Discharging eye Flashcards
Describe case 1
Epiphora (watery occular discharge)
overflow onto periocular skin
conrea clear
senile nuclear sclerosis
Unpigmented eyelids
Case 1 Ddx
Blocked NLD, punctal atresia
Conjunctivitis - allergic, bacterial, viral, UV radiation
Surface irritation - ectopic cilium, distichiasis, trichiasis
Foreign body
Lazy NLD or hair medial canthus
Case 1 tests
Schirmer tear test
Conjunctival cytology
Fluorescein passage to nose
NLD flush or explore under GA
Case 4
2yo
3-4 week history of bilateral eyelid swelling, mucopurulent discharge, swelling and redness
Describe the eye
Upper and lower eyelid erythema, oedema and olopecia
Mild watery discharge
Case 2 Ddx
Bacterial, fungal, viral, parasitic, immune-mediated blephritis
Neoplasia - MCT, LSA, sebaceous adenoma, lipoma
Inflammatory conditions - nodular fasciitis, histiocytosis
Case 2 tests
Skin scraping
Sticky-tape cytology
Incisional biopsy
Deep tissue MC&S
Case 2 - Bacteria blepharitis
Treatment
Bactericidal antibiotics
Anti inflammatories
Case 3
2yo
unilateral watery discharge and blepharospasm
Describe?
Narrow palpebral fissure, watery discharge along lower eyelid margin, trichiasis, entropion
Case 3 Ddx
Entropion - primary or secondary
Trauma
Conjunctival foreign body
corneal ulceration
Feline herpes virus infection
(distichiasis, ectopic cilium)
Case 3 - tests
Topical anaesthesia - may resolve entropion
Fluorescein stain - concurrent ulceration?
Case 3 treatment
Treat primary cause
Cat: FHV
Dog and cat: orbital fat atrophy and elophthalmos
Tacking in
Surgical correction of eyelid position
Case 4
8yo with sore left eye for 4 weeks
Minimal response to antibiotics
Describe?
Sticky, mucopurulent ocular discharge
Dull cornea, corneal vascularisation (keratitis)
Case 4 test
Shirmer tear test
Cytology?
Fluorescein stain
MC&S?
Case 4 diagnosis
KCS or dry eye
Treatment case 4
Clean eyes
optimmune, cyclosporin or tacrolimus eye drops/ointments
Topical preservative free lubricants
topical antibiotics
Canthoplasty or PDT surgery in refractory cases
Case 5
Constant bilateral discharge: sore, squinting eyes and recurring corneal ulceration
Describe
Epiphora, upper eyelid distichiasis
Dull cornea with faint axial oedema and ulceration
Case 5 Ddx
Distichiasis, ectopic cilium, trichiasis
(trauma)
(alkaline burn)
(chronic corneal epithelial defect)
Case 5 tests
Flourescein stain to confirm ulceration
Diagnosis case 5
Distichiasis and secondary corneal ulceration
Treatment
Transconjunctival excision in thick-eyelid breeds
Cryosurgery in the thin-eyelid breeds
Case 6: sore, swollen and discharging left eye, 3 weeks duration
Painful eating or opening mouth
Describe
Swollen, hyperaemic eyelids and periorbital region
conjunctival hyperaemia
TE protrusion
mild mucopurulent ocular discharge
mild exopthalmos
Case 6 Ddx
Orbital trauma
orbital foreign body
Infection: cellulitis and abscess
orbital cyst, neoplasia, haemorrhage
Severe uveitis?
Chronic glaucoma?
Case 6 tests
Physical palpation - open mouth
Retropulsion
Examine mouth
Orbital US, CT or MRI
Exploratory surgery
Diagnosis case 6: confirmed orbital abcess and probably FB on US
Treatment
Exploratory surgery
Dental abscesses are a more common cause for orbital cellulitis or abcess, so examine the mouth
Neoplasia accounts for 50% of orbital diseases
