LIVE IN THE MOMENT!

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LIVE 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

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Ophthalmic Diseases

• Chapter 4
• Common Diseases of Companion Animals

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Ophthalmic Diseases
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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

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Red, congested/swollen, painful
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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

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SCHIRMER TEAR TEST
Cats 11-23mm
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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

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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

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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

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EPIPHORA
FLUSHING THE NASOLACRIMAL DUCT
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Entropion 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

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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

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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

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Hypertrophy and Prolapse of 3rd eyelid gland
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Hypertrophy and Prolapse of Nictitans Gland
(Cherry Eye)

• Nictitating membrane is the 3rd eyelid is a
  protective structure
• Produces 30 of tears
• Cause is unknown
• Bassets, Beagle, Bos. Terr, C. Span
• Signs
• Young dog (lt2 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

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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/Cat12-22 mm Hg
• Causes
• Inherited (C Span, Basset, Chow)
• Secondaryobstruction 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 () IRIDOCORNEAL ANGLE

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Glaucoma

• Dx
• IOPgt30 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
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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
• DxFluorescein dye to cornea

Herpes virus
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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)

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Deep Corneal Ulcer

• Desmetocele erosion to membrane

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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