vision → loss of day vision → cataracts (±)

  • Dx

    • r/o metabolic disorders that could cause cataracts

    • Ophth exam

      • gray, granular appearance of retina

      • Hyperreflective retina

      • Vascular attenuation, optic nerve atrophy


Progressive retinal atrophy1

Progressive Retinal Atrophy

  • Rx

    • None

  • Client info

    • This is an inherited disease

    • Avoid buying affected breeds

      • Have ophth exam by board certified ophth to r/o PRA

    • Blind animals adapt well

      • Have trouble in strange surroundings

    • Cats need taurine supplemented food to avoid retinal degeneration


Anterior uveitis

Anterior Uveitis

  • Inflammation of uvea

  • Causes

    • Inflammation/infection – FeLV/FIP, fungal, bacterial

    • Neoplasia

    • Trauma


Uveitis clinical signs

Uveitis – Clinical Signs

  • Blepharospasm

  • Aqueous flare – increased turbidity of aqueous humor

  • Miosis of affected eye

  • Iridal swelling or congestion

  • Keratic precipitates

  • Ciliary flush in limbal region

  • +/- Corneal edema

  • +/- hyphema


Anterior uveitis hyphema

Anterior Uveitis – hyphema


Anterior uveitis1

Anterior Uveitis


Anterior uveitis keratic precipitates

Anterior Uveitis – keratic precipitates


Anterior uveitis treatment

Anterior Uveitis – Treatment

  • Topical steroids

  • Topical Antiinflmmatory drugs (ocufen)

  • Subconjunctival steroids

  • Systemic steroids

  • Atropine – dilates eye, decreases pain

  • Antibiotics – topically +/- systemically


Anterior uveitis client info

Anterior Uveitis – Client Info

  • Recheck within 3 days

  • Secondary glaucoma is frequent complication

  • Prognosis depends on cause

  • Treat for 2 months regardless of cause – blood-aqueous barrier disrupted for 6 weeks


Proptosed globe

Proptosed Globe

  • Cause

    • Trauma

    • Conformation

    • Retrobulbar abscess or neoplasia

  • Clinical Signs

    • Protrusion of the globe,

    • Eyelids unable to close, may be trapped behind globe


Proptosed globe1

Proptosed Globe


Proptosed globe2

Proptosed Globe


Proptosed globe treatment

Proptosed Globe – Treatment

  • Lubricate immediately

  • Reduce the globe into the socket ASAP to reduce trauma to optic nerve

  • Enucleation if optic nerve severed

  • Systemic and topical antibitics

  • +/- Steroids


Proptosed globe3

Proptosed Globe


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