Lecture 1 Flashcards
12 yo FS black lab, mass OD for 3 months, squinting and rubbing at it. All eye tests are normal. What is the most likely diagnosis? What treatment options are available?
meibomian gland adenoma (eyelid neoplasia)
95% are benign masses
option 1: monitor as long as there is no corneal irritation
option 2: surgical removal under GA, using wedge resection technique, 100% effective at preventing recurrance.
option 3: resection and cyrotherapy: local anesthetic, triple freeze thaw cycle, usually for OLDER patients or high risk GA patients, 80-90% effective at preventing reoccurance
what is this procedure?
cyrotherapy for a meibomian gland adenoma. use follow up cauterization to minimize bleeding
what is this and what are the common 2 clinical presentations?
melanocytoma, second most common eyelid skin neoplasm in the dog, usually slow growing
1: individual pedunculated heavily pigmented tumors
2: multiple pigmented tumors extending along eyelid margin
what is this and what is the appropriate treatment?
**make sure to take photos to monitor growth
1: surgical removal is curative: may have to do extensive blepharoplasty if lots of the eyelid is involved
2: cryotherapy
what is this likely? how would you treat this?
histiocytoma: common benign cutaneous neoplasm in young dogs
these will regress spontaneously
you can remove a maximum of ______ of the eyelid margin in most dogs without requiring blepharoplastic procedures to recreate additional eyelid length
25%
wot dis? what is the most appropriate treatment?
squamous cell carcinoma
1: cryotherapy
2: surgical removal (not very successful)
the most common eyelid mass in cats is
squamous cell carcinoma
does eye SCC in cats metastasize?
not usually, there are just locally invasive and erosive
what is this and what is the recommended treatment?
SCC
cryotherapy
or surgery (not successful)
what is this and what is the recommended treatment?
eyelid mass + chalazion (blocked meibomian gland)
the chalazion is the bigger swelling covered in hair, the eyelid mass is the little nubbin
treatment: leave it alone if it’s not causing any problem, or lance through conjunctival surface and curettage
what is blepharitis?
inflammation of the eyelid
what is a chalazion?
a chronic lipid granuloma due to blockage of the meibomian gland, usually presents as a firm non painful swelling
what is this?
focal blepharitis
what is a Hordoleum? how do you treat?
infection of the meibomian gland(s) creating a mass which can be painful
treatment: lance, warm compress, maybe consider anti-inflammatories and antibiotics
what is this
diffuse blephariti
diffuse hyperemia and thickening, ulcerative upper and lower eyelids
what are some causes of diffuse blepharitis ?
bacterial: juvenile cellulitis or pyoderma, most common in puppies, marked enlargement of draining facial LNs and ducts, pathogenesis not known (maybe a bacterial hypersensitivity)
parasitic: demodex or sarcoptes
autoimmune: SLE, pemphigus, etc
how to treat diffuse blepharitis of bacterial origin?
systemic pred with systemic antibiotics like cephalosporin (you need pred, just the antibiotics doesn’t do enough)
what is this and what is the appropriate treatment?
eyelid agenesis
lack of normal lateral 3/4 of upper eyelid margin with corneal blood vessels
usually upper eyelid is affected
treatment: ocular lubricants, cryoepilation to destroy hair follicles so hair does not irritate the cornea, create a new eyelid margin via surgery to protect the cornea
**do NOT do entropion surgery (hotz celus)
what are some sequale of eyelid agenesis?
trichiasis, exposure, KCS, severe keratitis and vascularization and ulceration
some don’t have any clinical signs
what is the problem here? treatment?
entropion–>see hairs touching the cornea and an associated corneal ulcer from irritation
Hotz celus procedure surgery
if entropion is severe enough, it can lead to…
pigmentation, scarring, corneal vasculaization
what are the 3 types of entropion and what are treatment options for each?
1)primary/developmental
- most common, often breed predisposition like bulldogs, great danes, etc
-treatment: temporary tacking in puppies and recheck in 2 weeks, modified hotz-celus surgery in adults
2) spastic
- secondary to ocular pain and the dog retracts the globe and the eyelids roll in ex: a corneal ulcer
- treat the underlying problem
3) cicatricial
- secondary to scar formation from trauma or chronic spastic
- very uncommon
-treatment: advancedreleasing techniques
what is this?
distichiasis: hairs coming from the eyelid margin/meibomian gland orifice
usually bilateral, doesn’t always cause problems
with stifer/coarse hair it will irritate the cornea
an owner brings Stuffy, a french bulldog to you and asks shes heard about the term trichiasis. what are you going to tell the owner?
trichiasis: normal hair in a normal follicle that rubs on the eye
rarely a problem, usually seen in brachy’s like Stuffy do don’t worry unless he seems bothered by his eyes
what is the treatment of choice for distichiasis?
cryoepilation
what is this and how should you treat this?
ectopic cilla (where the cilia emerges from palpebral conjunctiva)
can be associated with corneal ulceration
tx: surgical removal (en bloc)
what is this and what causes it?
prolapsed gland of the nictitans membrane
weak connective tissue
a dog comes to you with cherry eye and the owner wants to know why they should treat her. You explain why and you also explain treatment which is….
the gland of the NM produces lots of tears, and a chronically prolapsed gland will become inflammaed and tear production will decrease, leading to a whole other list of problems like infections and ulcers, etc.
treatment: morgan pocket technique surgery
what is this?
scrolled cartilage: vertical aspect of the T cartilage is bent 180 degrees rostrally, common in giant breeds dogs, mostly a cosmetic issue, but the abnormal cartilage can be removed and cauterized.
8yo english bulldog with 1 month OU hx of discharge. what do you see? most likely dx?
dry cornea, hyperemic conjunctiva, blood vessels in the cornea, corneal cloudiness, thick mucopurlent discharge
KCS
what causes KCS and how do you diagnose it?
due to lack of aqueous portion of the tear film
use schirmer tear test: normal is more than 15mm/min, and with KCS it will be less than 10 mm/min
clinical signs of KCS include
blepharospasm (squinting), conjunctivities (hyperemic), mucopurulent discharge, keratitis with ulcers and pigmentation sometimes
what is this?
corneal ulcer (descmetocele), corneal vessels, thick discharge
this is KCS
what are the 3 layers to the tear film?
mucin layer produced by conjunctival goblet cells, acts as a surfactant to help spread aqueous tear film on the corneal epithelial cells
aqueous layer produced by the lacrimal gland and gland of the nictitans membrane, and makes up the majority of the tear film
lipid layer produced by the meibomian gland and is the outer layer to decrease evaporation of the aqueous layer
an owner with a frenchie you just diagnosed with KCS is confused as to what has caused this. you say…
remember:ice cream really satisfies life’s temptations
Idiopathic/autoimmune
Congenital
Removal of gland of 3rd eyelid
Sulfa antibioics
Loss of parasympathetic input
Trigeminal nerve paralysis
most commonly it is idiopathic autoimmune lacrimal adenitis, which means the immune system attacks the lacrimal glands that produce the tears
it can also be congenital in small breed dogs, often associated with micro-ophthalmia
it can also be caused by removing the gland of the nictitans membrane
infectious cause: distemper
toxic drugs like sulfa antimicrobials
neurologic: lack of parasympathetic input
trigeminal nerve paralysis, lack of corneal sensation
true or false: KCS in cats is usually an autoimmune disorder
false, it is due to chronic blepharoconjunctivitis (like from FHV-1), and if you treat the underlying disease the tear production will return to normal
autoimmune is NOT a thing in cats
how do you treat KCS?
cyclosporin A: suppresses immune system( optimmune ointment)
use these 2x daily
Artificial tears–>help replace tears until cyclosporin starts to work
topical antibiotic if nasty discharge
topical steroids (but dont use if an ulcer present)
how do you know if KCS treatment is working?
75% of dogs will respond to cyclosporin with an increased STT, and some that do not have an increased STT will still improve clinically
if a dog isn’t responding to cyclosporin for KCS, what other drug can you try?
Tacrolimus, more potent than cyclosporin, must be compounded
when would you use pilocarpine?
for KCS if there is xeromycteria cases (dry nose), this drug is a parasympthomimetic, can use oral and topical together
parotid duct transportation is a treatment option for…
KCS, this is a last resort treatment and can have long term complications
