Painful eye

Question 1

Case 1: what can be seen?

Answer 1

Eye slightly closed - subtle blepharospasm

Loss of hair lid - hair follicle destruction

Pink, swollen eyelids - blehpritis

Ocular discharge - mucopurulent

Question 2

Case 1 Ddx

Answer 2

Infection

Allergen

Parasites - Demodex

Neoplastic

Irritative - solar

Question 3

Case 1 Tests

Answer 3

Conjunctival cytology

Skin scraping - for demodex

FNA - for neoplasm

Biopsy

Question 4

Case 1 - Allergic

Treatment?

Answer 4

Anti-inflammatory drugs - topical (pred), systemic (oral corticosteroids if really bad)

Antibiotics - Cephalexin, Clindamycin

if the discharge looks dirty and crusty eyelids

Question 5

What is this case commonly seen in the German Shepherd?

Answer 5

Pannus keratitis

Thickened, depigmented and inflamed third eyelid

Question 6

What is this and how would you treat?

Answer 6

Pyogranulomatous blephritis

Biopsy and send for bacterial culture - came back neg

Weeks of oral prednisalone

Question 7

Common cause of blephritis in cats

Answer 7

Acute Feline Herpes Virus blepharoconjunctivitis

Question 8

Case 2: What do you see?

Answer 8

• Blepharospasm
• Red conjunctiva
• Cloudy cornea (oedema and vascularisation)
• Large defect in axial cornea

Question 9

Case 2: Ddx

Answer 9

Infection

Degeneration

Ulceration

Question 10

Diagnostic tests

Answer 10

Corneal cytology

Culture and Sensitivity

Flourescein stain

Question 11

Cytology findings and diagnosis

Answer 11

Neutrophils with no bacteria seen

Ulcerative keratitis with stromal loss - would normally have bacteria involved but not seen in this case

Question 12

Case 2: Treatment

Answer 12

• 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

Question 13

Important things to remember about suspected corneal ulcers

Answer 13

• 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

Question 14

What do you see?

Answer 14

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.

Question 15

Ddx of case 3

Answer 15

Inflammation

Degeneration

Ulceration

Question 16

Tests for case 3

Answer 16

Flourescein stain

Cytology?

Culture and sensitivity?

Question 17

Diagnosis of case 3?

Answer 17

Ulcerative keratitis - chronic corneal erosion

Question 18

Case 3 treatment

Answer 18

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

Question 19

What can you see?

Answer 19

Conjunctival hyperaemia

Cloudy cornea (corneal oedema and keratomalacia)

Deep defect axial cornea

Perilimbal corneal vascularisation

Corneal vascularisation

Question 20

Case 4 tests?

Answer 20

Flourescen stain

Corneal cytology

MC&S?

Question 21

What can be seen here?

Answer 21

Fungal hyphae

Question 22

Treatment of fungi?

Answer 22

Topical antifungal medication

Anti-inflammatory med

Surgery?

Question 23

What is this?

Answer 23

Ectopic cilium

Question 24

Case 5: what can you see?

Answer 24

Eye slightly closed - subtle blepharospasm

Cloudy cornea - oemdema, vascularisation

Ocular diischarge - lactoferrin making the discharge look red

Question 25

Case 5 Ddx

Answer 25

inflammation Ulceration Neoplasia

Question 26

Case 5 tests

Answer 26

Cytology MC&S flouroscein stain

Question 27

What was seen on cytology in case 5? WHat does this indicate?

Answer 27

Eosinophils Eosinophilic keratitis from feline herpes virus

Question 28

Case 5 treatment

Answer 28

Anti-inflammatories/immunomodulating medication Dexamethasone Cyclosporin

Question 29

Ddx for these plaques?

Answer 29

Forein body ulceration neoplasia perforation and iris prolapse

Question 30

Case 6 tests

Answer 30

Flourocein MC&S? Cytology? Excisional biopsy

Question 31

Case 6 diagnosis

Answer 31

Feline keratitis migrans Corneal sequestration

Question 32

Case 6 treatment

Answer 32

Treat primary cause Artificial tears Medical treatment unrewarding Surgery - keratectomy with button graft or corneoconjuntical transposition

Question 33

Case 7: what can be seen?

Answer 33

Eyes slightly closed - blepharospasm Cloudy eye Anterior chamber deposits

Question 34

Case 7: Ddx

Answer 34

Inflammation, immune mediated disease Lipid aqueous Neoplasia

Question 35

Case7: tests

Answer 35

Transillumination Haematology, serum analysis Aqueocentesis

Question 36

Case 7: diagnosis

Answer 36

- anterior uveitis - Cat - neoplasia (lymphoma), FIB virus, toxoplasma, FeLV, Crypto Dog - neoplasia

Question 37

Describe the eye

Answer 37

Iris is vascular, distorted pupil Classic lymphoma

Question 38

What are these?

Answer 38

Keratic precipitates stuck on the corneal endothelium

Question 39

Treatment: case 7

Answer 39

Treat primary cause Anti-inflammatory/immunomodulating medication, topica Secondary glaucoma from inflammation blocking the drainage angle of the eye Surgery - enucleation

Question 40

Case 8: what can you see?

Answer 40

Severe blepharospasm Red eye (episcleral congestion) Cloudy eye (corneal oedema) Mid-dilated, unresponsive pupil

Question 42

Case 8: ddx

Answer 42

Inflammation Ulceration Glaucoma Neoplasia

Question 43

Tests for case 8

Answer 43

pupillary light reflex - none with glaucoma Menace response Tonometry U/S Gonioscopy on fellow eye

Question 44

Diagnosis of glaucoma

Answer 44

Primary - IOP \> 40mmHg Secondary - less induced uveitis

Question 45

Treatment of glaucoma

Answer 45

Treat primary cause - eg uveitis Reduce production of aqueous Increase outflow pain relief Surgery - enucleation