Conjunctival & Lacrimal diseases Flashcards by Elizabeth Pritchard

How does the appearance of Palpebral conj. differ from Bulbar conj.?

Palpebral conju.=thicker, pinker

Bulbar conj.= thin, translucent

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C/s of conjunctivitis?

Hyperemia Chemosis Serous-mucopurulent d/c Prominent lymphoid follicles Blepharospasm(PAIN!) Pruritus

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Although they are uncommon, what is the main type of conjunctival neoplasia in dogs?

MCT-benign

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How does conjunctivits in the dog differ from the cat?

Dog
-Most common=Secondary -Associated with: Systemic & Ocular diseases

Cat

Most common=Primary
Associated with: Feline herpesvirus, Chlamydophila, Calici virus, or Mycoplasma

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Which of the 4 immune mediated conjunctival disorders of dogs is-
Seen mostly in: Young, Large breed
Causes: Enlarged follicles/blisters
Treatment: Topical abx & anti-inflammatories

A. Lymphoreticular conjunctivitis
B. Ligneous or Membranous
C. Plasmoma
D. Nodular granulomatous episcleritis

A. Lymphoreticular conjunctivitis

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Which of the 4 immune mediated conjunctival disorders of dogs is-
Seen mostly in: Dobies & Goldens
Causes: Thicken proliferative conjunctiva, +/- systemic dz
Treatment: Difficult

A. Lymphoreticular conjunctivitis
B. Ligneous or Membranous
C. Plasmoma
D. Nodular granulomatous episcleritis

B. Ligneous or Membranous

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What is the commensal microflora of the conjunctiva?

Gram + Cocci

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Which of the 4 immune mediated conjunctival disorders of dogs is-
Seen mostly in: GSD
Causes: Thickened depigmented TEL–> “Cobblestone” appearance
Treatment: Topical CyS, steroids

A. Lymphoreticular conjunctivitis
B. Ligneous or Membranous
C. Plasmoma
D. Nodular granulomatous episcleritis

C. Plasmoma

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Which of the 4 immune mediated conjunctival disorders of dogs is-
Seen mostly in: Collies & Shelties
Causes: Inflammation & proliferation of episclera & conjunctiva
Treatment: Topical & systemic anti-inflammatories

A. Lymphoreticular conjunctivitis
B. Ligneous or Membranous
C. Plasmoma
D. Nodular granulomatous episcleritis

D. Nodular granulomatous episcleritis

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What is the most common cause of conjunctivitis & surface ocular disease,in general, in cats and kittens?

Feline Herpesviral Conjunctivitis

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What are the 3 different age presentations of FHC?

Neonatal Opthalmia: Ankylo/Symblepharon

8-12 wks: UR & occular signs

Mature: Recrudescence, Harbored in CN V

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FHC causes what type of occular signs?

Severe kerritoconjunctivitis w/ chemosis, corneal edema, & ulceration

Sequela= KCS, Lacrimal adenitis

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How is FHC diagnosed?

Tentatively on history & signs

Confirmed via PCR

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T/F: We would prefer to use systemic antivirals over topical antivirals for treating FHC.

False

Systemic antivirals are Hepatotoxic to cats

Topicals: Cidovir, Trifluridine, Idoxuridine

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What systemic antiviral is well tolerated by cats?

Famcyvlocir

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What is the 2nd most common cause of conjunctivitis in cats?

Chlamydophila felis

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What other ocular sign does C. felis cause aside from conjunctivitis?

Chemosis

Also causes +/- respiratory & GI signs

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What is the DOC for C. Felis?

Topical tetracyclines-Chloramphenicol(risks for humans!)

Systemic Doxycycline if severe(wash with water!)

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Why are we so concerned with Chronic conjunctivitis in cats?

It can lead to other ocular diseases

KCS
Epiphora
Eosinophilic Keratoconjunctivitis
Sequestrum

What special function does the precorneal tear film have?

Produces protective proteins-ANTIMICROBIAL!!

Impaired drainage of tear film or pain–> Overflow of tears=

Epiphora

Impaired production of tears by tear film=

Keratoconjunctivitis sicca(KCS)–>

Hypertoncity & dehydration
Frictional irritation
Impared cleansing of ocular surface
Microorganism overgrowth

What are some progressive signs of KCS?

Inflammation
Desiccation of ocular surfaces
Pain
Corneal dz
Impaired vision

Which type of KCS causes chronic conjunctivitis during early puppyhood, especially in yorkies & chihuahauas?

Congential-acinar hypoplasia

T/F: Most cases of Acquired KCS are immune-mediated.

True Lymphoplasmacytic inflammation of lacrimal & nictitans gland Progressive until complete gland destruction

Signalment for acquired KCS:

Mid-older aged Pugs, Cockers, MS, English BD, Lhasa apsos, Westies, CKCS, Shih tzus, Pekingese Burmese cats=uncommon

What are the infectious causes of acquired non-immune mediated KCS?

Canine distemper | FHV

What drugs can cause acquired non-immune mediated KCS?

Sulfa drugs Etogesic(NSAID) Atropine & general anesthesia(use eye lube during & after anesthesia!!)

T/F: KCS c/s generally have a rapid onset.

FALSE! Usually have a GRADUAL onset - Progressive conjunctivitis - Lackluster appearance - Hyperemic conjunctiva - Mucopurlent discharge - Discomfort & corneal ulcers - Corneal vascularization & pigmentation

What ophthalmic test do we always do with any case of conjunctivitis and before applying ANY ophthalmic preparations?

Schirmer tear test

What level of KCS does a dog with a STT of 8mm/min have?

Moderate Normal > 15 mm/min Early= 11-14 mm/min Moderate= 6-10 mm/min Severe=

T/F: There is no cure for KCS and treatment will be lifelong.

True Treatment goals - Stimulate tear production - Control 2nary inflammation or infection - Maintain lubrication with artificial tears

What drugs can be used as lacrimostimulants for KCS cases?

Cyclosporine A- directly lacrimogenic, inhibits pigmentation & vascularization Tacrolimus-refractory cases, 30% better response

Of the 4 aqueous artificial tears, which 2 last last longer?

Viscotears, Lubrithal > Hylasheild, Lacrilube

What drug can be used for acquired non-immune mediated KCS, caused by loss of CN V or VII(neurogenic), and ancillary in immune-mediated KCS?

Pilocarpine

What is the difference between 2% & 0.25% Pilocarpine?

2% topical solution is used OVER food 0.25% is used in eyes

What can repeated topical application of 0.25% Pilocarpine cause?

Uveitis! Use PO dosing(2%) Monitor for SLUD

Paratoid duct transposition causes ____ on eye and ____ when eating.

Saliva on eye, Tears when eating

What will happen if in KCS cases that respond to therapy if the meds are stopped?

RELAPSE will occur if meds are stopped!!!

T/F: KCS is as common in cats as it is in dogs.

FALSE Canine KCS= one of the most common ocular diseases Feline KCS=uncommon

What is needed for Feline KCS diagnosis?

``` Clinical signs Low STT( normal >10 mm/min, >5 mm/min can be normal too) ```

What causes physiologic epiphora?

Shallow lacrimal lake

What inflammatory/acquired cause of epiphora in cats is brought on by herpes?

Dacryocystitis

Dacryrocystitis vs. Dacryoadenitis

Dacryo- cystitis=inflammed lacrimal SAC adenitis=inflammed lacrimal GLAND

In what direction do we cannulate punctum and flush when diagnosing epiphora?

Dorsal-ventral | Lacrimal-nasal

What do we suspect the cause of eipihora to be if there is persistant mucopurulent d/c?