Clinical Approach to the Cloudy Eye

Question 1

Cloudiness in the eye may be localized to what 4 locations?

Answer 1

1. cornea
2. anterior chamber
3. lens
4. posterior segment (vitreous, retina)

Question 2

what are the 4 general causes of CORNEAL cloudiness?

Answer 2

1. corneal edema
2. corneal scar/fibrosis
3. corneal lipid
4. corneal mineral

Question 3

what are the 2 pathologies that cause corneal edema?

Answer 3

1. corneal ulcers
2. endothelial dysfunction (anterior uveitus, glaucoma, endothelial degeneration, and/or localized dysfunction)

you can tell the difference between the 2 diagnostically by performing flouroscein stain. Ulcers will be FS + and endothelial dysfunction will be FS neg.

Question 4

what breeds have a genetic predisposition for endothelium degeneration/dystrophy?

Answer 4

chihuahua
boston terriers
dachshund

Question 5

T/F: anterior lens luxation is usually a bilateral disease

Answer 5

true

Question 6

what are the 3 causes of corneal scar/fibrosis?

Answer 6

1. prior ulcer/trauma
2. chronic exposure (lagophthalmos or KCS)
3. chronic abrasion (entropion, distichia, ectopic cilia)

Question 7

How can you tell the difference between corneal scar/fibrosis and corneal edema?

Answer 7

they look very similar but corneal scars/fibrosis has more of a homogenous apperance and no stippling.
There can be blood vessels with corneal scarring/fibrosis, unlike corneal edema.

Question 8

what are the 2 causes of corneal lipid (lipid keratopathy)?

Answer 8

1. lipid dystrophy – hereditary (young dogs), non-painful, bilateral, NOT associated with trauma; has a glittery/sparkly appearance
2. lipid degeneration – prior keratitis, infiltrative corneal disease (neoplasia, IMK), topical corticosteroids, systemic metabolic disease;

Question 9

If lipid degeneration occurs due to metabolic disease, where would the lesion located usually?

Answer 9

at the periphery of the cornea
“lipemic arch”

Question 10

what are the 2 causes of corneal mineralization causing cloudy eyes?

Answer 10

1. degeneration (ocular dz or age-related)
2. metabolic dz

you can only differentiate via biopsy

Question 11

T/F: corneal mineralization is not as “sparkly” as lipid degeneration/dystrophy

Answer 11

true

Question 12

Corneal mineralization caused by metabolic disease typically has a _________ appearance.

Answer 12

moth-eaten

Question 13

How does the presence or absence of ocular pain help you differentiate the cause of cloudy eyes?

Answer 13

if there is pain, we know that it is edema which can be from ulcers, anterior uveitis, or glaucoma.

if pain is absent though, there can be other multiple causes such as scar/fibrosis, edema (endothelial degeneration), lipid, or mineralization

Question 14

if there is opacity of the anterior chamber, what are the 2 possibilties?

Answer 14

1. aqueous flare – from uveitis
2. lipid flare – from metabolic/hyperlipidemia +/- uveitis

Question 15

If there is opacity of the lens, what are the 2 possibilites?

Answer 15

1. nuclear sclerosis – no blockage of light traveling to the back of eye; can see with direct ophthalmoscopy
2. cataracts – opacities block light

Question 16

if there is opacity of the posterior segment, what are 2 possibilities of cause?

Answer 16

1. vitreous – vitreous haze d/t inflammation; asteroid hyalosis (Ca and P deposits resulting from aging, trauma, or neoplasia); synchesis scintillans
2. retinal detachment

Question 17

_________ is when you can visualize the vitreous moving because it is liquified from aging or trauma/neoplasia.

Answer 17

vitreous syneresis

Question 18

what are the top 2 differentials for diffuse corneal edema?

Answer 18

1. endothelial degeneration
2. glaucoma

Question 19

What diagnosis does the presence of diffuse edema and Haab’s striae confirm?

Answer 19

glaucoma

Question 20

what are 2 primary differentials for corneal edema?

Answer 20

1. corneal scar
2. endothelial dysfunction/dystrophy