Canine Ophthalmic Manifestations of Systemic Disease Flashcards by Blake Thordarson

orbital diseases: exophthalmia

orbital neoplasia: non-painful, slowly progressive and usually unilateral; PX is TERRIBLE
inflammatory: bad teeth, orbital cellulitis; Fever and PAINful and rapid onset

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orbital diseases: enophthalmia

loss of orbital contents (cachexia, dehydration, old masticatory myositis)
Horner’s Syndrome POST-ganglionic 76-80%; older goldens, hypothyroid, diabetics with peripheral neuropathy – look in the EARS too
- Ptosis, miosis, enophthalmos, third eyelid protrusion

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How can you tell if Horner’s Syndrome is POST-ganglionic?

Phenylephrine will make it BETTER and it will come back in 20 minutes or Less!

45 minutes to reverse indicates PRE-Ganglionic (ie: somewhere in the brain)

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Where do you always look if patient has Horner’s?

the EARS — check the ears!!

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Eyelid disorders: Infectious

bacteria (staph) fungal (MALASSEZIA) parasitic (demodex)

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What is the classic sign of Ivermectin toxicity/overdosing?

DILATED PUPILs

Blindness and optic neuritis can also happen in acute overdoses,

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Eyelid disorders: inflammatory

Atopy - recurrent BILATERAL steroid response to conjunctivits — TX w/ Atopica, systemic steroids
puppy strangles/juvenile cellulitis - THICK, HARD LIDS, scabby pinnae, big cervical LN. – TX Systemic Steroids
Vaccine reactions - tx with e-collar, epinephrine, IV antihistamines, careful of AIRWAY obstruction
immune-mediated diseases (pemphigus; systemic histiocytosis of bernese mountain dogs; VKH-like syndrome; lupus-discoid; dermatomyositis)

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Eyelid inflammatory: immune-mediated: Pemphigus

TX Systemic immunosuppressives

horrible, weepy blepharitis; mucocutaneous junctions all scabby and crusty

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Eyelid inflammatory: immune-mediated: systemic histiocytosis of Bernes Mountain Dogs

SEVERE BLEPHARITIS and Uveitis can happen too

GENETIC disease, don’t breed them.

Tx systemic immunosuppressives

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Eyelid inflammatory: immune-mediated: VKH-Like Syndrome

Young to middle aged

AKITAS

melanocytes attacked – depigmentation of NOSE and CHIN

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Eyelid inflammatory: immune-mediated: Lupus - Discoid (SLE more rarely)

perinasal and periocular rash in humans

blepharitis/facial dermatitis

KCS with polyarthritis and glomerulonephritis

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Eyelid inflammatory: immune-mediated: dermatomyositis

COLLIE disorder and RARE

Periocular dermatitis around the lids

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Conjunctiva and Sclera: Discoloration

juandice - hemolysis, the SCLERA is NOT discolered, its the CONJUNCTIVA (moves freely)
pallor - ANEMIA
hemorrhage - COAGULOPATHIES

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Conjunctiva and Sclera: Inflammatory diseases

allergic conjunctivitis
episcleritis (intraocular) - immune-mediated in Cocker Spaniels with DIFFUSE scleritis and other allergy issues
Nodular granulomatous episclerokeratitis in COLLIEs (lumpy bumpy skin lesions NOSE and FACE TX w/ systemic steroids and topical azathioprine and cyclopsporine)

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Conjunctiva and Sclera: Infectious diseases

Distemper (acute KCS and conjunctivitis, BILATERAL mucopurlent discharge, Snotty Nose, Febrile, Hard-Pad Disease, Neurologic signs)
rickettsial diseases - RMSF and ehrlichiosis cause REALLY RED CONJUNCTIVA with +/- fever
Neoplasia - 3rd eyelid LSA; eyelid/conjunctival melanoma (not as bad as limb or oral) limbal in Labs; Palpebral/3rd eyelid Melanomas are the WORST but still not as bad as oral/extremity melanomas

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Nasolacrimal/Tears: Primary KCS

due to immune-mediated adenitis of lacrimal and third eyelid glands
associated with ATOPY – Cyclosporine A and Tacrolimus responsive

Anytime you have an animal with KCS there may be other things causing!!

Nasolacrimal/Tears: Neurogenic KCS

due to lack of parasympathetic innervation; may also see Dry Nose on same side of face

NOT responsive to Cyclosporine A, it’s not immune-mediated

Unilateral - Check the EARS

Nasolacrimal/Tears: Drug induced KCS

Sulfasalazine - GI Tx of IBD –> Monitor STT
Trimeth-Sulfa - tx of bacT infections –> Monitor STT
Etodolac - not around anymore really; induced tear film deficiency –> Monitor STT

CAN go back to normal once drug is stopped, BUT once the tear production goes to ZERO, it is PERMANENT.

Cornea: Lipid Degeneration

can be:

inherited
primary
2˚ for lipid metabolism dz (hypothyroid, Cushing, DM)

Sparkly crystals in the STROMA, benign

Cornea: Edema in conjunction with anterior uveitis

Infectious canine hepatitis/CAV-1 or from the VACCINE

UNILATERAL - YOUNG, and vaccinated with a CHEAP vaccine

Cornea: Edema from using Tocainide

old-school antiarrythmic agent damaging corneal endothelial cells

used in boxers and dobermans a while ago

Lens: Diabetic Cataract

MIDDLE-AGED, RAPID onset and BILATERAL with “Y-suture clefts and equatorial cuffing”

Osmotic cataracts from formation of sorbitol

Most common cause of cataracts

Anterior Uvea: Hyphema

trauma
glaucoma
retinal detachments
post-op intraocular sx
coagulopathies
uveitis
intraocular mass/neoplasia

Anterior Uvea: Lipemic Aqueous Humor

look for cause of systemic lipemia
CATS and Diabetic Dogs - especially Diab. Schnauzers

Bilateral or Unilateral and can happen post-prandial and go away – indicating not uveitis or edema

Anterior Uvea: HW Dz

RARELY can see worm in anterior chamber

Posterior Segment Disease: Posterior Uveitis (chorioretinitis/retinitis)

Distemper and gold medallion lesions Acute chorioretinitis cryptococcosis

Posterior Segment Disease: Chorioretinal hemorrhage

1. coagulopathies - infectious and toxic 2. hyperviscosity syndromes 3. hypertension - vascular TORTUOSITY, not in cat (Diabetic dogs, Cushings, CRF, pheochromocytomas, HyperT in cats) 4. neoplasia

Posterior Segment Disease: Retinal "degeneration": SARDS - Sudden Acquired Retinal Degeration Syndrome (rare)

Photoreceptors just DIE -- normal one day, Blind the next. Electroretinogram tells NOT optic neuritis. **Cushinoid Systemic signs. RARE in dogs

Posterior Segment Disease: Retinal "degeneration": Vitamin E Deficiency

Little DARK SPOTS on the Tapetum - high fat diets, vit. e deficient RPE hyperpigmentation aka Central Progressive Retinal Atrophy

Posterior Segment Disease: Retinal "degeneration": Optic Disk Disease

Optic Neuritis: will see a SWOLLEN DISC, peripapillary edema, exudates, or hemorrhage. Blind with DEC. PLR If retrobulbar, disc may look normal. BLIND ANIMAL -- Pug encephalopathy, can show up as this. GME can look like this - Reticulosis or GME/granulomatous meningoencephalitis: +/- other neuro signs - Crypto: subretinal exudates, +/- other neuro signs - toxo: rare in dogs. multifocal chorioretinal scarring (gray lines) or active exudates - distemper: seen in acute dz; FUZZY disc, DEC PLR, vision loss

Posterior Segment Disease: Retinal "degeneration": Optic Disk Atrophy

see PALE or HYPERPIGMENTED disc, contracted, lack of vascularity over disc surface. May be BLIND with dec. or no PLR. Distemper Previous optic neuritis Toxin: LEAD, arsenic, thallium, ivermectin in collies and herding breeds.