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Opthalmology > Conjunctivitis, KCS and NL system > Flashcards

Conjunctivitis, KCS and NL system Flashcards

1
Q

What are the six causes of red eye?

A
  • G – glaucoma
  • O – orbital disease
  • S – scleritis/episcleritis
  • U – uveitis
  • C – conjunctivitis
  • K – Keratitis
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2
Q

What are the clinical signs of conjunctival disease?

A
  • Conjunctival hyperemia
  • Ocular discharge
  • Chemosis
  • Follicular hyperplasia
  • Conjunctival masses
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3
Q

Which is more common: primary or secondary conjunctivitis?

A
  • The conjunctivitis is often the innocent bystander

- Primary conjunctivitis is much less common than secondary conjunctivitis

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4
Q

What are some etiologies of conjunctival disease?

A
  • Infectious - viral, bacterial, parasitic, fungal
  • Immune mediated
  • Toxic or chemical or traumatic
  • Tear film abnormalities
  • Frictiona - exogenous: FB, dust, smoke, wind; endogenous: tear film defect, entropion, ectropion and lagophthalmos
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5
Q

What are some differential diagnosis of conjunctival diseases?

A
  • GOSUCK - must rule out all other disease

- Due to another blinding ocular disease

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6
Q

What are some etiologies of primary conjunctivitis?

A
  • Cats and ruminants - primary infectious agents
    o Cats: C felis, FHV, mycoplasma
    o Cows: IBR, Moraxella
    o Sheep/goats: Chlamydophila, mycoplasma
  • Dogs and horses - rarely infectious but DDX should include:
    o Dogs: distemper, adenovirus, herpes virus
    o Horses: EHV, Onchocerca cerrvicalis
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7
Q

How do we diagnose conjunctival disease?

A
  • Conjunctival biopsy/scrapings

- Bacterial culture - rarely recommended

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8
Q

What are the 4 common causes of conjunctivitis in cats?

A
  • Feline Herpes virus
  • Chlamydophila felis
  • Mycoplasma
  • Eosinophilic keratoconjunctivitis
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9
Q

Describe FHV induced conjunctivitis?

A
  • Most common cause of conjunctivitis and keratitis is cats
  • Ubiquitous virus
  • Primary inoculation of oral, nasal or conjunctival mucosa
    o Primary disease is usually self-limiting
    o Typical in kittens leading to bilateral disease
  • Life long latency develops within the trigeminal ganglia (80%)
  • Throughout life episodes of reactivation may be stimulated by stress or even administration of steroids
    o Adults - unilateral, unassociated with systemic signs, milder but chronic
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10
Q

What is the pathognomic sign of FHV conjunctivitis?

A
  • Dendritic ulceration of the cornea
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11
Q

How do you diagnose FHV?

A
  • Clinical signs

- PCR - beware of FP or FN

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12
Q

How do you treat FHV?

A
  • Supportive
  • Mild conjunctivitis does not require treatment
  • Oral L-lysine 500mg BID adults (half the dose in kittens)
  • Severe conjunctivitis or keratitis
    o Topical anti-viral or oral anti-viral BID for 14 days with topical antibiotics if ulcers are present
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13
Q

What are the clinical signs for C. felis conjunctivitis?

A
  • Bilateral Chemosis - most prominent

- Possible sequestration of bacteria in non-ocular sites (GIT)

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14
Q

How do you diagnose C. felis infection?

A
  • PCR or cytology

o Looking for intracytoplasmic elementary bodies in the epithelial cells

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15
Q

How do you treat C. felis infection?

A
  • Topical antibiotics - fluoroquinolones

- Systemic antibiotics - doxycycline or azithromycin

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16
Q

What is feline eosinophilic keratoconjunctivitis?

A
  • Proliferative conjunctivitis with or without keratitis
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17
Q

How do you diagnose EKC?

A
  • Cytological scrapings or biopsy of the lesions

o Looking for mast cells or eosinophils

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18
Q

How do you treat EKC?

A
  • Topical corticosteroids
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19
Q

Describe canine follicular conjunctivitis.

A
  • Likely the most common cause of primary conjunctivitis in dogs
    o Typically young dogs
    o Due to unknown antigenic stimulation
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20
Q

How would you diagnosis CFC?

A
  • Clinical signs - follicles on the conjunctiva
21
Q

How do you treat CFC?

A
  • Usually self-limiting generally does not require treatment
  • Can use eye-wash, lube +/- topical steroids if recurrent or non-resolving
22
Q

What are the components of the lacrimal system?

A
  • Lacrimal puncta
  • Lacrimal gland
  • Lacrimal sac
  • Canaliculi
  • Nasolacrimal duct
  • Nasal punctum
23
Q

What are some lacrimal diseases?

A
  • Inability to produce normal tears
    o Quantitative abnormality - insufficient aqueous component to tears = KCS
    o Qualitative abnormality - abnormal mucus or lipid component to tears
  • Inability to drain tears
    o Obstruction within the lacrimal system
24
Q

What is Keratoconjunctivitis sicca (KCS)?

A
  • Deficiency of aqueous tear production
25
Q

What are the pathological changes associated with KCS?

A
  • Tear film becomes more hypertonic which dehydrates the corneal and conjunctival epithelium
  • Leads to edema, friction, epithelium keratinization, vessel infiltration
26
Q

What are the clinical signs of KCS?

A
  • Dry, lusterless cornea
  • Mucoid and mucopurulent discharge
  • Blepharospasm
  • Corneal ulceration
  • Corneal vascularization and pigmentation (if chronic)
27
Q

What are the etiologies of KCS?

A
  • Immune mediated destruction of the lacrimal gland most common
  • Congenital - no gland or small gland
  • Drug induced - TMS
  • Infectious - CDV
  • Neurogenic - denervation
  • Orbital trauma
  • Alkali or acid burns to the conjunctiva
28
Q

How do you diagnose KCS?

A
  • Clinical signs

- Schirmer tear test

29
Q

How do you treat KCS?

A
  • Lacrimostimulants FOR LIFE
    o Topical cyclosporine
  • Lacrimomimetics
    o Teargel, lacrilube
30
Q

What is the prognosis of a patient with KCS?

A
  • Good if early dx and STT >2mm/min
31
Q

How do you treat neurogenic KCS?

A
  • Oral pilocarpine to stimulate lacrimal gland
32
Q

How do you treat refractory or congenital KCS?

A
  • Parotid duct transposition
33
Q

What are qualitative tear film disorders?

A
  • Deficiency in lipid (from Meibomian gland) or mucin (goblet cells)
34
Q

What are the etiologies for qualitative tear film disorders?

A
  • Severe blepharitis
  • Conjunctivitis
  • Idiopathic
35
Q

How do you dx qualitative tear film disorders?

A
  • Tear film breakup time

* similar pathology, clinical signs and treatment as with KCS*

36
Q

What are nasolacrimal disease?

A
  • Lack of patency or inflammation
37
Q

What are the clinical manifestations of NL disease?

A
  • Epiphora
  • Punctal discharge
  • Punctal FB
  • Swelling of the ventral medial canthal region
  • Draining fistulas
38
Q

How do you diagnose NL disease?

A
  • Schirmer tear test  >25mm/min
  • Fluorescein dye passage test - 3-5 mins
  • Punctal cannulation and lavage
    o Normograde - small animals
    o Retrograde - horses
    o Culture and sensitivity
  • Imaging - confirm and determine the extent of disease
    o Plain radiographs
    o Dacryocystorhinography
    o CT/MRI
39
Q

What are some congenital causes of NL disease?

A
  • Lacrimal punctal atresia
  • Atresia of canaliculus, NL sac and or NL duct
  • Cysts - canaliculops, dacryops
40
Q

What is the main cause of congenital NL disease in large animals?

A
  • NL puncta atresia - common in horses, alpacas and llamas
41
Q

When do the clinical signs of NL puncta atresia occur?

A
  • 2-16 weeks of age

o Epiphora and mucopurulent ocular discharge

42
Q

How do you diagnose NL puncta atresia in large animals?

A
  • Clinical exam, NL lavage and contrast radiography
43
Q

How do you treat congenital NL puncta atresia?

A
  • Incision into the duct
  • Cannulate for several weeks
  • Antibiotics and steroids
44
Q

What are common acquired NL diseases?

A
  • Dacryocystitis  inflammation of lacrimal sac and duct which narrows the lumen of the duct and strictures form
  • Trauma/laceration
45
Q

What causes dacryocysitis?

A
  • Usually secondary to FB in the lacrimal duct
  • External compression - tooth root abscess, neoplasia, inflammation
  • Osteomyelitis
  • Thelezia sp in large animals
46
Q

How do you diagnose dacryocysitis?

A
  • Clinical exam
  • NL lavage
  • Dacryocystorrhinography
  • Cytology
  • Biopsy of tissue
  • Culture
  • Surgical exploration
47
Q

How do you treat dacryocysitis?

A
  • Requires treatment of underlying disease to resolve

o REFER - flushing of the NL system; dacryocystostomy followed by stent placement and antibiotic therapy

48
Q

How do you treat trauma/laceration induced NL disease?

A
  • REFER - microsurgical apposition and cannulation

Opthalmology (3 decks)

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