Orbits and Eyelid Diseases Flashcards
Congenital/ heritable orbital diseases
- Microphthalmia
- Strabismus
- Physiological exophthalmos
Acquired orbital diseases
A) Exophthalmia: forward displacement of the ocular globe
- Retrobulbar cellulitis or abscess
- Proptosis
- Eosinophilic myositis and extraocular myositis
- Orbital neoplasia
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B) Enophthalmia: Caudal displacement of the eye with protrusion of 3rd eyelid
- Loss of orbital tissue mass
- Horner’s syndrome
- Ocular pain
Microphthalmia
- cause
- clinical signs
- dx
- tx
-Cause: congenital, genetic
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Clinical signs:
- small globe
- palpebral opening usually smaller
- intraocular abnormalities
- blindness (vs nanophthalmia)
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Diagnosis: examination
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Treatment: benign neglect/enucleation
Strabismus
- cause
- clinical signs
- dx
- tx
Cause:
- congenital or genetic
- muscle or nerve
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Clinical signs: convergence/divergence
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Diagnosis: examination
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Treatment: benign neglect/surgery
Physiologic Exophthalmos
- cause
- clinical signs
- dx
- tx
- Cause: shallow orbits (brachycephalic)
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Clinical signs: - protruding eyes
- inadequate/incomplete blink (sleep
with eyes open!)
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Diagnosis: examination
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Treatment: canthoplasty to shorten the palpebral fissure length.
Orbit: Abscess/Cellulitis
- cause
- clinical signs
- dx
- tx
Cause: acute retrobulbar infection
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Clinical signs:
- exophthalmos
- prolapse of third eyelid
- reduced retropulsion of globe
- pain upon opening mouth
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Diagnosis:
- PLR, fluorescein stain
- oral exam
- ocular ultrasound
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Treatment:
- systemic antibiotics and NSAID’s
- surgical exploration?
Orbit: Proptosis
- cause
- clinical signs
- dx
- tx
- prognosis
Cause:
- trauma
- brachycephalics vs dolicocephalics/cats > brachycephalics eyes fall out easily
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Clinical signs:
- severe exophthalmos
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Diagnosis:
- indirect PLR, fluorescein stain
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Treatment:
- tarsorrphaphy vs enucleation
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Prognosis:
- vision with strabismus > for brachycephalics, easy to put back in
- blind > if an animal with a closed orbit has an eye out (or dolichocephalic and cats) its not going back in….
proptosis clinical signs > prognosis > treatment
- direct PLR > Guarded to good > Tarsorraphy
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- direct PLR > Guarded to good > Tarsorraphy
- Medial rectus muscle avulsion > Guarded to poor > Tarsorraphy +/- enucleation later
<> - 2+ rectus muscle avulsion > Poor to grave > Enucleation
<> - Intraocular hemorrhage > Poor > Tarsorraphy +/- enucleation later
<> - Optic nerve transection > Grave > Enucleation
<> - Breed > Good - grave > Tarsorraphy - enucleation (brachycephalic is better than dolichocephalic or cat)
Orbit: Eosinophilic Myositis and Extraocular Myositis (dog)
- cause
- clinical signs
- dx
- tx
Cause: ? Immune-mediated
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Clinical signs:
- surprised look
- lg breed dogs (Goldens, LR, GSD)
- exophthalmos
- difficulty opening mouth
(- As condition progresses into chronic
> Enophthalmia due to fibrosis and atrophy of muscles
> Lack of ocular movement due to fibrosis of extraocular muscles)
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Diagnosis: muscle biopsy
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Treatment: oral prednisone
Orbit: Neoplasia (dog/cat)
- cause
- clinical signs
- dx
- tx
Cause: malignant tumors
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Clinical signs:
- progressive exophthalmia
- no pain on opening mouth
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Diagnosis:
- ultrasound, CT/MRI
- +/- FNA
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Treatment:
- exenteration/orbitectomy/orbitotomy
- radiation?
Orbit: Enophthalmia
- cause?
- clinical signs
- dx
- tx
Cause:
- Horner’s Syndrome (dog>cat)
- Loss of orbital tissue mass (dog/cat):
> dehydration, weight loss,
> cachexia, muscle loss
- Phthisis bulbi (dog/cat)
- Ocular pain (dog/cat)
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Clinical signs:
- Protrusion of third eyelid
- Other signs associated with Horner’s Syndrome (ptosis, miosis)
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Diagnosis: examination
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Treatment: depends on the cause
Eyelid: Coloboma
- cause
- clinical signs
- dx
- tx
(A coloboma is a hole in one of the structures of the eye, such as the iris, retina, choroid, or optic disc)
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Cause: Congenital, genetic
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Clinical signs:
- Absence of upper lateral palpebral margin (usually)
- Often concurrent intraocular abnormalities
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Diagnosis: examination
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Treatment: Surgery – rotational flap/cryotherapy with dermal filler
Eyelid: Ophthalmia Neonatorium
- cause
- clinical signs
- dx
- tx
Cause: FHV-1?
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Clinical signs:
- bulging eyelids prior to opening (normally open at 7-12 days)
- mucopurulent discharge
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Diagnosis: examination
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Treatment: open eyelids then irrigation, topical antibiotics, topical lubrication
Eyelid: Blepharitis
- cause
- clinical signs
- dx
- tx
inflammation of the eyelid
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- Cause: Chalazion, hordoleum, cellulitis
- Clinical signs: several (dry eye, allergies, infection)
- Diagnosis: examination, biopsy, culture
- Treatment: pending cause
Eyelid: Tight Medial Canthal Syndrome / Lazy Tear Ducts
- cause
- clinical signs
- dx
- tx
- Cause: Tight eyelids, ineffective lacrimal pump
- Clinical signs: brachycephalic, tear staining
- Diagnosis: examination
- Treatment: surgery?, oral antibiotics
Eyelid: Medial Trichiasis
- cause
- clinical signs
- dx
- tx
- Cause: hair growing from nasal
caruncle act like a wick - Clinical signs: epiphora
- Diagnosis: examination
- Treatment: caruncular excision/medial canthoplasty
Eyelid: Aberrant Hairs - types
- Distichia - eyelash coming from an abnormal part of the eyelid (eg. meibomian gland)
<><> - Ectopic cilia - Hair comes out palpebral conch, grins on cornea. Must remove surgically.
<><> - Trichiasis - normal hairs, normal location, laying wrong
Eyelid: Entropion
- cause
- clinical signs
- dx
- tx
Cause: developmental, genetic, cicatricial, secondary to enophthalmos
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Clinical signs:
- wet eyelids rolling inwards
- +/- corneal ulceration
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Diagnosis:
- examination
- topical anesthetic
- pull out lateral canthus
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Treatment: tacking sutures vs surgery
Eyelid: Ectropion
- cause
- clinical signs
- dx
- tx
Cause: genetic (breed standard), cicatricial
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Clinical signs:
- eyelid rolling outwards, conjunctivitis (exposure)
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Diagnosis: examination
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Treatment: various surgeries + wedge resection
Eyelid: Laceration
- cause
- clinical signs
- dx
- tx
Cause: trauma
Clinical signs: lacerated palpebral margin
Diagnosis: fluorescein stain uptake for corneal ulceration
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Treatment:
- surgical reconstruction
- must have excellent tissue apposition expect swelling
Eyelid: Neoplasia, dogs
- cause
- clinical signs
- dx
- tx
Cause: Dogs: meibomian gland adenoma
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Clinical signs:
- raised eyelid mass
- +/- associated chalazion
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Diagnosis: examination, FNA
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Treatment:
- < 1/3 eyelid wedge resection
- >1/3 blepharoplasty
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Eyelid: Neoplasia, cats
- cause
- clinical signs
- dx
- tx
Cause: Cats: squamous cell carcinoma /
mast cell tumor
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Clinical signs: erosive plaques/nodules
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Diagnosis: biopsy
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Treatment:
- surgical excision
- radiation
- cryotherapy
Third Eyelid: Prolapse
- cause
- clinical signs
- dx
- tx
Cause: Congenital/genetic
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Clinical signs:
- ovoid mass presents acutely at medial canthus
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Diagnosis: examination
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Treatment:
- surgical repositioning via pocket
technique
Third Eyelid: Everted cartilage
- cause
- clinical signs
- dx
- tx
Cause: familial/genetic
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Clinical signs: scrolled/bent cartilage
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Diagnosis: examination
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Treatment: surgically remove bent stem
Third Eyelid: Follicular Conjunctivitis
- cause
- clinical signs
- dx
- tx
Cause: activation of the local immune
system (allergic or antigenic response of local immune system)
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Clinical signs:
- lymphoid hyperplasia
- conjunctivitis
- mucopurulent discharge
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Diagnosis: examination
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Treatment:
- apply topical anesthetic
- debride follicles
- topical steroid-antibiotic drop
Third Eyelid: Neoplasia
- cause
- clinical signs
- dx
- tx
Cause:
- gland: adenoma/adenocarcinoma
- conjunctiva: hemangioma, melanoma
- lymphoid follicles: lymphoma
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Clinical signs: raised, discoloured
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Diagnosis: biopsy
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Treatment: excision of entire third eyelid
