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Ophthalmology Rotation > Feline Ophthalmology > Flashcards

Feline Ophthalmology Flashcards

1
Q

Eyelid Agenesis

A
  • Absence a portion of the eyelid
    – Secondary trichiasis and exposure keratoconjunctivitis
    – Most common in cats and horses
    – Cats upper temporal eyelid (also commonly associated with other ocular abnormalities, PPM, retinal dysplasia, cataracts…)
    – Horses upper nasal eyelid
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2
Q

Surgical Repair of Eyelid Agenesis

A
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3
Q

Corneal Sequestrum

  • what
  • signs
A
  • Area of corneal degeneration with amber to brown discoloration
  • Usually in the central/paracentral cornea
  • Variable vascularization
  • Variable ocular pain
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4
Q

Corneal Sequestrum

  • who
  • treatment
A
  • Unique to cats
  • More common
    • Persians
    • Himalayans
  • DSH with corneal irritation
    • Ulcer, entropion, FHV 1
  • Surgery required for removal…referral
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5
Q

Corneal Sequestrum

  • surgery
A
  • Surgical removal - keratectomy +/- conjunctival graft, cornealconjunctival transpostion, cyanoacrylate glue, lamellar or penetrating corneal transplant
  • Recurrence is always possible!!!
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6
Q

Penetrating Keratoplasty

A
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7
Q

Eosinophilic Conjunctivitis/Keratoconjunctivitis

  • what
  • signs
A
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8
Q

Eosinophilic Conjunctivitis/Keratoconjunctivitis

  • diagnosis
  • treatment
A
  • Diagnosis
    – Eosinophils on cytology
  • Treatment
    • Topical
      • Prednisolone acetate 0.1% T-QID
      • Dexamethasone 0.1% T-QID
      • BID
      • Optimmune 0.2% cyclosporine BID
      • Cyclosporine 1 or 2% BID
      • Tacrolimus 0.02 or 0.03% BID
      • Topical megestrol acetate TID
    • Systemic
      • Prednisolone
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9
Q

Eosinophilic Conjunctivitis/Keratoconjunctivitis

  • Topical megestrol acetate TID 3 weeks
A
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10
Q

Eosinophilic Keratitis

  • Prognosis:
A

Prognosis: usually favorable…but treatment may be long term

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11
Q

feline ophthalmology (rankin)

Feline Herpesvirus 1

  • cause what in eyes
A

Corneal ulcers
– Geographic
– Dendritic
– Stromal keratitis

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12
Q

feline ophthalmology (rankin)

Diagnosis of FHV-1

A
  • CLINICAL SIGNS!!!!
  • If it is a cat and it has a corneal ulcer….
  • Conjunctival cytology
    • Intranuclear inclusions, neutrophils
  • PCR – sensitive and specific
  • IFA - insensitive
    • Fluoroescein stain may cause false positive
  • Serology (serum neutralization titer) - insensitive
  • Virus isolation
    • Definitive dx for acute infection
    • Insensitive for chronic infection
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13
Q

feline ophthalmology (rankin)

Feline Herpesvirus Topical Treatment

A
  • Cidofovir 0.5% solution
    • Compounding pharmacy
    • 2 times daily
  • Idoxuridine 0.1% solution
    • Compounding pharmacy
    • 4-6 times daily
  • Trifluridine 1% solution
    • Viroptic® and generic
    • Refrigerated
    • Topically irritating to most patients
  • Topical antibiotic- to prevent bacterial infection
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14
Q

feline ophthalmology (rankin)

FHV Systemic Treatment

A
  • Famciclovir
    • 250 mg or 125 mg tablets (Famvir ®)
    • 30-40 mg/kg B-TID po
  • Do NOT use valacyclovir
  • Lysine
    • 250 mg po BID in kittens
    • 500 mg po BID adult cats
    • Give with food
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15
Q

feline ophthalmology (rankin)

Complications of FHV-1

A
  • Globe rupture
  • Symblepharon
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16
Q

Feline Glaucoma

A
  • Primary glaucoma in cats is very very rare
  • Secondary glaucoma
    – Uveitis
    – Intraocular neoplasia
    – Feline aqueous misdirection syndrome
  • Treatment
    – Topical carbonic anhydrase inhibitors (dorzolamide 2%)
    – Beta blockers (0.25%)
    – Latanoprost ineffective in cats
    – Do not use oral carbonic anhydrase inhibitors
17
Q

Feline Aqueous Humor Misdirection Syndrome

  • who
  • what
  • signs
A

▪ Generally older cats
▪ AH shunted into the vitreous
– Shifts the lens & iris anteriorly
▪ Anisocoria
▪ Shallow anterior chamber
▪ IOP often not elevated initially…

18
Q

Feline Aqueous Humor Misdirection Syndrome

  • Treatment
A
  • Topical carbonic anhydrase inhibitors B-TID
  • Monitor IOP q1-3 months (both eyes)
  • Refer for surgery if unresponsive to medications
19
Q

Feline Cataracts

A
  • Primary inherited cataracts are rare
  • Most cataracts are secondary
    – Anterior uveitis
    – Trauma
    – Lens luxation
20
Q

feline ophthalmology (rankin)

Systemic Hypertension

A

Generally older cats (>10years)

Present with dilated pupils or vision loss

21
Q

feline ophthalmology (rankin)

Hypertensive Retinopathy

  • signs
22
Q

feline ophthalmology (rankin)

Hypertensive Retinopathy

  • etiology
A
  • Idiopathic
    – 20%
  • Chronic kidney disease
    – 19% to 65%of cats
  • Hyperthyroidism
    – 10% to 20%
  • Diabetes mellitus
  • Primary aldosteronism
  • Pheochromocytoma
  • Chronic anemia
23
Q

feline ophthalmology (rankin)

Hypertensive Retinopathy

  • diagnostics
  • treatment
A
  • Diagnostics
    – Systolic blood pressure
    > 160 mmHg
    – CBC/chemistry panel/UA/T4
  • Treatment
    – Treat underlying condition
    – Antihypertensive medication
  • Amlodipine (0.18-0.22mg/kg PO SID, 0.625mg PO SID)
  • Goal BP < 150 mmHg
  • Prognosis for vision?
24
Q

feline ophthalmology (rankin)

Enrofloxacin Retinal Toxicity

A
  • Acute retinal degeneration
  • 1997 label dosing changed from 2.5mg/kg BID to 5-20mg/kg as a split or single dose
    • May occur even at recommended dose (2.5mg/kg BID)
      • Especially in cats with impaired drug metabolism (renal/hepatic dz.)
      • IV administration of enrofloxacin may increase risk of retinal toxicity
  • In most cases the blindness is permanent
  • Use enrofloxacin if no other alternative
    • Use only the lowest dose/shortest amount of time
25
Q

Safety of Other Fluoroquinolones?

A
  • Prudent precaution to consider that ALL fluoroquinolones may have the potential to induce ocular lesions in cats and that all fluoroquinolones should be used with caution in cats
  • Pradofloxacin Veraflox®
    • Oral suspension for cats
26
Q

Polymyxin B and Anaphylaxis

A
  • 61 cats
  • Anaphylactic event within 4 hours
  • BNP or Terramycin ophthalmic ointment
  • Highlights the importance of reporting adverse drug events to the FDA or drug manufacturer
27
Q

feline ophthalmology (rankin)

Diffuse Iris Melanoma

A
  • Most common feline primary intraocular tumor
  • Malignant melanocytic neoplasm
  • Slow, progressive, often multifocal areas of pigmentation of the iris
  • Secondary glaucoma from involvement of the iridocorneal angle
28
Q

feline ophthalmology (rankin)

Distinguish DIM from Iris Nevus

29
Q

feline ophthalmology (rankin)

Diffuse Iris Melanoma

  • prognosis
30
Q

feline ophthalmology (rankin)

Treatment Options for DIM

A
  • Monitor for progression
    – Photos or drawings in the medical record
    – Recheck at 2-4 months intervals
  • Diode laser ablation???
  • Enculeation
    – Thoracic radiographs
    – Abdominal US

Ophthalmology Rotation (20 decks)

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