Painful eye Flashcards
Case 1: what can be seen?
Eye slightly closed - subtle blepharospasm
Loss of hair lid - hair follicle destruction
Pink, swollen eyelids - blehpritis
Ocular discharge - mucopurulent
Case 1 Ddx
Infection
Allergen
Parasites - Demodex
Neoplastic
Irritative - solar
Case 1 Tests
Conjunctival cytology
Skin scraping - for demodex
FNA - for neoplasm
Biopsy
Case 1 - Allergic
Treatment?
Anti-inflammatory drugs - topical (pred), systemic (oral corticosteroids if really bad)
Antibiotics - Cephalexin, Clindamycin
if the discharge looks dirty and crusty eyelids
What is this case commonly seen in the German Shepherd?
Pannus keratitis
Thickened, depigmented and inflamed third eyelid
What is this and how would you treat?
Pyogranulomatous blephritis
Biopsy and send for bacterial culture - came back neg
Weeks of oral prednisalone
Common cause of blephritis in cats
Acute Feline Herpes Virus blepharoconjunctivitis
Case 2: What do you see?
- Blepharospasm
- Red conjunctiva
- Cloudy cornea (oedema and vascularisation)
- Large defect in axial cornea
Case 2: Ddx
Infection
Degeneration
Ulceration
Diagnostic tests
Corneal cytology
Culture and Sensitivity
Flourescein stain
Cytology findings and diagnosis
Neutrophils with no bacteria seen
Ulcerative keratitis with stromal loss - would normally have bacteria involved but not seen in this case
Case 2: Treatment
- Refer for debridement and conjunctival graft
- temporary tarsorrhaphy for protection (fix lids together)
- topical Ab
- topical atropine - relieve the pain from iris spasm
- pain relief, anti-inflammatories
Important things to remember about suspected corneal ulcers
- severely oedematous cornea will not take up flouroscein stain even if there is an ulcer
- very deep ulcers won’t hold the stain - down to desmetaceal membrane
- no ulcer there
What do you see?
Red conjunctiva
cloudy cornea
shallow defect on axial cornea
corneal vvascularisation - blood vessels will not come out of the sclera and into the cornea for about a week. Then it takes about 1mm per day.
Ddx of case 3
Inflammation
Degeneration
Ulceration
Tests for case 3
Flourescein stain
Cytology?
Culture and sensitivity?
Diagnosis of case 3?
Ulcerative keratitis - chronic corneal erosion
Case 3 treatment
Debride with cotton bud/high speed opthalmic blurr
Bandage contact lens
Third eyelid flap/temporary tarorraphy not necessary
topical antibiotic +/- topical atropine
- pain relief, anti-inflammatory medication
What can you see?
Conjunctival hyperaemia
Cloudy cornea (corneal oedema and keratomalacia)
Deep defect axial cornea
Perilimbal corneal vascularisation
Corneal vascularisation
Case 4 tests?
Flourescen stain
Corneal cytology
MC&S?
What can be seen here?
Fungal hyphae
Treatment of fungi?
Topical antifungal medication
Anti-inflammatory med
Surgery?
What is this?
Ectopic cilium
Case 5: what can you see?
Eye slightly closed - subtle blepharospasm
Cloudy cornea - oemdema, vascularisation
Ocular diischarge - lactoferrin making the discharge look red
Case 5 Ddx
inflammation
Ulceration
Neoplasia
Case 5 tests
Cytology
MC&S
flouroscein stain
What was seen on cytology in case 5?
WHat does this indicate?
Eosinophils
Eosinophilic keratitis from feline herpes virus
Case 5 treatment
Anti-inflammatories/immunomodulating medication
Dexamethasone
Cyclosporin
Ddx for these plaques?
Forein body
ulceration
neoplasia
perforation and iris prolapse
Case 6 tests
Flourocein
MC&S?
Cytology?
Excisional biopsy
Case 6 diagnosis
Feline keratitis migrans
Corneal sequestration
Case 6 treatment
Treat primary cause
Artificial tears
Medical treatment unrewarding
Surgery - keratectomy with button graft or corneoconjuntical transposition
Case 7: what can be seen?
Eyes slightly closed - blepharospasm
Cloudy eye
Anterior chamber deposits
Case 7: Ddx
Inflammation, immune mediated disease
Lipid aqueous
Neoplasia
Case7: tests
Transillumination
Haematology, serum analysis
Aqueocentesis
Case 7: diagnosis
- anterior uveitis
- Cat - neoplasia (lymphoma), FIB virus, toxoplasma, FeLV, Crypto
Dog - neoplasia
Describe the eye
Iris is vascular, distorted pupil
Classic lymphoma
What are these?
Keratic precipitates stuck on the corneal endothelium
Treatment: case 7
Treat primary cause
Anti-inflammatory/immunomodulating medication, topica
Secondary glaucoma from inflammation blocking the drainage angle of the eye
Surgery - enucleation
Case 8: what can you see?
Severe blepharospasm
Red eye (episcleral congestion)
Cloudy eye (corneal oedema)
Mid-dilated, unresponsive pupil
Case 8: ddx
Inflammation
Ulceration
Glaucoma
Neoplasia
Tests for case 8
pupillary light reflex - none with glaucoma
Menace response
Tonometry
U/S
Gonioscopy on fellow eye
Diagnosis of glaucoma
Primary - IOP > 40mmHg
Secondary - less induced uveitis
Treatment of glaucoma
Treat primary cause - eg uveitis
Reduce production of aqueous
Increase outflow
pain relief
Surgery - enucleation
