Conjunctival & Lacrimal diseases Flashcards
How does the appearance of Palpebral conj. differ from Bulbar conj.?
Palpebral conju.=thicker, pinker
Bulbar conj.= thin, translucent
C/s of conjunctivitis?
Hyperemia Chemosis Serous-mucopurulent d/c Prominent lymphoid follicles Blepharospasm(PAIN!) Pruritus
Although they are uncommon, what is the main type of conjunctival neoplasia in dogs?
MCT-benign
MCT-benign
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
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
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
What is the commensal microflora of the conjunctiva?
Gram + Cocci
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
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
What is the most common cause of conjunctivitis & surface ocular disease,in general, in cats and kittens?
Feline Herpesviral Conjunctivitis
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
FHC causes what type of occular signs?
Severe kerritoconjunctivitis w/ chemosis, corneal edema, & ulceration
Sequela= KCS, Lacrimal adenitis
How is FHC diagnosed?
Tentatively on history & signs
Confirmed via PCR
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
What systemic antiviral is well tolerated by cats?
Famcyvlocir
What is the 2nd most common cause of conjunctivitis in cats?
Chlamydophila felis
What other ocular sign does C. felis cause aside from conjunctivitis?
Chemosis
Also causes +/- respiratory & GI signs
What is the DOC for C. Felis?
Topical tetracyclines-Chloramphenicol(risks for humans!)
Systemic Doxycycline if severe(wash with water!)
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?
FB
