Clinical approach to a Cloudy Eye

Question 1

What is the diagnostic approach for a cloudy eye?

Answer 1

Localize the lesion (region)
Qualify the Lesion (what is it)
Determine lesion etiology (what’s causing it)

Question 2

How do you:
Localize the lesion:
Diagnose the lesion:
Know where the lesion originated:

Answer 2

Exam- specific technique (tonometry)

Subjective/objective qualifiers based on physical appearance

Other ocular and non-ocular exam findings, history and signalment

Question 3

What are some historical factors to consider?

Answer 3

Onset: rapid, gradual, recent, chronic, progressive

Signalment: Breed predisposition, age

Symptoms: Ocular and non-ocular

Question 4

Where can cloudiness be localized to?

Answer 4

Cornea, anterior chamber, lens, posterior segment (vitreous and retina)

Question 5

What kinds of materials can be seen causing cloudiness in the cornea?

Answer 5

Edema - ulceration, endothelial dysfunction
Homogeneous

Scar/Fibrosis - prior ulcer/trauma, chronic exposure, chronic abrasion
Homogenous

Lipid - lipid, dystrophy, lipid degeneration

Mineral - Degeneration and Metabolic

Question 6

What 2 main things cause corneal edema and what causes them?

Answer 6

Ulceration

Endothelial Dysfunction - anterior uveitis, glaucoma, endothelial degeneration, localized dysfunction

Question 7

What kind of edema is associated with endothelium degeneration?

Answer 7

Speculated corneal edema

Question 8

What is a common cause of corneal edema in a horse that is non-painful and doesn’t stain?

Answer 8

Immune mediated keratitis - chronic corneal opacity with no presence of ulcer or uveitis

Non-painful

Question 9

If you find corneal edema in one eye you should…

Answer 9

Check the other

Question 10

What is rubuiosis?

Answer 10

Vascular lines going in toward the cornea in the iris

Question 11

What is synechia?

Answer 11

Abnormal adhesions between iris and Lense or cornea

Question 12

What is a persistent pupillary membrane?

Answer 12

When the pupil is covered with lines from iris and cornea

Question 13

What causes corneal scar or fibrosis?

Answer 13

Prior ulcer/trauma
Chronic exposure (lagophthalmos or KCS)
Chronic abrasion - entropion, distichia and ectopic cilia
Homogenous

Question 14

What can help you differentiate corneal scar from ulcer?

Answer 14

A slit lamp
-Flouresien stain may help

Question 15

What causes corneal lipid (Lipid Keratopathy?

Answer 15

Lipid dystrophy- hereditary
Lipid Degeneration - prior keratitis, infiltrative corneal disease, topical corticosteroids and systemic metabolic disease

Question 16

What does lipid dystrophy look like?

Answer 16

Numerous coalescing small particles
Common in collies
Glittery, sparkly and refractile

Question 17

What does lipid degeneration look like?

Answer 17

More pronounced, hyperlipidemia
Sparkly
-Can be at site of corneal ulceration
-Metabolic Disease
-Infiltrative corneal disease (Associated with melanoma, pannus, NGE, corneal lesion)

Question 18

What causes corneal mineralization?

Answer 18

Degeneration - ocular disease and age-related change

Metabolic - systemic metabolic disease

Question 19

What does corneal mineralization look like?

Answer 19

-particles coalescing to form a lesion
-spiculated
-Less refractile

Question 20

What are some hints that is may be corneal mineralization versus lipids?

Answer 20

Mineral deposits, lipid rare with blood vessels
-less shiny and refractile
-Moth eaten
-Spiculated (crack like)

Question 21

A good question to ask yourself while trying to differentiate is, is it painful?
Yes:
No:

Answer 21

Yes: edema (ulcer, anterior uveitis, glaucoma

No: Scar or fibrosis, edema (endothelial degenerations), lipid and mineral

Question 22

What kinds of things can happen in the anterior chamber?

Answer 22

Aqueous Flare (protein) - Uveitis - painful
Lipid Flare -Metabolic/hyperlipidemia (uveitis) - non-painful

Question 23

What does it look like when you have aqueous flare?

Answer 23

-Some degree of corneal edema
-Need focal light to see it
-Hazy and turbid
-may accompany miosis and uveitis
-iris color change

Question 24

What are signs of anterior uveitis?

Answer 24

Miosis, iris color change, aqueous flare, painful, conjunctival hyperemia

Question 25

What does lipemic aqueous look like?

Answer 25

Milky - cant see inside past it
Minimal discomfort
Commonly unilateral

Question 26

What is a quick diagnostic for lipid flare?

Answer 26

Take blood and spin down the serum - look like milk

Question 27

What are some issues that can occur with the Lense?

Answer 27

Nuclear Sclerosis (aging normal)
Cataract (opacity)

Question 28

What does nuclear sclerosis look like?

Answer 28

nothing prevents light from going through - can see retina
-nucles of Lense demarcated

Question 29

How do you ID these diseases?

Answer 29

Direct ophthalmoscopy - see back of eye

Question 30

What does a cataract look like?

Answer 30

Light cant go through the retina
-Insipient - covers half (<10%)
-Early immature - small (>10%)
-Mature - 100%
-Hypermature - absorb or liquify
(Y cleft = diabetes)

Question 31

What can be cloudy in the posterior segment?

Answer 31

Vitreous- inflammation, asteroid hyalosis, synchesis scintillans

Retinal - retinal detachment

Question 31

What does asteroid hyalosis look like?

Answer 31

Snow globe like particles in back of eye - look like cataract
-Multifocal opacities
*Incidental - age related degenerative changes - intracocular neoplasms

Question 32

What does retinal detachment look like?

Answer 32

Bilateral diminished tapetal reflection due to retinal detachment (hypertension)