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Ocular and dermatologic manifestations of disease > Ocular manifestations of systemic disease > Flashcards

Ocular manifestations of systemic disease Flashcards

1
Q

What are the systemic causes of blepharitis? (dogs)

A 
Distemper
Trypanosomiasis
Leishmania
Insect bites
Demodex
Immune-mediated (SLE, Canine idiopathic granulomatous disease, strangles, Pemphigus)
Atopy
Flea bite sensitivity
Zinc responsive
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2
Q

What are the systemic causes of blepharitis in cats?

A 
Bartonella
Dermatophytosis
Crytptococcus
Insect bites
Demodex
Immune-mediated (SLE, Pemphigus)
Atopy
Flea bite sensitivity
Food sensitivity
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3
Q

What are the systemic causes of ptsosis in dogs

A

Pseudorabies
Horner’s syndrome
Multifocal diseases affecting the oculomotor nucleus, including toxoplasmosis, distemper, mycosis, and granulomatous meningoencephalitis

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4
Q

What are the systemic causes of conjunctivitis in dogs?

A 
Canine distemper virus
Canine herpesvirus in neonates
Canine oral papilloma virus
Infectious canine hepatitis (canine adenovirus 1 [CAV-1])
Monocytic ehrlichiosis (Ehrlichia canis)
Rocky Mountain spotted fever (Rickettsia rickettsii)
Lyme borreliosis (Borrelia burgdorferi)
Leishmaniasis 
Trypanosomiasis
Canine idiopathic granulomatous disease
Atopy
Zinc responsive dermatosis
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5
Q

What are the systemic causes of conjunctivitis in cats?

A

Chlamydiosis (Chlamydophila felis, formerly Chlamydia psittaci)
Neochlamydia hartmannellae (obligate amebic host of Hartmannella vermiformis)
Mycoplasmosis
Bartonellosis
Feline rhinotracheitis ([FRV], feline herpesvirus 1 [FHV-1])
Feline calicivirus (FCV)
Feline immunodeficiency virus (FIV)
Atopy
Food hypersensitivity

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6
Q

What are the infectious causes of keratoconjunctivitis?

A

Dogs
Canine distemper virus (CDV)
Canine herpesvirus (neonates only)
Pseudorabies
Canine oral papilloma virus
Lyme borreliosis (Borrelia burgdorferi)
Coccidioidomycosis (Coccidioides immitis)
Leishmaniasis (Leishmania infantum, Leishmania chagasi)
Trypanosomiasis (Trypanosoma brucei, Trypanosoma vivax)

Cats
FHV-1
Bartonellosis

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7
Q

What are the systemic causes of opaque corneal opacities?

A 
Dogs
Hypothyroidism
Mucopolysaccharidosis
Tyrosinemia
Hyperlipidemia
Systemic histiocytosis

Cats
FeLV

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8
Q

What are the systemic causes of KCS?

A

American hepatozoonosis (Hepatozoon americanum)
Hyperadrenocorticism
Sulfonamide toxicity
Phenazopyridine toxicity
Ionizing radiation
Systemic autoimmune secretory gland adenitis (associated with hypothyroidism, systemic lupus erythematosus, etc.)
Canine distemper

Cat
Feline dysautonomia

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9
Q

What is associated with feline sympblepharon?

A 
Feline rhinotracheitis (feline herpesvirus 1 [FHV-1])
Chlamydiosis (Chlamydophila [formerly Chlamydia] psittaci)
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10
Q

What are the Systemic Noninfectious Causes of Retinal/Chorioretinal Scarring and Atrophy in the Dog?

A

Chronic vitamin E deficiency
Hypertension
Chronic severe anaemia
Sulfonamide/trimethoprim toxicity in Doberman pinschers
Sudden acquired retinal degeneration (SARD) syndrome
Uveodermatologic syndrome

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11
Q

What are the Systemic Noninfectious Causes of Retinal/Chorioretinal Scarring and Atrophy in the cat?

A

Chédiak-Higashi syndrome (also causes nontapetal hypopigmentation)
Taurine deficiency
Hyperviscosity syndrome

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12
Q

What are the systemic causes of lipaemia retinalis?

A 
Cat
Primary inherited hyperchylomicronemia
Idiopathic hyperchylomicronemia
Idiopathic transient hyperlipidemia (and anemia) in kittens
Glucocorticoid excess (iatrogenic)
Dog
Hyperadrenocorticism
Hypothyroidism
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13
Q

What are the causes of retinal haemorrhage in the dog?

A 
Canine distemper virus (CDV)
Monocytic ehrlichiosis (Ehrlichia canis)*
Rocky Mountain spotted fever (Rickettsia rickettsii)
Lyme borreliosis (Borrelia burgdorferi)
Blastomycosis (Blastomyces dermatitidis)
Coccidioidomycosis (Coccidioides immitis)
Systemic hypertension*
Hyperviscosity syndrome*
Polycythemia*
Thrombocytopenia
Thrombopathy
Severe anemia
Diabetes
Anticoagulant poisoning
Lymphoma
Multiple myeloma
Intracranial neoplasia
Granulomatous meningoencephalitis (GME)
Ionizing radiation
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14
Q

What are the causes of retinal haemorrhage in the cat?

A 
Lymphoma
Intracranial neoplasia
Systemic hypertension*
Hyperviscosity syndrome*
Thrombocytopenia
Thrombopathy
Severe anemia
Diabetes
Anticoagulant poisoning
FIP
Tuberculosis
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15
Q

What are the systemic causes of retinal detachment in the dog?

A 
Monocytic ehrlichiosis (Ehrlichia canis)
Lyme borreliosis (Borrelia burgdorferi)
Blastomycosis (Blastomyces dermatitidis)
Histoplasmosis (Histoplasma capsulatum)
Cryptococcosis (C. neoformans)
Opportunistic deep mycoses (e.g., aspergillosis)
Protothecosis
Dirofilaria
Systemic hypertension
Hyperviscosity syndrome
Multiple myeloma
Systemic histiocytosis
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16
Q

What are the systemic causes of retinal detachment in the cat?

A

Feline infectious peritonitis virus (FIPV)
Tuberculosis (Mycobacterium bovis, Mycobacterium tuberculosis, Mycobacterium avium)
Cryptococcosis (Cryptococcus neoformans)
Blastomycosis (B. dermatitidis)
Coccidioidomycosis (Coccidioides immitis)
Systemic hypertension
Hyperviscosity syndrome

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17
Q

What are the systemic causes of optic neuritis in the dog?

A

Canine distemper virus (CDV)
Infectious canine hepatitis ([ICH], canine adenovirus 1 [CAV-1])
American hepatozoonosis (Hepatozoon americanum)
Blastomycosis (Blastomyces dermatitidis)
Coccidioidomycosis (Coccidioides immitis)
Toxoplasmosis (Toxoplasma gondii)
Systemic hypertension
Hyperviscosity syndrome
Intracranial neoplasia
Granulomatous meningoencephalitis (GME)

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18
Q

What are the systemic causes of optic neuritis in the cat?

A

Feline infectious peritonitis virus (FIPV)
Tuberculosis (Mycobacterium bovis, Mycobacterium tuberculosis, Mycobacterium avium)
Cryptococcosis (Cryptococcus neoformans)
Histoplasmosis (Histoplasma capsulatum)
Systemic hypertension
Hyperviscosity syndrome

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19
Q

What are the systemic causes of exopthalmus?

A 
Dog
Masticatory myositis
Lymphoma
Systemic histiocytosis
Retrobulbar abscess/tumor/granuloma

Cat
Cryptococcosis (Cryptococcus neoformans)
Lymphoma
Retrobulbar abscess/tumor/granuloma

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20
Q

What are the systemic causes of enopthalmus?

A

Masticatory myositis
Dehydration
Cachexia
Horner’s syndrome (enophthalmos associated with ptosis, third lid prolapse, and miosis)

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21
Q

What are the ocular signs of leishmaniasis and how do they respond to treatment?

A

Anterior uveitis was the most common manifestation and other prevalent findings included blepharitis and keratoconjunctivitis. Several distinct variations of eyelid lesions were seen including a dry dermatitis with alopecia, diffuse blepharedema, cutaneous ulceration, and discrete nodular granuloma

Often respond in correlation with systemic resolving
Uveitis often chronic

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22
Q

What are the main non-infectious diseases that are associated with periocular and eyelid signs?

A

 VKH: depigmentation, blepharitis
 Pemphigoid/SLE/TEN: crusting and ulceration
 Drug eruption: crusting and ulceration
 Atopy: edema, pruritis, blepharitis
 Zinc responsive dermatosis: blepharitis
 Hypothyroidism: blepharitis, KCS

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23
Q

What signs can you see with SLE?

A 
 Immune complex disease
– Trapped immune complexes attract PMNs, platelets, and fix complement
 KCS
 Iridocyclitis
 Lids
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24
Q

What may you see with atopy?

A

 50% have conjunctivitis

 blepharitis

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25
Q

What are the main non infectious diseases in dogs that cause corneal opacity?

A

 Hyperlipidemia: arcus lipoides, multifocal stromal deposits
 Hypothyroidism: lipid keratopathy
 Cushing’s: central corneal calcium deposits

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26
Q

What are the causes of hyperlipidaemia and what do they cause in the eye?

A 
 primary
– hyperlipoproteinemia in Miniature Schnauzers
 secondary: diabetes, hypothyroidism, pancreatitis, Cushing’s, liver disease
 increased triglycerides 
– lipid-laden aqueous humor
– lipemia retinalis
 increased cholesterol
– lipid keratopathy
– atherosclerosis
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27
Q

What are the main Noninfectious Systemic Diseases

Associated with Uveitis?

A 
 Metastatic neoplasia
– lymphoma
 VKH (Vogt Koranagi Harada) or UDS (Uveodermatologic Syndrome)
 Histiocytosis
 Food allergy
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28
Q

What is UDS?

A

 spontaneous autoimmune disease against melanin containing tissues
 Akitas (induced by tyrosinase related protein-1 (TRP-1); DLA gene, OESD, Goldens, Samoyeds, Irish Setters
 panuveitis, retinal detachments
 poliosis/vitiligo- nose, muzzle

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29
Q

Outline histiocytosis

A

Mostly Bermese mountain dogs
 multisystemic, perivascular infiltration of histiocytes
 eyelid and episcleral masses, exophthalmos, uveitis, retinal detachment, glaucoma, and corneal edema
 May not be neoplastic
 Polygenic inheritance

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30
Q

Outline granulomatous meningoencephalitis

A

 CNS disease with perivascular infiltrates of mononuclear cells
 Small breed dogs
 Etiology: inflammation/neoplasia
– May be CNS lymphoma
 CSF tap and CT to dx
 usually presents with CNS signs
 acute blindness with fixed dilated pupils
– Ocular form can progress
 optic neuritis (absent if retrobulbar) leading to optic nerve atrophy
 peripapillary retinitis with RD
 Therapy: systemic steroids

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31
Q

What are the signs of hypertension in the retina

A

 Retinal hemorrhages
 Retinal oedema
 Retinal detachments, esp. with subretinal effusions
 Retinal degeneration

32
Q

What are the Noninfectious Systemic Diseases Associated with Ocular Hemorrhage?

A 
 Coagulopathies
– Clotting factor deficiencies
– DIC
– Platelet abnormalities
– Vitamin K associated toxins
 Vasculopathies
– Polycythemia
– Hyperviscosity syndrome
 Multiple myeloma
 Plasma cell tumor
 Immune mediated diseases
– Hemolytic anemia
– Thrombocytopenia - rubeosis
33
Q

Outline nephrotic syndrome in the eye

A

 Glomerulonephritis from immune complex deposition in the glomerular capillaries
 Proteinuria, hypoalbuminemia, hypercholesterolemia,
and ascites
 Retinal Detachment

34
Q

Which systemic diseases can cause cataracts?

A

 Diabetes
 Hypocalcemia: cataracts
 Riboflavin deficiency
 Mannosidosis in Persian cats: inborn error of metabolism

35
Q

How can hypocalcaemia present in the eye?

A

– CATARACTS!!
– Prolapsed nictitans (cats)
– Papilledema, optic neuritis, conjunctivitis, keratitis, blepharospasm, loss of eyelashes, strabismaus, nystagmus, anisocoria

36
Q

How do hypocalcaemic cataracts present?

A

 Typically appear multifocal (punctate to linear white
opacities) in anterior and posterior subcapsular regions
 Successful tx of hypocalcemia will halt progression

37
Q

What adverse drug reactions can occur in the eye (give examples)

A 
 Sulfonamides: KCS, retinitis, hemorrhages
 Edotolac: KCS
– Reversible if given < 6 months
 Phenylbutazone
 Adriamycin
38
Q

Outline lymphosarcoma of the eye

A

 ocular metastasis is common
 masquerade syndromes
 uveitis, hyphema, pseudohypopyon
 tortuous retinal vessels, perivascular cuffing, retinal detachment or neoplastic infiltration

39
Q

What are the ocular signs of diabetes?

A 
 CATARACTS!!!
 Uveitis
 Poor corneal wound healing
 Lipemia retinalis, lipid laden aqueous
 KCS: 28% lower STT; 37% lower corneal sensation;
58% lower TFBUT
 Horner’s, stromal abscesses
 Canine Keratomycosis
 Retinopathy
40
Q

Outline diabetic cataracts

A

 Glucose is main lens energy source
– Hexokinase is overwhelmed
– Aldose reductase (AR) and sorbitol
dehydrogenase (SD) metabolize glucose
– Up to 33% of glucose is metabolized by the sorbitol pathway in diabetics (normal is 5%)
 sorbitol draws water into the lens causing lens fiber swelling & rupture
 early cataractous changes appear as vacuoles in the equatorial lens cortex in dogs
– posterior cortex in cats
 cataracts rapidly progress to maturity
 cataracts develop in dogs»cats
 80% of dogs within 16 months of diagnosis.
 Lower aldose reductase activity in older cats despite
high AR/SD ratio.
 Lower AR activity in cats than age matched dogs.

41
Q

What may you see in bacterial septicaemia

A

 anterior uveitis to endophthalmitis
 embolization of bacteria
 circulating Ag-Ab complexes

42
Q

How does distemper affect the eye?

A

– ocular discharge, KCS
– ± corneal ulcers
– optic neuritis (blindness)
– Chorioretinitis- “gold-medallion”

dx - conjunctival epithelial scrapings
– ± intracellular inclusion bodies

43
Q

What are the ocular signs of infectious canine hepatitis

A

 canine adenovirus I (CAV-I), “blue eye”
 ocular signs: 7 days PI or post vaccination
– uveitis and corneal edema
– edema is due to an Arthus reaction to viral replication in the endothelium
– ocular signs often unilateral and temporary (1-2 weeks)
 severe cases: Afghans!
– bullous keratopathy
– secondary glaucoma

44
Q

What are the ocular signs of blastomycocis?

A 
– corneal edema/vascularization
– granulomatous chorioretinitis
– retinal detachment
– secondary glaucoma
– optic neuritis
45
Q

What are the ocular signs of Erlichia canis?

A

 acute, subclinical, and chronic phases
 replicates in mononuclears
 incites a vasculitis in target tissues
 tortuous vessels & grey perivascular foci
 chorioretinitis & retinal vasculitis, optic neuritis, retinal
detachment/hemorrhages
 uveitis, hyphema

46
Q

How does rocky mountain spotted fever affect the eye?

A

 Rickettsia rickettsii
 multifocal vasculitis
 uveitis, conjunctivitis, retinal vasculitis/perivasculitis

47
Q

Outline orbital neoplasia

A

– Over 80% of orbital tumors are malignant with
poor prognosis.
– Usually unilateral except lymphosarcoma,
granulomatous meningoencephalitis.
– Suspect neoplasia for unilateral exophthalmos
in older dogs and cats.
– Slow onset of exophthalmos
– Not usually painful around the mouth
– No systemic signs early

48
Q

What is masticatory muscle eosinophilic myositis?

What are the signs?

A 
– Immune mediated with circulating antibodies against masticatory Type IIM myofibers.
– Recurrences frequently observed. Severity
variable.
 Clinical signs: OU
– 1) Exophthalmos
– 2) Painful to open mouth
– 3) Blindness
– 4) Enophthalmos in chronics
– Diagnosis:
 Muscle biopsy: eosinophils
49
Q

Outline eosinophilic masticatory muscle myositis

A

 Young German Shepherds & Weimaraners
– Also described in Labrador & Golden Retrievers
 Swelling of temporal & pterygoid muscles responsible for globe displacement
– Masseter m. is also swollen & painful
 Inflammation can last for 1-3 weeks without treatment
 Suspected immune mediated cause
 Optic neuritis and blindness have been described in
association with acute EM.
 Leukocytosis with marked peripheral eosinophilia

50
Q

Outline extraocular muscle polymyositis

A

 Labrador, Golden, Great Dane, Hovawart, & mixed breed dogs
 Bilateral disease
 Neospora caninum associated with extraocular polymyositis in a litter of German Shorthaired pointers.
 Ultrasound, CT, or MRI will reveal swollen extraocular muscles
– a. etiology: immune mediated against EOM (Type I myofibers), common in 8-10 month old Golden Retrievers
 Also large breed dogs after castration
– b. Clinical Signs
 1) OU (96%)
 2) non-painful
 3) chemosis precedes exophthalmos in 81%
of cases, usually without TE prolapse
 4) may have severe ON impingement with
optic neuritis +/- blindness
 5) enophthalmos
 EMG: abnormal in EOM

51
Q

Outline the treatment of extraocular polymyositis

A

– 1) 54% reoccur, 46% have 2 or more recurrences
– 2) 72% reoccur if taper steroids in less than 21 days
– 3) Oral Cyclosporine (5mg/ kg PO q 12 hours then taper)
MAY BE treatment of choice as immunohistochemical
stains indicate T-lymphocyte response
– 4) systemic steroids

52
Q

What is Sjögren’s syndrome?

A

 Autoimmune attack against moisture producing glands
– KCS
– Xerostomia
 Associated with arthritis, SLE

53
Q

Which systemic diseases can cause KCS?

A

 Systemic diseases causing KCS:
– Canine distemper virus
– Hypothyroidism, hyperadrenocorticism, demodectic mange, SLE, RA
– Diabetes: 28% lower STT; 37% lower corneal sensation; 58% shorter TFBUT
 Neutering/spaying: Lack of testosterone causes lacrimal gland feminization
 Iatrogenic - removal of the gland of the nictitans.
 Chronic blepharoconjunctivitis - scarring of lacrimal ducts
 Immune mediated lacrimal gland adenitis is most
common cause of KCS in dogs.
– up to 75-80% of cases.

54
Q

What are the main breeds associated with KCS?

A

– English Bulldogs,
– West Highland White Terriers, Lhasa Apso, Cocker Spaniels, Pugs, Pekinese, Yorkies, Shih Tzu, Boston Terriers, Dachshunds
– Miniature Schnauzers: few
tears and no clinical signs!!

55
Q

Outline KCS

A

 a. Medical:
– Always attempt 1-2 months of medical treatment because KCS may be transient.
 Goals to remove pain and maintain vision:
– a. Replace tears
– b. Stimulate production of tears with CSA topically
 1-2% cyclosporine A – increases tear production in
80% of cases
– has T helper cell inhibitory activity
– also reduces pigmentary keratitis and fibrosis
– dose: BID OU
– may take 3-4 weeks before increasing tear production.
 If initial STT is 0-2 mm/min, fewer animals respond favorably to CSA i.e. 60 vs 80%
 This probably relates to atrophy and fibrosis of glandular tissue and an inability to regain secretory function within the gland.

56
Q

What are the types of retinal detachment?

A

– rhegmatogenous (most common)
 hole in the retina through which the vitreous can move
– non-rhegmatogenous
 no retinal holes

57
Q

Outline canine vitamin E deficiency

A

– Caused by extremely poor nutrition
– Foci of brown discoloration
– Lipofuscin accumulation in RPE
– Resembles Central Progressive Retinal Atrophy (CPRA) now known as Retinal Pigment Epithelial Dystrophy RPED

58
Q

What is box carring?

A

Areas of non-perfusion in the retinal due to hypertension

59
Q

How does the amount of retinal haemorrhage affect the prognosis in hypertension?

A

More h+ = worse prognosis

60
Q

What can hypercalcaemia cause?

A

Metastatic calcification including band keratopathy

61
Q

How does hypertension affect the eye?

A

 Hypertension
– Increase in systemic BP in 87 % of hyperT4 cats,
however, ocular signs are relatively uncommon
– Retinopathy: Retinal detachment with subretinal
effusion, retinal edema and hemorrhage and subsequent degeneration

62
Q

What occurs in Erlos-Danos syndrome?

A

 The fragile skin and unstable joints found in EDS are the result of faulty collagen.
– Keratoconus
– High myopia
– Cataracts

63
Q

Outline uveal tumours in cats

A 
 Melanoma-most common primary tumor
– diffuse iridal tumors can obstruct the iridocorneal
angle causing glaucoma
– hepatic metastasis may occur
 LSA-most common secondary tumor
– associated with FeLV infection
64
Q

What can cause a nutritional retinopathy in cats?

A

Taurine deficiency

65
Q

What are the most common causes of conjunctivitis in cats?

A 
 Herpesvirus
– hyperemia
 Chlamydophila psittaci
– chemosis
 Mycoplasma felis
– ulcers
 calicivirus
 various types of bacteria
 allergic/environmental
66
Q

Outline herpes virus in cats

A

 80% of cats have it
– Most do not have disease
 early acute signs of infection – sneezing, fever, lethargy, inappetance
 Systemically ill
– serous ocular discharge, hypermic conjunctivitis
 chronic (recurrent) signs of infection
– mucopurulent ocular discharge, dendritic corneal ulcers, stromal ulcers, corneal vascularization/scarring, KCS

67
Q

What are the main causes of sequestra in cats

A 
Causes
•Herpes
•KCS
•Entropion
•Post ulcer
•Gridding
Treatments
•Medical
•Transpositions
68
Q

Outline eosinophilic keratitis in cats

A

 proliferative, white to pink, irregularly surfaced,
vascularized corneal mass
– most commonly originates from the temporal or nasal limbus
– may involve adjacent conjunctiva and nictitans
 diagnosis
– cytology of corneal scrapings
– eosinophils, mast cells, lymphocytes, plasma cells
 therapy: recurrences are common
– topical corticosteroids
– systemic megestrol acetate

69
Q

How do you diagnose herpes virus

A

 best to test during active disease
– Lots of viral shedding
 IFA testing of conjunctival scrapings
– fluorescein stain after collecting samples to avoid false positives
– Not accurate
 PCR is best and detects virus DNA in corneal and conjunctival scrapings but results vary according to the lab
 Tests are less reliable in chronic cases
 Dendritic ulcers are pathognomonic (acute stages)
 Clinical signs are important in the diagnosis.

70
Q

Outline herpes virus therapy

A

 topical antiviral medications
– idoxuridine (0.5%) five times/day or vidarabine (3%)
– cidofovir 0.5% BID
 topical antibiotics
– controls secondary bacterial infections
 recurrent herpesvirus
– rule out FeLV and FIV co-infections
– oral famciclovir 40 mg/kg BID for PO for 3 weeks (Famvir tablets)
– oral lysine (500 mg BID PO); VIRALYS for cats
– interferon alpha-2 (300 units/day PO)
– topical alomide 0.1% (Lodoxamide): mast cell and eosinophil stabilizer

71
Q

Outline feline ocular bartonellosis

A

 Bartonella hensela: gram negative rods
•Iritis
•KPs
•White vitreous exudate causing lack of tapetal reflex

72
Q

Outline cryptococcosis

A

 ocular signs
– cats more often affected than dogs
– optic neuritis, dilated pupils, exudative granulomatous chorioretinitis
 systemic signs
– CNS, skin and respiratory lesions
 ocular extension from vascular*, respiratory, or CNS systems
 may identify organism in vitreal or CSF aspirates
*most common

73
Q

Outline histoplasma capsulatum

A

 Uncommon; affects cats > dogs
 usually ocular extension from a respiratory infection
 granulomatous choroiditis with retinal detachment

74
Q

How can FIP present in the eye?

A 
 anterior > posterior uveitis
 aqueous flare, keratic precipitates
 fibrin and/or hypopyon in AC
 retinal vasculitis, optic neuritis
 elevated total plasma protein
 polyclonal gammopathy
75
Q

How can toxoplasmosis appear in the eye?

A 
 ocular lesions + generalized disease
 hematologic spread of sporozoites
 multiplication of tachyzoites in
ocular tissues 
 uveitis
– multifocal retinitis or retinochoroiditis

Ocular and dermatologic manifestations of disease (8 decks)

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