Discharging eye

Question 1

Describe case 1

Answer 1

Epiphora (watery occular discharge)

overflow onto periocular skin

conrea clear

senile nuclear sclerosis

Unpigmented eyelids

Question 2

Case 1 Ddx

Answer 2

Blocked NLD, punctal atresia

Conjunctivitis - allergic, bacterial, viral, UV radiation

Surface irritation - ectopic cilium, distichiasis, trichiasis

Foreign body

Lazy NLD or hair medial canthus

Question 3

Case 1 tests

Answer 3

Schirmer tear test

Conjunctival cytology

Fluorescein passage to nose

NLD flush or explore under GA

Question 4

Case 4

2yo

3-4 week history of bilateral eyelid swelling, mucopurulent discharge, swelling and redness

Describe the eye

Answer 4

Upper and lower eyelid erythema, oedema and olopecia

Mild watery discharge

Question 5

Case 2 Ddx

Answer 5

Bacterial, fungal, viral, parasitic, immune-mediated blephritis

Neoplasia - MCT, LSA, sebaceous adenoma, lipoma

Inflammatory conditions - nodular fasciitis, histiocytosis

Question 6

Case 2 tests

Answer 6

Skin scraping

Sticky-tape cytology

Incisional biopsy

Deep tissue MC&S

Question 7

Case 2 - Bacteria blepharitis

Treatment

Answer 7

Bactericidal antibiotics

Anti inflammatories

Question 8

Case 3

2yo

unilateral watery discharge and blepharospasm

Describe?

Answer 8

Narrow palpebral fissure, watery discharge along lower eyelid margin, trichiasis, entropion

Question 9

Case 3 Ddx

Answer 9

Entropion - primary or secondary

Trauma

Conjunctival foreign body

corneal ulceration

Feline herpes virus infection

(distichiasis, ectopic cilium)

Question 10

Case 3 - tests

Answer 10

Topical anaesthesia - may resolve entropion

Fluorescein stain - concurrent ulceration?

Question 11

Case 3 treatment

Answer 11

Treat primary cause

Cat: FHV

Dog and cat: orbital fat atrophy and elophthalmos

Tacking in

Surgical correction of eyelid position

Question 12

Case 4

8yo with sore left eye for 4 weeks

Minimal response to antibiotics

Describe?

Answer 12

Sticky, mucopurulent ocular discharge

Dull cornea, corneal vascularisation (keratitis)

Question 13

Case 4 test

Answer 13

Shirmer tear test

Cytology?

Fluorescein stain

MC&S?

Question 14

Case 4 diagnosis

Answer 14

KCS or dry eye

Question 15

Treatment case 4

Answer 15

Clean eyes

optimmune, cyclosporin or tacrolimus eye drops/ointments

Topical preservative free lubricants

topical antibiotics

Canthoplasty or PDT surgery in refractory cases

Question 16

Case 5

Constant bilateral discharge: sore, squinting eyes and recurring corneal ulceration

Describe

Answer 16

Epiphora, upper eyelid distichiasis

Dull cornea with faint axial oedema and ulceration

Question 17

Case 5 Ddx

Answer 17

Distichiasis, ectopic cilium, trichiasis

(trauma)

(alkaline burn)

(chronic corneal epithelial defect)

Question 18

Case 5 tests

Answer 18

Flourescein stain to confirm ulceration

Question 19

Diagnosis case 5
Distichiasis and secondary corneal ulceration

Treatment

Answer 19

Transconjunctival excision in thick-eyelid breeds

Cryosurgery in the thin-eyelid breeds

Question 20

Case 6: sore, swollen and discharging left eye, 3 weeks duration

Painful eating or opening mouth

Describe

Answer 20

Swollen, hyperaemic eyelids and periorbital region

conjunctival hyperaemia

TE protrusion

mild mucopurulent ocular discharge

mild exopthalmos

Question 21

Case 6 Ddx

Answer 21

Orbital trauma

orbital foreign body
Infection: cellulitis and abscess

orbital cyst, neoplasia, haemorrhage

Severe uveitis?

Chronic glaucoma?

Question 22

Case 6 tests

Answer 22

Physical palpation - open mouth

Retropulsion

Examine mouth

Orbital US, CT or MRI

Exploratory surgery

Question 23

Diagnosis case 6: confirmed orbital abcess and probably FB on US

Treatment

Answer 23

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