1. LIVE IN THE MOMENTLIVE IN THE MOMENT! “The secret of health for both mind and body is not to mourn for the past, not to worry about the future, or not to anticipate troubles, but to live in the present moment wisely and earnestly.” -Buddha

2. Ophthalmic Diseases Chapter 4 Common Diseases of Companion Animals

3. Ophthalmic Diseases

5. Conjunctivitis CONJUNCTIVA: pink tissue that lines the inner surface of the eyelids and covers the front portion of the eyeball except for the cornea Causes – Allergy (atopy) – Anatomic (ectropion, entropion) – Bacterial infection (predisposed by): Injury ↓Tear production Foreign body Respiratory disease (bacteria, virus) Causes (in cats it is usually infectious) – Feline herpes virus (most common cause of bilateral conjunctivitis) – Calicivirus – Chlamydia psittaci bacteria – Mycoplasma

6. Red, congested/swollen, painful

7. Conjunctivitis Signs – Redness – Chemosis (swelling of conjunctiva) – Ocular discharge (tears, mucus) Diagnosis – Determine 1º disease, if any – Rule out FB – Rule out ‘dry eye’ in recurrent cases Schirmer tear test – 1 min- tears show as blue dye

8. SCHIRMER TEAR TEST Cats: 11-23mm

9. Conjunctivitis Rx – Topical antibiotic ointment neomycin/bacitracin/polymyxin B(BNP or triple antibiotic) 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

10. Epiphora EPIPHORA: excessive 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

11. 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 – May act as a wick Client info – Staining due to pigment in tears, not blood – Some dogs have life-long problem

12. EPIPHORA FLUSHING THE NASOLACRIMAL DUCT

13. EntropionEntropion: eyelids that roll in against the cornea 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 – Chesapeake, Labs, Chow, Samoyed – 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

15. Entropion Treatment – Surgical correction is treatment of choice Temporary mattress suture to evert eye (young animal) Lateral canthoplasty (to shorten eye lid) Hotz-Celsus: Remove elliptical piece of tissue from under eye

17. 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

18. Hypertrophy and Prolapse of 3 rd eyelid gland

19. Hypertrophy and Prolapse of Nictitans Gland (Cherry Eye) Nictitating membrane is the 3 rd eyelid; is a protective structure Produces ~30% of tears Cause is unknown – Bassets, Beagle, Bos. Terr, C. Span Signs – Young dog (<2 y) – Epiphora – Usually no pain Dx – r/o tumor in older dogs and cats Rx – Sx to remove gland is an option, but not recommended – Suture back in place

20. 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 (ciliary body, iris, choroid) Signs – Ocular pain – Episcleral injection – Corneal edema – Dilated pupil (unresponsive to light) – Blind (±)

21. 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

22. 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

23. 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 for cats with herpes virus) – 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)

24. Deep Corneal Ulcer Desmetocele – erosion to membrane

26. Ulcerative Keratitis (Corneal Ulcers) Client info – Most ulcers heal quickly with treatment – Avoid using old medications – Rx with cortisone will inhibit healing of ulcer – Do not touch eye with ointment applicator

27. Chronic Superficial 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) – Increased ultraviolet light/high altitudes increases incidence Signs – Opaque lesions that begin at limbus and extend into cornea Milky, pink, or tan

28. Chronic Superficial Keratitis (Pannus)

29. Breeds – Ger. Shep, B. Collie, greyhound, Sib. Husky Dx – r/o KCS, corneal ulcers Rx – Corticosteroids often lifelong – Cyclosporine often lifelong – Antibiotic eye ointment Client info – No cure – If Rx is stopped, disease will return and progress – High altitudes and ↑sun predispose animals

30. DOGGLES!!!!

31. Keratoconjunctivitis Sicca (KCS) Lack of tear production; tears 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

32. KCS

33. 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

36. 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; usually does not affect sight

37. CATARACTS

39. Progressive Retinal Atrophy A group of hereditary disorders causing loss of rods, cones, and/or blood supply – Breeds Toy/min. Poodle, G. Ret, I. Set, C. Span, Schnauzer, Collie, Samoyed, N. Elkhound Recessive gene isolated in some breeds Signs—slow onset of blindness – Loss of night vision (rods) → loss of day vision (cones) → cataracts (±) Dx – r/o metabolic disorders that could cause cataracts – Ophth exam gray, granular appearance of retina Hyperreflective retina Vascular attenuation, optic nerve atrophy

41. Normal canine retinaPRA, optic nerve atropy and vessel attenuation PROGRESSIVE RETINAL ATROPHY

42. 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 well balanced diet Taurine deficiency can lead to PRA

43. Anterior Uveitis Inflammation of uvea: ciliary body, iris, choroid Causes – Inflammation/infection – FeLV/FIP, fungal, bacterial – Neoplasia – Trauma

44. 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

45. Anterior Uveitis – hyphema

46. Anterior Uveitis

47. Anterior Uveitis – keratic precipitates

48. Anterior Uveitis – Treatment Topical steroids or Topical Anti-inflmmatory drugs (ocufen) Or systemic steroids Atropine – dilates eye, decreases pain Antibiotics – topically +/- systemically

49. 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

50. Proptosed Globe Cause – Trauma – Conformation – Retrobulbar abscess or neoplasia Clinical Signs – Protrusion of the globe, – Eyelids unable to close, may be trapped behind globe

51. Prognosis Favorable – brachycephalic dog, – positive direct or consensual pupillary light response – normal findings on posterior segment exam – proptosed eye with vision on initial presentation Unfavorable indicators – non-brachycephalic – cat breed – hyphema, – no visible pupil – facial fractures – optic nerve damage and avulsion of 3 or more extraocular muscles

52. Proptosed Globe

53. 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

54. Proptosed Globe

55. References http://www.vetmed.ucdavis.edu/courses/vet_ey es/ http://www.vetmed.ucdavis.edu/courses/vet_ey es/ Alleice Summers, Common Diseases of Companion Animals http://www.vetmed.wisc.edu/Data/CourseMate rial/Miller/Emergencies.pdf