Pupil Iris Sclera Conjunctiva Ophthalmic Diseases 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 • ↓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 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 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 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 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 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 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 • 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) 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 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 (±) 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) 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 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 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) Keratitis Pannus—superficial corneal vascularization/scar tissue Progressive, bilateral, can result in blindness • Cause – Thought to be immune-mediated Pannus (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 (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 • Desmetocele – erosion to membrane 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 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 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 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 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 • Inflammation of uvea • Causes – Inflammation/infection – FeLV/FIP, fungal, bacterial – Neoplasia – Trauma 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 Anterior Uveitis – keratic precipitates 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 • 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 • Cause – Trauma – Conformation – Retrobulbar abscess or neoplasia • Clinical Signs – Protrusion of the globe, – Eyelids unable to close, may be trapped behind globe Proptosed Globe Proptosed Globe 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 Globe