1 Flashcards
Treatment options for entropion
- Vertical mattress sutures/staples
- Hot celsus technique
- Excise lateral canthal ligament (+ hot celsus)
Entropion pathology
LOWER LAT Lid margin rolls in -> pain + irritation of cornea -> globe reiteration -> lid turns in more (-VE FEEDBACK)
What is the most common form of neeoplasia of the eyelid?
Tarsal gland adenoma (warty cauliflower appearance)
What causes atonic entropion and trichiasis?
Loss of tone in skin of upper eyelid + excessive head skin -> drooping upper eyelid -> hairs impinge on cornea
How would you treat atonic entropion + trichiasis?
STADES PROCEDURE: excise skin adj to upper eyelid
What is hot celsus technique vs stades procedure? When would each be indicated?
HOT CELSUS = excise wedge parallel to lower lid (entropion), STADES = excise parallel to upper lid (atonic entropion + trichiasis)
Define trichiasis
Facial folds -> cause hair to rub on ocular surface
Define distichiasis
Abnormally positioned cilia @ lid margin (close to tarsal gland opening)
How would you treat distichiasis?
Refer for electrolysis/cryosurgery
Ectropion pathology
LOWER lid turns out -> gap between lid + cornea _> exposure conjunctivitis
How would you treat a conjunctival cilia?
Excise wedge of tissue containing cilium +/- cryosurgery to prevent recurrence.
Treatment of ectropion
Usually cosmetic but can wedge excision bordering lat canthus
Define lagophthalmos
Bug eyed brachycephalic dogs with macropalpebral fissures-> pushes globe out -> chronic keratitis + progressive pigmentary infiltration
How is lagophthalmos treated?
Nasal canthoplasty + section medial lig
Define blepharitis + forms of progression
= inflame of eyelid tarsal glands
Meibomianitis = inflam of tarsal glands
Chalazon = obstruction of tarsal gland secretion -> gland rupture -> firm spherical yellow lipogranulomas
What would a dorsal vertically orientated ulcer indicate?
Conjunctival cilia
List 5 causes of 3rd eyelid protrusion
- Reduction in globe contents eg. cachexia, dehydration, masticatory m. atrophy
- Reduction in globe size
- Orbital mass lesion eg. abscess, tumour
- Altered nervous control eg. Horners’ syndrome, tetanus
- Retracted globe eg. anything causing ocular pain
Draw the normal and cherry eye position of the nictitans gland
Refer to notes
Why should third eyelid not be removed and what is the only indication for doing so?
Responsible for approx 1/3 of tear volume. Neoplasia only indication
What are the treatment options for prolapsed nictitans gland?
- Excise gland - high risk of p/op dry eye
- Anterior anchoring technique: suture anchors gland to orbital rim -> prevents norm movement of 3rd eyelid
- Pocket technique: crescent shaped incisions dorsal + ventral to gland on inside surface, appose opposite edges to create pocket around gland, tie knot on outside (so doesn’t abrade cornea)
What is the pathology + treatment of a scrolled 3rd eyelid?
Cartilage kinks and folds outwards-> entire 3rd eyelid no longer contacts cornea. Treat by excising kinked portion of cartilage from deep surface of membrane.
What are the clinical signs of nictitans plasmacytic conjunctivitis, which dogs are most likely to get it?
GSD, Belgian Shepherds, collie types
- bilat thickening + depigmentation of 3rd eyelid
- pink/red fleshy infiltrate
- irreg. surface
What is nictitans plasmacytic conjunctivitis?
Plasma cell +lymphocytic infiltration (immune mediated), often assoc with chronic superficial keratitis
How would you treat a reddened conjunctiva with purulent ocular discharge + slightly increased tear production?
= bacterial conjunctivitis, fusidic acid
What is the normal reference range for dogs and cats on the Schirmer I Tear Test?
D: approx 21mm (>15mm)
C: approx 17mm
IN 1 MINUTE
What is the cause of bacterial conjunctivitis and how is it treated?
Often gram =ve bacteria eg. Staph following primary (rare) infection or secondary to eyelid masses, foreign bodies or irregularities.
Treated with fusidic acid 1-2x/d.
What is the pathology + signalment of keratoconjunctivitis sicca?
AKA: dry eye.
due to lack of aqueous portion of tear film deficiency, commonly because of bilateral immune-mediated destruction of lacrimal tissue, also can be caused by endocrinopathies, some drugs e.g.. sulfadiazine, viral adenines.
Westies + Spaniels = common
What are the clinical signs of dry eye?
- conjunctivitis
- neovascularisation + pigmented cornea
- lacklustre cornea
- mucopurulent discharge
How is dry eye treated?
- Tear replacement- lubricating gel 4-6x/d
- Tear stimulants eg. topical 0.2% cyclosporine (‘optimmune’)
- Parotid duct transposition
Define ‘epiphora’
Excess tear production due to drainage problem
How is epiphora diagnosed?
- Directly observe: normal puncta openings? FB? any medial canthal abnormalities e.g.. ectropion
- Fluoroscein in lacrimal puncta- should be seen out of nose within 4 mins
- Nasolacrimal cannulation (w/ topical anaesthesia + sedation)
- Dacryocystorhinography (flush w/ contrast)
Define dacryocystitis
Inflammation of lacrimal sac often due to FB e.g.. grass seed
A German Shepherd with a rough red fleshy infiltrate in its ventro-lateral cornea presents. What is the pathology and treatment?
Chronic superficial keratoconjunctivitis (‘pannus’). Cyclosporine treatment.
What is the pathology and appearance of corneal dystrophy?
Primary bilat inherited disorder where cholesterol/f.a./phosopholipids deposit. Well demarcated, w/ central/paracentral grey crystalline opacities, no pain.
Older dog, steamy, blue stromal oedema-> cause?
Corneal endothelial degeneration
Describe the clinical signs of corneal ulceration?
- pain
- conjunctival hyperaemia
- corneal oedema (milky)
- irregular surface contour
- neovascularisation of cornea
- secondary anterior uveitis
How would you approach a corneal ulcer case?
- Schirmer I Tear Test (unless lacrimating/deep)
- Fluoroscein + blue light (taken up by exposed stroma)
- Observe + draw diagrams of surface area, site (central/peripheral), edges (obvious/underrun/gelatinous), depth (superficial, deep, full thickness)
- Look for underlying cause
- Look for potential complications eg. brachycephalic, steroids
What are the potential causes of corneal ulceration?
- external trauma (common)
- hair/lash trauma
- infection (secondary to trauma, FeHV)
- exposure keratopathy
- tear film abnormalities
- spontaneous chronic corneal epithelial defect (SCCED)
Define superficial chronic corneal epithelial defects
AKA: Boxer ulcers
edges of ulcer don’t adhere to underlying stroma
Define descemetocoele
Descemetes membrane bulges out due to loss of stromal support (clear centre as no stroma left to be oedematous)
How would you treat superficial and midstromal ulcers?
Topical broad spec antibiotics
How would you treat superficial under run ulcers?
- Topical anaesthesia to cornea
- Debride by pushing back ulcer w/ sterile dry cotton swab
- Augment healing by diamond burr/superficial grid/punctate keratotomy
- soft corneal bandage lens
- recheck every 7-14d until -ve fluoroscein
