1. LIVE IN THE MOMENTLIVE IN THE MOMENT! “The secret of health for both mind and body is not to mourn for the past, not to worry about the future, or not to anticipate troubles, but to live in the present moment wisely and earnestly.” -Buddha

2. Ophthalmic Diseases Chapter 4 Common Diseases of Companion Animals

3. Ophthalmic Diseases

5. Conjunctivitis CONJUNCTIVA: pink tissue that lines the inner surface of the eyelids and covers the front portion of the eyeball except for the cornea Causes – Allergy (atopy) – Anatomic (ectropion, entropion) – Bacterial infection (predisposed by): Injury ↓Tear production Foreign body Respiratory disease (bacteria, virus) Causes (in cats it is usually infectious) – Feline herpes virus (most common cause of bilateral conjunctivitis) – Calicivirus – Chlamydia psittaci bacteria – Mycoplasma

6. Red, congested/swollen, painful

7. Conjunctivitis Signs – Redness – Chemosis (swelling of conjunctiva) – Ocular discharge (tears, mucus) Diagnosis – Determine 1º disease, if any – Rule out FB – Rule out ‘dry eye’ in recurrent cases Schirmer tear test – 1 min- tears show as blue dye

8. SCHIRMER TEAR TEST Cats: 11-23mm

9. Conjunctivitis Rx – Topical antibiotic ointment neomycin/bacitracin/polymyxin B(BNP or triple antibiotic) Gentamicin ophthalmic ointment Antibiotic w/ cortisone (if cornea is intact) Client info – Do not allow dogs to ride with head out window – Keep medial canthus of eye clean (warm water, clip hair) – Vaccinate kittens to prevent URI – Do not touch eye with applicator – Discard unused medication

10. Epiphora EPIPHORA: excessive tearing Causes (2 causes) – Overproduction of tears Ocular pain, irritation (from hair, etc) – Faulty drainage by lacrimal system Blockage of duct (swelling, inflam) Blockage of puncta (hair, debris) Imperforate puncta (no opening) – Cockers – Poodles Trauma

11. Epiphora  Signs  Watering of eye  Discoloration of hair  Dx  Fluorescein dye test  Dye at nose shows duct is open  Rx  Treat 1º cause  Flush lacrimal ducts  Surgically open imperforate puncta  Topical antibiotic ointment  Keep hair trimmed around eyes  May act as a wick  Client info  Staining due to pigment in tears, not blood  Some dogs have life-long problem

12. EPIPHORA FLUSHING THE NASOLACRIMAL DUCT

13. EntropionEntropion: eyelids that roll in against the cornea Causes – Congenital large orbits w/ deep-set eyes (poor lid support) – Collies, G. Dane, I. Set, Dobe, G. Ret, Rott, Weim Poor ocular muscle development – Chesapeake, Labs, Chow, Samoyed – Trauma → scarring with distortion of lid – 2º to painful corneal lesion, conjunctiva inflammation (most common cause in cats) Signs – Epiphora (tearing) – Chemosis (swelling of conjunctiva) – Conjunctivitis – Pain – Corneal ulceration (±) – Photophobia

15. Entropion Treatment – Surgical correction is treatment of choice Temporary mattress suture to evert eye (young animal) Lateral canthoplasty (to shorten eye lid) Hotz-Celsus: Remove elliptical piece of tissue from under eye

17. Ectropion Causes – Congenital Bassets, Blood, C Span, E Bull, St Bern Signs – Conjunctivitis – Epiphora – Keratitis (corneal inflammation/scarring), usually from exposure – Purulent exudate Rx – Surgery to shorten eye lid – Other procedures

18. Hypertrophy and Prolapse of 3 rd eyelid gland

19. Hypertrophy and Prolapse of Nictitans Gland (Cherry Eye) Nictitating membrane is the 3 rd eyelid; is a protective structure Produces ~30% of tears Cause is unknown – Bassets, Beagle, Bos. Terr, C. Span Signs – Young dog (<2 y) – Epiphora – Usually no pain Dx – r/o tumor in older dogs and cats Rx – Sx to remove gland is an option, but not recommended – Suture back in place

20. Glaucoma Aqueous humor provides nourishment to lens and cornea Increased intraocular pressure; → Blindness Normally, the amt of fluid produced = amt of fluid leaving eye Normal: Dog/Cat—12-22 mm Hg Causes – Inherited (C Span, Basset, Chow) – Secondary—obstruction of drainage angle Neoplasia Luxation of lens Hemorrhage Uveitis (ciliary body, iris, choroid) Signs – Ocular pain – Episcleral injection – Corneal edema – Dilated pupil (unresponsive to light) – Blind (±)IRIDOCORNEAL ANGLE

21. Glaucoma Dx – IOP>30 mm Hg Rx – Acute (this is an emergency; prevent blindness) Latanoprost (Xalatan 0.005%) – Facilitates aqueous outflow Dichlorphenamide (Daranide) – Decreases aqueous production Surgical – Cryosurgery or laser (destroys part of ciliary body) » Decreases aqueous production – Chronic Enucleation to relieve pain Schiotz Tonometer Tono-Pen

22. Ulcerative Keratitis (Corneal Ulcers) Ulcers usually heal within a few days Causes – Trauma – Chemical burns – Foreign objects – KCS (Keratoconjunctivitis Sicca) – Conformational abnormalities – Herpes virus (cats) Signs – Pain – Epiphora – Blepharospasm (eyelid spasm) – Hyperemia of conjunctiva Dx —Fluorescein dye to cornea Herpes virus

23. Ulcerative Keratitis (Corneal Ulcers) Rx – Topical atropine (1%) ointment (Debate over benefits and how long to use) Decrease pain, blepharospasm – Topical broad-spectrum antibiotic ointment – Viral ointments or solutions (Viroptic for cats with herpes virus) – Surgery Eyelid flap, conjunctival flap – Serum (autologous) Blocks proteases released from leukocytes and bacteria (helps prevent continued collagen loss) – keep in refrigerator (throw out after 72 hours)

24. Deep Corneal Ulcer Desmetocele – erosion to membrane

26. Ulcerative Keratitis (Corneal Ulcers) Client info – Most ulcers heal quickly with treatment – Avoid using old medications – Rx with cortisone will inhibit healing of ulcer – Do not touch eye with ointment applicator