chronic superficial keratitis (pannus) pannus—superficial corneal vascularization/scar tissue...
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Chronic Superficial Keratitis (Pannus)
Pannus—superficial corneal vascularization/scar tissueProgressive, 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
Chronic Superficial Keratitis (Pannus)• 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
DOGGLES!!!!
Keratoconjunctivitis Sicca (KCS)Lack of tear production; tears lubricate, nourish, ↓bacteria, aid in healingTears 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; usually does not affect sight
CATARACTS
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
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
Anterior Uveitis
• Inflammation of uvea: ciliary body, iris, choroid
• 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 – Treatment
• Topical steroids or• Topical Anti-inflmmatory drugs (ocufen)• Or 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
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
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