Dzs conj, lacr system, TE DW (Whitley)

Question 1

Tear film

Answer 1

• 3 layers
  
  • outer: meibomian glands
  • middle aqueous: lacrimal glands
  • inner mucin: goblet cells, epithelial cells
• lubricates, cleanses and protects globe
• Surface health depends on sufficient quantity and stability

Question 2

Diagnostic tests

Answer 2

• direct observation
• Schirmer tear test
• Cult and Sensitivity
• Viral PCR, IFA (Herpes)
• Fluorescein stain
• Rose Bengal/Lissamine Green stain
• Tear film break-up time
• Cytology
• Biopsy
• Flush NLD
• N-L Contrast radiography/CT

Question 3

Cytology

Answer 3

• Good tool for conjunctivitis
• procedure
  
  • topical anesthesia
  • sample cells of cytologic id/dx
    
    • cornea
    • conj

Question 4

Dzs of conj

Answer 4

• Inflammation
• Tear deficiencies
• Disruption of tear flow
• Gland of the TE malposition
• Neoplasia

Question 5

conjunctivitis

Answer 5

• non-specific
• Signs vary
  
  • hyperemia
  • chemosis
  • d/c
  • blepharospasm
  • red eye
• Lymphoid follicles
  
  • indicate chronicity
• DX
  
  • primary conj dx made by ruling out secondary causes

Question 6

Conjunctivitis

Etiologies

Answer 6

• KCS
• Allergic
• Bacterial
• Viral
• Parasitic
• Physical irritation/trauma
• Intraocular disease
• Systemic illness

*always look for primary cause, don’t just treat CS

Question 7

Conjunctivitis in dogs

Answer 7

• Usually secondary to Dry eye
• infectious cause is uncommon
• Dobies
  
  • ligneous (auto-immune I think)
• Causes
  
  • allergic-atopy
  • follicular
  • contact hypersensitivity
    
    • tx: neomycin, thimersol, benzalkonium chloride

Question 8

Conjunctivitis TX

Answer 8

• depends on etiology
  
  • KCS
    
    • tear stimulants
  • herpes
    
    • antivirals
  • OMSD
    
    • systemic
  • topical-inflammatories
  • topical abx
  • lubricants

Question 9

Conjunctivitis in cats

Answer 9

• Most is primary
• infectious cause common
  
  • Herpesvirus (FHV-1)
  • Chlamydophilia
  • Mycoplasma
  • Calicivirus

Question 10

Feline Herpesvirus Conjunctivitis

Answer 10

• FHV-1
• Most common cause of conjunctivitis/keratitis/ulcers in cats
  
  • 97% of cats are seropositive
• CS
  
  • Conjunctivitis in kittens and cats
  • Neonatal ophthalmia
  • Keratitis
  • Corneal dz
    
    • ulcers
  • upper resp dz
  • dendritic ulcers
• Disease characteristics
  
  • mild dz, self limiting
  • cases requiring treatment
    
    • severe conjunctivitis
    • concurrent keratitis
    • corneal ulceration

Question 11

Herpesvirus treatment

Answer 11

• Antiviral
  
  • topical
    
    • cidofovir 0.5% compounded BID
    • idoxuridine 0.1 % compounded 4-6 times/day
  • systemic
    
    • Famcyclovir (Famvir)
    • Do not use Valcyclovir
• treat for 2 weeks past resolution of signs
• Supplemental
  
  • L-lysine
    
    • use lifelong to reduce recurrency
    • treats or food additive
    • treat all cats in house
• Do not treat with corticosteroids

Question 12

Chlamydophila conjunctivitis

Answer 12

• hyperemia and more pronounced chemosis than herpes virus
• CS
  
  • chemosis
  • conjunctival hyperemia
  • serous discharge
  • blepharospasm
  • no corneal dz
• Histo
  
  • blue staining bodies near nucleus
• TX
  
  • tetracyclines
  • erythromycin
  • azithromycin, doxy
  • fluoroquinolones
  • chloramphenicol
• 3 weeks of therapy

Question 13

Mycoplasma conjunctivitis

Answer 13

• Primary or secondary pathogen…?
• SPP
  
  • M. felis
  • M. gatae
• TX
  
  • tetracycline
  • erythromycin
  • doxy

Question 14

Feline Calicivirus Conjunctivitis

Answer 14

• Much less common etiology of conjunctivitis
• CS
  
  • conjunctival ulcers
  • oral ulcers
  • multiple conjunctival ulcers with fluorescein pos
• TX….?
  
  • not herpes virus drugs

Question 15

Feline conjunctivitis chart

Answer 15

Question 16

Conjunctivitis

sequelae

Answer 16

• Discomfort
• Follicle development
• Tear film abnormalities
• symblepharon
  
  • adherence of conj
• secondary bacterial inf

Question 17

conjunctival/subconjunctival hemorrhages

Answer 17

• causes
  
  • trauma most common
    
    • foaling trauma
  • choking
  • coagulopathy
  • vasculitis
• evaluate for uveitis and retinal hemorrhages
• blood usually resolves in 21 days

Question 18

Subconjunctival fat prolapse

Answer 18

• non-painful, soft pink mass beneath bulbar conjunctiva
• surgical removal is curative
• may look like lymphoma
  
  • FNA

Question 19

Conj neoplasia

Answer 19

• Squamous cell carcinoma
  
  • cat
  • dog horse
• cow
  
  • SCC usually eyelid and cornea

Question 20

KCS

Answer 20

• Quantitative tear deficiency
  
  • aqueous portion
• Clinical signs
  
  • blepharospasm
  • conjunctival hyperemia
  • mucoid discharge
  • ulcers
  • dry appearance
  • dull cornea
  • neovascularization
  • pigment
  • dry mucus crusting on lids

*green smoo think KCS

Question 21

KCS

Etiology

Answer 21

• Immune mediated (most common)
• Congenital
• Drug related
  
  • sulfas
  • atropine
• Traumatic
• Neurologic
• Systemic dz
  
  • Canine distemper
• Chronic blepharoconjunctivitis
• Iatrogenic
  
  • surgery around orbit, nerve damage
  • amputation of TE

Question 22

KCS

TX

Answer 22

• Medical
  
  • stimulate tear production: T-cell inhibitor
    
    • topical cyclosporine
    • Tacrolimus
  • supplement tears
  • control bacterial over-proliferation
  • decrease surface inflammation
• Surgical
  
  • surgical stabilization of ulcers
    
    • conj flaps
  • parotid duct transposition
    
    • saliva similar pH to tears
    • mineral deposits
    • epiphora

Question 23

Tear quality deficiency

Answer 23

• Normal Schirmer Tear Test with signs of KCS
  
  • lack of mucin
• Tear film evaporates quickly
• Premature mucin breakup time
  
  • < 10 s
• Rose Bengal or Lissamine
• Treat similar to KCS
  
  • cyclosporine

Question 24

Tear flow disruption

Answer 24

• NLD obstruction
  
  • epiphora
  • mucoid d/c
  • secondary conjunctivitis
• Small dog epiphora
  
  • esp little white dog
• Medial canthal pocket syndrome
• Jones test
  
  • tests NL efficiency
• NLD flushing
  
  • topical anesthesia
  • identify punctum
  • small gauge cath
  • pulse gently

Question 25

Dacryocystorhinography

Answer 25

* Contrast radiography

Question 26

Small dog epiphora

Answer 26

* Poodle epiphora * tear staining of the face * small dogs, brachycephalic cats * multifactorial * medial canthal entropion * excessive tear production from irritation * obstruction NLD * Lower punctum atresia/displacement/folding over * hair from medial caruncle acting as wick * facial folds * prominence of eye with a shallow lacrimal lake * brachycephalic breeds

Question 27

Medial Canthal pocket syndrome

Answer 27

* Large dogs * large, deep orbits, smaller globes * Nasal fornix is large * traps debris =\> conjunctivitis * Mucous at medial canthus * breed dispositions * dobies * labs * TX * flush with eye wash * use tear replacements

Question 28

Prolapse of gland of TE

Answer 28

* Cherry eye * weak fascial attachements * disposition * young dogs * brachycephalic dogs * uncommon in cats * dogs predisposed to KCS * TX * reposition: pocket technique * anchor to intraocular muscles * Remove bent area of cartilage * Anchor to periosteum

Question 29

TE anomalies

Answer 29

* Encircling TE * Eversion of TE cartilage * abnormally formed cartilage * great danes and German short haired pointers

Question 30

Protrusion of TE

Answer 30

* non-specific sign * ocular pain * decreased orbital tissue volume * Decreased ocular size * Retrobulbar dz * Systemic dz * Horners * Tetanus \*examine TE and behind it!

Question 31

Horner's syndrome

Answer 31

* Sympathetic denervation * many etiologies * CS * Miosis * Ptosis * Enophthalmos * Elevated TE

Question 32

Neoplasia of TE

Answer 32

* Bulbar and palpebral conjunctiva * melanoma * SCC * Hemangioma * Lymphoma * Mast cell tumor * Third eyelid * SCC * Adenocarcinoma * Melanoma * Lymphoma