Ocular manifestations of systemic disease Flashcards
What are the systemic causes of blepharitis? (dogs)
Distemper Trypanosomiasis Leishmania Insect bites Demodex Immune-mediated (SLE, Canine idiopathic granulomatous disease, strangles, Pemphigus) Atopy Flea bite sensitivity Zinc responsive
What are the systemic causes of blepharitis in cats?
Bartonella Dermatophytosis Crytptococcus Insect bites Demodex Immune-mediated (SLE, Pemphigus) Atopy Flea bite sensitivity Food sensitivity
What are the systemic causes of ptsosis in dogs
Pseudorabies
Horner’s syndrome
Multifocal diseases affecting the oculomotor nucleus, including toxoplasmosis, distemper, mycosis, and granulomatous meningoencephalitis
What are the systemic causes of conjunctivitis in dogs?
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
What are the systemic causes of conjunctivitis in cats?
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
What are the infectious causes of keratoconjunctivitis?
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
What are the systemic causes of opaque corneal opacities?
Dogs Hypothyroidism Mucopolysaccharidosis Tyrosinemia Hyperlipidemia Systemic histiocytosis
Cats
FeLV
What are the systemic causes of KCS?
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
What is associated with feline sympblepharon?
Feline rhinotracheitis (feline herpesvirus 1 [FHV-1]) Chlamydiosis (Chlamydophila [formerly Chlamydia] psittaci)
What are the Systemic Noninfectious Causes of Retinal/Chorioretinal Scarring and Atrophy in the Dog?
Chronic vitamin E deficiency
Hypertension
Chronic severe anaemia
Sulfonamide/trimethoprim toxicity in Doberman pinschers
Sudden acquired retinal degeneration (SARD) syndrome
Uveodermatologic syndrome
What are the Systemic Noninfectious Causes of Retinal/Chorioretinal Scarring and Atrophy in the cat?
Chédiak-Higashi syndrome (also causes nontapetal hypopigmentation)
Taurine deficiency
Hyperviscosity syndrome
What are the systemic causes of lipaemia retinalis?
Cat Primary inherited hyperchylomicronemia Idiopathic hyperchylomicronemia Idiopathic transient hyperlipidemia (and anemia) in kittens Glucocorticoid excess (iatrogenic) Dog Hyperadrenocorticism Hypothyroidism
What are the causes of retinal haemorrhage in the dog?
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
What are the causes of retinal haemorrhage in the cat?
Lymphoma Intracranial neoplasia Systemic hypertension* Hyperviscosity syndrome* Thrombocytopenia Thrombopathy Severe anemia Diabetes Anticoagulant poisoning FIP Tuberculosis
What are the systemic causes of retinal detachment in the dog?
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
What are the systemic causes of retinal detachment in the cat?
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
What are the systemic causes of optic neuritis in the dog?
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)
What are the systemic causes of optic neuritis in the cat?
Feline infectious peritonitis virus (FIPV)
Tuberculosis (Mycobacterium bovis, Mycobacterium tuberculosis, Mycobacterium avium)
Cryptococcosis (Cryptococcus neoformans)
Histoplasmosis (Histoplasma capsulatum)
Systemic hypertension
Hyperviscosity syndrome
What are the systemic causes of exopthalmus?
Dog Masticatory myositis Lymphoma Systemic histiocytosis Retrobulbar abscess/tumor/granuloma
Cat
Cryptococcosis (Cryptococcus neoformans)
Lymphoma
Retrobulbar abscess/tumor/granuloma
What are the systemic causes of enopthalmus?
Masticatory myositis
Dehydration
Cachexia
Horner’s syndrome (enophthalmos associated with ptosis, third lid prolapse, and miosis)
What are the ocular signs of leishmaniasis and how do they respond to treatment?
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
What are the main non-infectious diseases that are associated with periocular and eyelid signs?
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
What signs can you see with SLE?
Immune complex disease – Trapped immune complexes attract PMNs, platelets, and fix complement KCS Iridocyclitis Lids
What may you see with atopy?
50% have conjunctivitis
blepharitis
What are the main non infectious diseases in dogs that cause corneal opacity?
Hyperlipidemia: arcus lipoides, multifocal stromal deposits
Hypothyroidism: lipid keratopathy
Cushing’s: central corneal calcium deposits
What are the causes of hyperlipidaemia and what do they cause in the eye?
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
What are the main Noninfectious Systemic Diseases
Associated with Uveitis?
Metastatic neoplasia – lymphoma VKH (Vogt Koranagi Harada) or UDS (Uveodermatologic Syndrome) Histiocytosis Food allergy
What is UDS?
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
Outline histiocytosis
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
Outline granulomatous meningoencephalitis
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
What are the signs of hypertension in the retina
Retinal hemorrhages
Retinal oedema
Retinal detachments, esp. with subretinal effusions
Retinal degeneration
What are the Noninfectious Systemic Diseases Associated with Ocular Hemorrhage?
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
Outline nephrotic syndrome in the eye
Glomerulonephritis from immune complex deposition in the glomerular capillaries
Proteinuria, hypoalbuminemia, hypercholesterolemia,
and ascites
Retinal Detachment
Which systemic diseases can cause cataracts?
Diabetes
Hypocalcemia: cataracts
Riboflavin deficiency
Mannosidosis in Persian cats: inborn error of metabolism
How can hypocalcaemia present in the eye?
– CATARACTS!!
– Prolapsed nictitans (cats)
– Papilledema, optic neuritis, conjunctivitis, keratitis, blepharospasm, loss of eyelashes, strabismaus, nystagmus, anisocoria
How do hypocalcaemic cataracts present?
Typically appear multifocal (punctate to linear white
opacities) in anterior and posterior subcapsular regions
Successful tx of hypocalcemia will halt progression
What adverse drug reactions can occur in the eye (give examples)
Sulfonamides: KCS, retinitis, hemorrhages Edotolac: KCS – Reversible if given < 6 months Phenylbutazone Adriamycin
Outline lymphosarcoma of the eye
ocular metastasis is common
masquerade syndromes
uveitis, hyphema, pseudohypopyon
tortuous retinal vessels, perivascular cuffing, retinal detachment or neoplastic infiltration
What are the ocular signs of diabetes?
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
Outline diabetic cataracts
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.
What may you see in bacterial septicaemia
anterior uveitis to endophthalmitis
embolization of bacteria
circulating Ag-Ab complexes
How does distemper affect the eye?
– ocular discharge, KCS
– ± corneal ulcers
– optic neuritis (blindness)
– Chorioretinitis- “gold-medallion”
dx - conjunctival epithelial scrapings
– ± intracellular inclusion bodies
What are the ocular signs of infectious canine hepatitis
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
What are the ocular signs of blastomycocis?
– corneal edema/vascularization – granulomatous chorioretinitis – retinal detachment – secondary glaucoma – optic neuritis
What are the ocular signs of Erlichia canis?
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
How does rocky mountain spotted fever affect the eye?
Rickettsia rickettsii
multifocal vasculitis
uveitis, conjunctivitis, retinal vasculitis/perivasculitis
Outline orbital neoplasia
– 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
What is masticatory muscle eosinophilic myositis?
What are the signs?
– 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
Outline eosinophilic masticatory muscle myositis
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
Outline extraocular muscle polymyositis
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
Outline the treatment of extraocular polymyositis
– 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
What is Sjögren’s syndrome?
Autoimmune attack against moisture producing glands
– KCS
– Xerostomia
Associated with arthritis, SLE
Which systemic diseases can cause KCS?
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.
What are the main breeds associated with KCS?
– 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!!
Outline KCS
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.
What are the types of retinal detachment?
– rhegmatogenous (most common)
hole in the retina through which the vitreous can move
– non-rhegmatogenous
no retinal holes
Outline canine vitamin E deficiency
– 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
What is box carring?
Areas of non-perfusion in the retinal due to hypertension
How does the amount of retinal haemorrhage affect the prognosis in hypertension?
More h+ = worse prognosis
What can hypercalcaemia cause?
Metastatic calcification including band keratopathy
How does hypertension affect the eye?
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
What occurs in Erlos-Danos syndrome?
The fragile skin and unstable joints found in EDS are the result of faulty collagen.
– Keratoconus
– High myopia
– Cataracts
Outline uveal tumours in cats
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
What can cause a nutritional retinopathy in cats?
Taurine deficiency
What are the most common causes of conjunctivitis in cats?
Herpesvirus – hyperemia Chlamydophila psittaci – chemosis Mycoplasma felis – ulcers calicivirus various types of bacteria allergic/environmental
Outline herpes virus in cats
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
What are the main causes of sequestra in cats
Causes •Herpes •KCS •Entropion •Post ulcer •Gridding Treatments •Medical •Transpositions
Outline eosinophilic keratitis in cats
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
How do you diagnose herpes virus
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.
Outline herpes virus therapy
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
Outline feline ocular bartonellosis
Bartonella hensela: gram negative rods
•Iritis
•KPs
•White vitreous exudate causing lack of tapetal reflex
Outline cryptococcosis
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
Outline histoplasma capsulatum
Uncommon; affects cats > dogs
usually ocular extension from a respiratory infection
granulomatous choroiditis with retinal detachment
How can FIP present in the eye?
anterior > posterior uveitis aqueous flare, keratic precipitates fibrin and/or hypopyon in AC retinal vasculitis, optic neuritis elevated total plasma protein polyclonal gammopathy
How can toxoplasmosis appear in the eye?
ocular lesions + generalized disease hematologic spread of sporozoites multiplication of tachyzoites in ocular tissues uveitis – multifocal retinitis or retinochoroiditis
