Clinical approach to a Cloudy Eye Flashcards
What is the diagnostic approach for a cloudy eye?
Localize the lesion (region)
Qualify the Lesion (what is it)
Determine lesion etiology (what’s causing it)
How do you:
Localize the lesion:
Diagnose the lesion:
Know where the lesion originated:
Exam- specific technique (tonometry)
Subjective/objective qualifiers based on physical appearance
Other ocular and non-ocular exam findings, history and signalment
What are some historical factors to consider?
Onset: rapid, gradual, recent, chronic, progressive
Signalment: Breed predisposition, age
Symptoms: Ocular and non-ocular
Where can cloudiness be localized to?
Cornea, anterior chamber, lens, posterior segment (vitreous and retina)
What kinds of materials can be seen causing cloudiness in the cornea?
Edema - ulceration, endothelial dysfunction
Homogeneous
Scar/Fibrosis - prior ulcer/trauma, chronic exposure, chronic abrasion
Homogenous
Lipid - lipid, dystrophy, lipid degeneration
Mineral - Degeneration and Metabolic
What 2 main things cause corneal edema and what causes them?
Ulceration
Endothelial Dysfunction - anterior uveitis, glaucoma, endothelial degeneration, localized dysfunction
What kind of edema is associated with endothelium degeneration?
Speculated corneal edema
What is a common cause of corneal edema in a horse that is non-painful and doesn’t stain?
Immune mediated keratitis - chronic corneal opacity with no presence of ulcer or uveitis
Non-painful
If you find corneal edema in one eye you should…
Check the other
What is rubuiosis?
Vascular lines going in toward the cornea in the iris
What is synechia?
Abnormal adhesions between iris and Lense or cornea
What is a persistent pupillary membrane?
When the pupil is covered with lines from iris and cornea
What causes corneal scar or fibrosis?
Prior ulcer/trauma
Chronic exposure (lagophthalmos or KCS)
Chronic abrasion - entropion, distichia and ectopic cilia
Homogenous
What can help you differentiate corneal scar from ulcer?
A slit lamp
-Flouresien stain may help
What causes corneal lipid (Lipid Keratopathy?
Lipid dystrophy- hereditary
Lipid Degeneration - prior keratitis, infiltrative corneal disease, topical corticosteroids and systemic metabolic disease
What does lipid dystrophy look like?
Numerous coalescing small particles
Common in collies
Glittery, sparkly and refractile
What does lipid degeneration look like?
More pronounced, hyperlipidemia
Sparkly
-Can be at site of corneal ulceration
-Metabolic Disease
-Infiltrative corneal disease (Associated with melanoma, pannus, NGE, corneal lesion)
What causes corneal mineralization?
Degeneration - ocular disease and age-related change
Metabolic - systemic metabolic disease
What does corneal mineralization look like?
-particles coalescing to form a lesion
-spiculated
-Less refractile
What are some hints that is may be corneal mineralization versus lipids?
Mineral deposits, lipid rare with blood vessels
-less shiny and refractile
-Moth eaten
-Spiculated (crack like)
A good question to ask yourself while trying to differentiate is, is it painful?
Yes:
No:
Yes: edema (ulcer, anterior uveitis, glaucoma
No: Scar or fibrosis, edema (endothelial degenerations), lipid and mineral
What kinds of things can happen in the anterior chamber?
Aqueous Flare (protein) - Uveitis - painful
Lipid Flare -Metabolic/hyperlipidemia (uveitis) - non-painful
What does it look like when you have aqueous flare?
-Some degree of corneal edema
-Need focal light to see it
-Hazy and turbid
-may accompany miosis and uveitis
-iris color change
What are signs of anterior uveitis?
Miosis, iris color change, aqueous flare, painful, conjunctival hyperemia
What does lipemic aqueous look like?
Milky - cant see inside past it
Minimal discomfort
Commonly unilateral
What is a quick diagnostic for lipid flare?
Take blood and spin down the serum - look like milk
What are some issues that can occur with the Lense?
Nuclear Sclerosis (aging normal)
Cataract (opacity)
What does nuclear sclerosis look like?
nothing prevents light from going through - can see retina
-nucles of Lense demarcated
How do you ID these diseases?
Direct ophthalmoscopy - see back of eye
What does a cataract look like?
Light cant go through the retina
-Insipient - covers half (<10%)
-Early immature - small (>10%)
-Mature - 100%
-Hypermature - absorb or liquify
(Y cleft = diabetes)
What can be cloudy in the posterior segment?
Vitreous- inflammation, asteroid hyalosis, synchesis scintillans
Retinal - retinal detachment
What does asteroid hyalosis look like?
Snow globe like particles in back of eye - look like cataract
-Multifocal opacities
*Incidental - age related degenerative changes - intracocular neoplasms
What does retinal detachment look like?
Bilateral diminished tapetal reflection due to retinal detachment (hypertension)
