Intraocular Non-inflammatory and Inflammatory Diseases Flashcards
What are the two important acquired non-inflammatory diseases of the ANTERIOR SEGMENT?
- hyphema
2. neoplasia
Causes of hyphema
- uveitis (RMSF, ehrlichia, neoplasia, etc.)
- trauma (blunt or sharp, rapid decompression)
- neoplasia (primary or systemic)
- hypertension
- coag factor abnormalities (warfarin, vWF Dz)
- Platelet disorders (IMTP, LSA, BM suppression, NSAIDs)
- hyperviscosity syndromes (multiple myeloma, FIP)
- congenital/genetic defects (collie eye, uveal cyst/pigmentary uveitis in Goldens, color dilute Aussies and Mini Dachsunds)
- Chronic glaucoma and retinal detachments
DX Hyphema
- Get a thorough history probing for toxins, inside-outside, tick exposure, signs of systemic illness, petechia and hemorrhage, drugs like NSAIDs
- PE looking for lymphadenopathy, spleno- or hepatomegaly, jaundice, petechia or echymosis
- look at the bad AND good eye - do thorough ocular exam
- CBC/Chem/UA, Coag profile (PT/PTT/ACT)
- Check Blood Pressure
- Titers for infectious causes (Bartonella, FIP, FeLV, for cats; ehrlichia, RMSF, brucella, lepto for dogs
TX of anterior segment disease
- you guessed it, treat underlying disease
- symptomatic so.. Reduce underlying inflammation (steroids or NSAIDs topical
- Cycloplegic agents - reduce painful spasm
- reduce/stop additional hemorrhage (epinephrine/phenylephrine)
- tissue plasminogen factor to break up clots
- anti-glaucoma therapy if indicated (miotics worsen uveitis, use CAIs or Beta blockers)
Prognosis of anterior segment disease
depends on underlying:
vitreal hemorrhage takes a while to resolve
retinal detachment is poor prognosis for vision and eye
glaucoma is poorer prognosis for vision
Canine anterior uveal melanoma
Large, Dark Dogs: Germans, Labs, Goldens, can be in little dogs
enlarging darkening mass; ACUTE hyphema, and/or ACUTE glaucoma.
TX: Laser or excise, if can’t can wait till gets big then enucleate
PX: good, metastasis rate is low
ciliary body adenoma/adenocarcinoma
Goldens over represented
PINK mass behind the iris, gluacoma, hyphema
TX: Enucleation best. Simple excision is low yield.
PX: good, also metastasis rate is low
Metastatic neoplasia
anterior uveitis, hyphema, hypyon, glaucoma, acute blindness, retinal detachments (Rottweilers)
TX: Chemo and symptomatic tx of uveitis
PX: POOR –> 90% of systemic neoplasia is Stage V LSA once it’s reached the eye
other neoplasia: SCC, osteosarcoma, hemangiosarc, adenocarcinomas with POOR PX’s each of them
Diffuse iris melanoma
Feline disease
progressive darkening of the iris, “blochty”, ultimately glaucoma
TX: none. Should enucleate because of potential to metastasize.
PX: watch the eye. CAN metastasize but VERY slow to do so. PIGMENT in filtration angle, PIGMENT migrating through the SCLERA and cats with glaucoma, are more likely to MET.
Feline metastatic neoplasia
LSA is not a death sentence for cats as it is for dogs
will see swollen iris, detached retina, hyphema,
TX: enucleation if primary, tx for systemic LSA
others: SCC rare in cats in eye, nasal/sinus adenocarcinoma reported
** Undifferentiated sarcoma ** – cats with puncture wound and phthisis bulbi get tumor of lens epithelial cell origin
Exogenous causes of uveitis
surface ocular disease (corneal ulcers and abscesses) - not as much of an issue in cats as in dogs
systemic dz w. release of inflammatory mediators that hematogenously spread to the eye (pyometra, abscesses, discospondylitis, bad teeth, etc.)
Infectious (8) and non-infectious (1) causes of uveitis in canine
if it is bilateral think SYSTEMIC, if not bilateral it could still be systemic but likely other
- Brucellosis
- Lepto
- Lyme
- Toxo
- Ehrlichiosis
- RMSF
- Systemic mycosis
- infectious canine hepatitis (distemper)
- Lymphosarcoma - hyphema, chorioretinitis, anterior uveitis, hypoyon
In the western united states, what is the majority of caine uveitis caused by?
immune mediated disease
In the eastern united sates, what is the majority of canine uveitis caused by?
infectious diseases
define uveitis
inflammation of the iris, ciliary body, and/or the choroid
CAT diseases that cause uveitis
- FeLV associated - all cases of feline uveitis should be FeLV screened
- FIV associated - “par planitis” – inflammatory precip. on posterior lens capsule, anterior vitreal debris, and “snow banking” along the pars plana near the ciliary body
- FIP - bilateral anterior uveitis (young cats especially), retinal detachments, hemorrhaging and exudates can be seen, dramatic Keratic Precipitates and RUBIOSIS IRIDES can be seen in kittens
- toxoplasmosis - uni- or bilateral, anterior segment (Flare, rubiosis and KP just like FIP but FIP isn’t unilateral) or posterior segment (multifocal areas of inactive chorioretinitis potentially potentially surrounded by active inflammation
- FHV-1 - rare to be a cause of anterior uveitis
- systemic mycosis - rare in gets, cryptococcosis if anything
- bartonellosis - more prevalent than used to think. treat with doxycycline and pradofloxacin
DDX for endogenous uveitis
- lens induced in dog (phacolytic old dog cataracts or phacoanaphalycatic from lens capsular rupture)
- uveodermatologic syndrome (V-K-H Syndrome)
- immune-mediated chorioretinitis/serous retinal detachment in LARGE dogs
uveodermatologic syndrome (V-K-H Syndrome)
BILATERAL autoimmune disorder against the pigmented cells of neuroectodermal origin. Can see anterior uveitis, retinal detachments, hair depigmentation, skin depigmentation periocular and facial dermatitis
AKITAS are the poster children for this disease
lens induced in dog
phacolytic old dog cataracts or phacoanaphalycatic from lens capsular rupture
immune-mediated chorioretinitis/serous retinal detachment in LARGE dogs
LARGE DOGS - Labs, Goldens, Germans; BILATERAL serous retinal detachment; respond well to steroids, even regain vision when retina “lays back down”
Idiopathic uveitis in dog and cat
many cases of acute AND chronic cases of uveitis go undiagnosed
old cats with chronic uveitis, cataracts, luxated lenses, glaucoma (toxoplasmosis, FIV? FeLV? Bartonellosis? FeHV-1?)
Diagnostic workup of anterior segment disease
- thorough exam (US if can’t visualize the retina)
- good History (regional travel- fungus, lyme disease; indoor/outdoor; other pets sick?; any signs of systemic illness; where it come from? stray? shelter?
- PE auscult and palpate
- MDB (CBC/Chem/UA
- abdominal US if abnormal palpation
- Thoracic - fungal pneumonia or lymphadenopathy
- titers if signs and hx fit
TX of anterior segment disorders
- start with systemic DOXYCYCLINE; anti-fungals if indicated
- supportive… so topical steroids, topical atropine, topical NSAIDs (if cornea ulcerated since can’t use steroids), systemic NSAIDs (dog not cat), systemic steroids or immunosuppressives (anti-inflam or anti-immune if indicated)
Long-term PX of the eye for anterior segment disorders
- cataract formation/lens luxation (common in cat with chronic disease)
- glaucoma - common with posterior synechia and iris bombe also with chronic disease and pre-iridal fibrovascular formation
- phthisis bulbi - due to chronic hypOtension and retinal detachments
- retinal detachment/degeneration - serous or exudative detachments
