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Feline Ocular Disorders Flashcards

1
Q

Feline conjunctivitis - most common primary causes

A
  • Infectious

- Herpesvirus and Chlamydia

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2
Q

Feline conjunctivitis - most common secondary causes

A
  • Traumatic injury with scratch or bite, foreign body
  • Dental disease
  • Hypersensitivity, allergy, eosinophilic
  • Neoplasia
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3
Q

Dfdx for respiratory and eye infection

A
  • Herpesvirus of Calicivirus
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4
Q

Dfdx for just an eye infection

A
  • Not calicivirus

- Could still be herpesvirus

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5
Q

Clinical signs of conjunctivitisi

A
  • Hyperemia, chemosis, exudate, pain
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6
Q

Steroids in cats with conjunctivitis

A
  • Don’t do it, even if you don’t see an ulcer
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7
Q

Chlamydia bacteria type

A
  • Chlamydophila felis
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8
Q

How contagious is chlamydia?

A
  • Highly
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9
Q

Signs with chlamydia***

A
  • Mild to severe conjunctivitis
  • Often begins unilateral and spreads to the fellow eye
  • No corneal involvement (DOES NOT CAUSE AN ULCER)**
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10
Q

Cytology of Chlamydia

A
  • Epithelial cell, intracytoplasmic inclusion bodies may be seen on conjunctival cytology
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11
Q

Treatment for Chlamydia

A
  • Topical terramycin or erythromycin and systemic doxycycline
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12
Q

What is the only definitive way to diagnose Herpesvirus or know that it’s present?

A
  • Presence of a corneal ulcer
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13
Q

Bartonella appearance

A
  • May be associated with conjunctivitis +/or uveitis
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14
Q

Diagnosis of Bartonella

A
  • Serology
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15
Q

Treatment for Bartonella

A
  • Doxycycline

- May not be eliminated

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16
Q

Calicivirus clinical signs

A
  • Conjunctivitis occurs with CONCURRENT URI and often ulcers on the tongue
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17
Q

Dfdx for concurrent URI and conjunctivitis

A
  • Herpesvirus
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18
Q

Does calicivirus cause corneal ulcers?

A
  • NO IT DOES NOT
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19
Q

Treatment for calicivirus

A
  • Symptomatic therapy for respiratory disease and topical terramycin or erythromycin for conjunctivitis for secondary bacterial infection
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20
Q

Mycoplasma - what type of bacteria?

A
  • Normal bacterial inhabitant of conjunctiva
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21
Q

Mycoplasma and conjunctivitis

A
  • Possible cause of conjunctivitis
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22
Q

Treatment for Mycoplasma

A
  • Topical terramycin
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23
Q

Who gets Mycoplasma?

A
  • Goats and cattle

- Sometimes cats

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24
Q

Most common cause of conjunctivitis in cats

A
  • FHV1 AKA Rhinotracheitis
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25
How contagious is Herp?
- Highly - >90% cats are carriers - Ubiquitous
26
Herpes outbreaks
- Initially URI | - Subsequent outbreaks are ocular
27
Clinical signs of Herpes outbreaks
- Brown waxy exudate - SErous discharge to purulent - Conjunctivitis can be mild to severe - Chronic or recurring - Unilateral or bilateral
28
Where is FHV1 latent?
- trigeminal ganglion
29
How is FHV1 induced to recrudesce?
- Stress
30
Injectable vaccine to prevent ocular disease FHV1
- Does NOT prevent | - Intranasal vacine is much better
31
Where are the ulcers for FHV1?
- Central cornea | - If it's peripheral, maybe think something else
32
Consequences of neonatal herpes infection
- Symblepharon (adhesion of conjunctiva or eyelids) - Ophthalmia neonatorum - ulcerations - Perforations - Pthisis bulbi
33
Treatment for neonatal herpes infection
- Depends on the issue, but she would vaccinate them for sure
34
Herpes diagnosis
- Often based on clinical signs (and it being a cat) | - Inconsistent data on diagnostic value of PCR, virus isolation, fluorescent antibody
35
Herpes conjunctivitis treatment
- Lysine - Topical antibiotic - Oral doxycycline - Avoid stress - Intranasal vaccine
36
Lysine - how does it work?
- Interferes with viral replication as an arginine antagonist - Reduces shedding
37
Which topical antibiotics for herpesvirus?
- Terramycin or erythromycin ointment or tobramycin solution - Secondary bacterial infection
38
Why oral doxy for herpes?
- Coinfection with chlamydophila
39
What is pathognomonic for feline herpes keratitis?
- Dendritic or punctate ulcers
40
How can you see dendritic or punctate ulcers?
- Fluorescein, cobalt filter, and magnification | - DARKENED ROOM
41
Progression of dendritic or punctate ulcers
- May progress to geographic ulcers | - Deep stromal ulcers may be perforated
42
Loose epithelial edge of corneal ulcer - how to treat for herpes keratitis?
- Debride | - DO NOT GRID
43
What is associated with eosinophilic keratitis?
- FHV-1
44
How do you diagnose eosinophilic keratitis?
- Raised white plaques and cytology with at least 1 eosinophil
45
How easy is it to treat eosinophilic keratitis?
- No easy
46
Treatments for eosinophilic keratitis
- Antivirals, vaccination, cyclosporine, mast cell blockers | - Steroids may clear BUT (!) may lead to herpes corneal ulcers
47
Treatment of herpes keratitis
- Lysine - Terramycin or erythromycin - Doxycycline - Topical antiviral - Oral antiviral - Intranasal FVRC vaccine
48
Topical antivirals for herpes keratitis
- Idoxuridine (5x a day, compounded) - Trifluridine (5x a day and expensive) - Cidofiovir (compounded, $$$, twice a day)
49
Which oral antiviral for herpes keratitis?
- Oral famcyclovir - Expensive - Takes about 6 weeks - Acyclovir is TOXIC to cats and not effective
50
Acyclovir for cat
- TOXIC | - Not effective
51
Why don't you grid keratotomy a cat?
- It can lead to a sequestrum
52
Corneal sequestrum appearance
- Brown discoloration of the cornea - It's a dead area of the cornea - Ca be a black or dark brown seed-like appearance - Not pigment - Chronic irritation - Don't blink well - Poor tear film
53
What is a corneal sequestrum a sequela to?
- Herpes keratitis - Chronic ulcer or irritant - Foreign body - Grid keratotomy
54
Primary treatment for corneal sequestrum
- Can't treat with medical therapy (long-term, painful, anti-virals) - Keratectomy and Graft are ideal
55
Breeds predisposed for corneal sequestrum
- Persian cats
56
Are corneal sequestrums painful?
- YES
57
Stain uptake with corneal sequestrum
- All around the edge
58
Causes of feline uveitis
- Infectious disease (herpes) - Trauma - Neoplasia - Lens induced - Immune mediated lymphocytic-plasmacytic
59
What are the most common causes of feline uveitis in the cat?
- Infectious disease (herpes) | - Lymphoma
60
Appearance of feline uveitis
- Flare and some hypopyon
61
Do you usually see rapid onset cataracts causing LIU in cats?
- Not as much | - More that chronic uveitis leads to cataracts leading to LIU
62
What are the infectious causes of uveitis in cats AKA the "F diseases"
- FeLV - FIV - FIP - FHV1 -
63
Other infectious diseases that cause uveitis in cats
Toxoplasmosis - Bartonella - Systemic mycosis
64
Diagnostics for feline uveitis
- Complete physical and ocular exam - CBC/Chem/UA - Serology (FeLV/FIV/FIP) - Toxo Titers IgG and IgM - She will aspirate aqueous and do cytology (I don't think we should do this) - Bartonella - Fungal screen if suspicious
65
What is it if feline uveitis diagnostics are negative?
- IMmun mediated lymphocytic-plasmacytic uveitis | - But could be Herpes or Bartonella
66
Granuloma in the choroid - what should you think?
- FIP
67
Feline fungal diseases
- Histoplasmosis - Blastomycosis - Coccidioides - Cryptococcus - Aspergillus
68
Treatment for diffuse iris melanoma
- Enucleation
69
Oral causes of uveitis
- Dental disease | - Neoplasia
70
LSA and uveitis
- You can see it in the eye sometimes - It hides in the eye sometimes - Nodules on the iris
71
What do you worry about with perforated lens?
- LIU and secondary glaucoma - They are also at risk for post-traumatic sarcoma - Very high chance
72
With lens perforation, what is the usual recommendation in a cat?
- Removing the eye right away | - Don't want the post-traumatic sarcoma
73
Uveitis and cataracts
- Kind of a chicken and the egg situation | - Uveitis may be lens induced or cataract may be secondary to uveitis
74
Treatment of feline uveitis
1. Directed toward primary agent if possible 2. Topical anti-inflammatory 3. Systemic nati-inflammatory 4. Mydriatic/cycloplegic 5. Systemic antibiotic if indicated
75
Topical anti-inflammatory for uveitis
- Diclofenac (NSAID) - ideal - Prednisone acetate if no ulcer (but expect to develop one) - Be careful with diclofenac still because it can affect kidney function
76
Systemic anti-inflammatory for cats
- NSAID (not labeled long term) | - Prednisolone used with caution (many side effects)
77
Bartonella tx for uveitis
- Doxycycline/azithromycin
78
Toxoplasma tx for uveitis
- Clindamycin
79
Septicemia tx for uveitis
- Clavamox or based on C&S
80
Herpes tx for uveitis
Lysine Famcyclovir (vaccine)
81
Mycosis cause of uveitis tx for uveitis
- Anti-fungal | - Fluconazole, etc.
82
Sequelae of chronic feline uveitis
- Cataract - Lens luxation - Glaucoma
83
How does uveitis lead to glaucoma?
- Obstruction of the drainage angle or synechia
84
Review the treatment for feline glaucoma
- Dorzolamide/timolol BID best choice for cats with glaucoma or enucleation if blind, tumor, or unable to manage pain
85
Normal feline fundus - Is the optic nerve myelinated or not? - Where are vessels? - Where is the optic nerve relative to the tapetum?
- Non-myelinated optic nerve - Vessels extend from the periphery of the optic nerve - optic nerve is in the tapetum - Large tapetal area
86
Enrofloxacin and cat retinas
- IT IS TOXIC | - Avoid or do not exceed 5 mg/kg/day
87
Causes of feline retinal degeneration
- Enrofloxacin - Other toxicities - Taurine deficiency - Hereditary - Traumatic
88
Taurine deficiency in cats
- can cause retinal degeneration - Not very common now - May need to supplement Bengals
89
Hereditary causes of retinal degeneration in cats
- Abyssinian cats
90
Trauma that leads to retinal degeneration - what should you consider in cats?
- Development of sarcomas
91
What should you consider with a cat that has absent PLRs and dilated pupils?
- hypertension | - Check blood pressure
92
What can cause hypertension in cats?
- Hyperthyroidism - Renal disease - Primary
93
Around what value does hypertension become a concern?
- Around 230 mmHg
94
What will the fundus look like with hypertensive retinopathy?
- Retinal hemorrhages | - Serous detachment
95
Prognosis for hypertensive retinopathy and retinal detachment
- It will reattach as blood pressure lowers | - Best prognosis for vision if it attaches under 2 weeks, but may get some vision up to 6 weeks
96
Treatment for feline hypertension
- Amlodipine | - Start at a lower dose and give to effect
97
How should you handle an extremely hypertensive cat?
- Do not stress them out | - They are at risk for cerebral hemorrhage and death
98
Pulmonary hypertension appearance on retinal exam
- Tortuous, thickened vessels
99
Haw's syndrome
- Elevation of 3rd eyelids - No underlying ocular disease - GI disease (diarrhea) often present - No treatment indicated for the eyes

Ophthalmology (8 decks)

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