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Ophthalmology Rotation > Conjunctiva > Flashcards

Conjunctiva Flashcards

1
Q

conjunctiva (rankin)

Red Eye

A
  • Conjunctival hyperemia
    • Extensive branching
    • Extraocular disease
  • Episcleral Injection
    • Radial pattern from limbus
    • Dark red
    • Intraocular disease
  • Subconjunctival hemorrhage
    • Difuse red
    • Trauma/bleeding disorder
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2
Q

Ocular Discharge

A
  • Serous
    • Viral (FHV 1)
    • Epiphora
  • Mucoid
    • KCS (dry eye disease)
  • Mucopurulent
    • Bacterial infection
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3
Q

conjunctiva (rankin)

Diagnostic Tests for “Red Eye”

A
  • Fluorescein stain
  • Schirmer tear test
    • don’t do for deep ulcer
  • Intraocular pressure
    • don’t do for deep ulcer
  • +/- Conjunctival cytology
  • +/- Aerobic culture and sensitivity
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4
Q

Ophthalmia Neonatorum

A
  • Infection prior to lid separation
    • Puppies bacterial
    • Kittens viral (FHV-1) or Chlamydia
  • Treatment
    • Separate eyelids
    • Flush with sterile saline
    • Puppies-broad spectrum antibiotic ointment-BNP (bacitracin/neomycin/polymyxin B)
    • Kittens tetracycline ointment ( Terramycin ®)
    • Treat 4-6 times daily
  • Sequelae
    • Symblepharon (conjunctiva stuck to more conjunctiva, or conjunctiva to cornea), corneal perforation, corneal scar formation, blindness…
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5
Q

conjunctiva (rankin)

Canine Conjunctivitis

A
  • Rarely infectious!!!!!!
  • Usually secondary to other abnormalities
    • Entropion, ectropion, trichiasis, eyelid tumors…
    • Tear film abnormalities-keratoconjunctivitis sicca (KCS)
    • Irritants-chemicals, dust, smoke….
  • Bacteria can frequently be cultured at low numbers from NORMAL conjunctiva
    • Staphylococcus , Streptococcus , Cornyebacterium , and Bacillus spp.
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6
Q

conjunctiva (rankin)

Treatment of Canine Conjunctivitis

A
  • Treat the underlying cause
  • Broad spectrum topical antibiotic QID
  • Topical corticosteroids (hydrocortisone)
    • Fluorescein negative!!!
  • If no response to therapy
    • Re-evaluate diagnosis
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7
Q

conjunctiva (rankin)

Follicular Conjunctivitis

A
  • Typically seen in young dogs
  • Lymphoid follicles bulbar surface of the nictitans
  • Etiology-immune mediated, allergic, chronic irritation….
  • Treatment-topical steroids +/- topical antihistamines (olopatadine)
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8
Q

conjunctiva (rankin)

Feline Conjunctivitis

A
  • Usually infectious!!!
    • Do NOT use topical steroids!
    • Feline herpesvirus 1 FHV-1
    • Chlamydia
    • Mycoplasma
    • Calicivirus
  • Eosinophilic conjunctivitis
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9
Q

conjunctiva (rankin)

Feline Herpesvirus 1 FHV-1

A
  • Most common cause of feline conjunctivitis
    • Seroprevalance up to 97% of cats
    • >80% of cats that recover are carriers
    • Approximately ½ of the carriers shed under normal conditions
  • Corneal ulcers/keratitis
  • Latency occurs in trigeminal ganglion
  • URI
  • Kittens most susceptible
  • Short lived in the environment <18hrs
  • Virus is inactivated by most disinfectants
  • Sneezing carriers the virus approximately 4 feet

DON’T USE TOPICAL STEROIDS IN CATS

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10
Q

conjunctiva (rankin)

FHV-1 Diagnostics

A
  • Clinical signs!!!!
  • Conjunctival cytology
    • Intranuclear inclusions, PMNs
  • PCR - sensitive and specific
  • IFA - insensitive
    • Fluor. stain may cause false +
  • Serology (serum neutralization titer) insensitive
  • Virus isolation
    • Definitive dx for acute infection
    • Insensitive for chronic infection
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11
Q

conjunctiva (rankin)

FHV-1

  • time to recover
  • when to treat
A
  • Most recover in 10-21 days
  • Which cases should you treat?
    • Moderate to severe conjunctivitis
    • Corneal disease
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12
Q

conjunctiva (rankin)

Treatment of FHV-1

A
  • Topical and systemic antiviral medications
  • Oral lysine
  • Decrease stress
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13
Q

conjunctiva (rankin)

Antiviral Topical Treatment

A
  • Cidofovir 0.5% solution
    • Compounding pharmacy
    • 2 times daily
  • Idoxuridine 0.1% solution
    • Compounding pharmacy
    • 4-8 times daily
  • Trifluridine 1% solution
    • Refrigerated
    • Topically irritating
    • 4-8 times daily
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14
Q

conjunctiva (rankin)

Antiviral Systemic Treatment

A
  • Famciclovir
    • 250 mg tablets ( Famvir ®)
    • 30-40 mg/kg B-TID po
    • NOT the same as valacyclovir!
  • Lysine
    • 250 mg po BID kittens
    • 500 mg po BID cats
    • Give with food
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15
Q

conjunctiva (rankin)

Antiviral Therapy for FHV-1

A

Continue therapy for at least 1 week after resolution of clinical signs

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16
Q

Sequela to FHV-1

A
  • Recurrence
  • Corneal disease/ulceration /perforation
  • Chronic epiphora
  • Symblepharon
17
Q

conjunctiva (rankin)

Chalmydia felis

A
  • URI in young cats
  • Chemosis usually begins unilaterally then bilateral
  • Follicles with chronicity
18
Q

conjunctiva (rankin)

Chlamydia Diagnostics

A
  • Cytology
    • Intracytoplasmic inclusion bodies
    • Days 3-14
  • PCR
19
Q

conjunctiva (rankin)

Chlamydia Treatment

A
  • Oral medication
    • **Doxycycline (kittens over 4 weeks of age)
      • 5mg/kg po BID OR 10mg/kg SID
      • Esophageal stricture
    • Azithromycin (5-10mg/kg SID)
    • Pradofloxacin (5-7.5 mg/kg SID)
  • Treat for at least a month
    • Ideally at least 2 weeks beyond resolution of clinical signs
  • Topical medications QID
    • In addition to oral therapy
    • Tetracycline ( Terramycin ®)
    • Erythromycin
  • Recurrence common
  • Zoonotic - rarely
20
Q

conjunctiva (rankin)

Mycoplasma

A
  • Mycoplasma felis and M. gatae
  • Opportunistic
  • Conjunctival pseudomembranes
  • Diagnosis
    • Cytology-small cytoplasmic basophilic inclusion bodies
    • Culture in special media
    • PCR test for M. felis
  • Pathogenicity
    • Questionable
    • Isolated from normal cats
21
Q

conjunctiva (rankin)

Mycoplasma Treatment

A
  • Topical medications QID
    • Tetracycline ( Terramycin ®)
    • Fluoroquinolones
  • Oral medication
    • Doxycycline (kittens over 4 weeks of age)
      • 5mg/kg po BID OR 10mg/kg SID
      • Esophageal stricture
    • Pradofloxacin (5-7.5 mg/kg SID)
  • Duration of therapy
    • At least 2 weeks
22
Q

conjunctiva (rankin)

Calicivirus

A
  • URI
  • Oral and nasal ulceration
  • Polyarthritis
  • Low pathogenicity for conjunctiva
  • Topical antivirals are ineffective
  • RNA virus
  • Supportive care
23
Q

Conjunctival Neoplasia

A
  • Mast cell tumor
  • Papillomas
  • Hemangioma
  • Lymphoma
  • Melanoma
  • SCC
24
Q
A

Mast cell tumor

25
Q
A

Papillomas

26
Q
A
  • Hemangioma
  • Hemangiosarcoma
27
Q
A

Lymphosarcoma

28
Q
30
Q

Geographic Infectious Conjunctival Lesions

Ophthalmology Rotation (20 decks)

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