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Chronic Superficial Keratitis (Pannus)
Pannus—superficial corneal vascularization/scar tissue Progressive, bilateral, can result in blindness Cause Thought to be immune-mediated (Infiltration of cornea with lymphocytes, plasma cells) Increased ultraviolet light/high altitudes increases incidence Signs Opaque lesions that begin at limbus and extend into cornea Milky, pink, or tan
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Chronic Superficial Keratitis (Pannus)
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Chronic Superficial Keratitis (Pannus)
Breeds Ger. Shep, B. Collie, greyhound, Sib. Husky Dx r/o KCS, corneal ulcers Rx Corticosteroids often lifelong Cyclosporine often lifelong Antibiotic eye ointment Client info No cure If Rx is stopped, disease will return and progress High altitudes and ↑sun predispose animals
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DOGGLES!!!!
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Keratoconjunctivitis Sicca (KCS)
Lack of tear production; tears lubricate, nourish, ↓bacteria, aid in healing Tears from 2 glands: 70%--Lacrimal gland; 30%--Nictitans gland Signs Recurrent conjunctivitis, corneal ulcers, keratitis Dull, dry, irregular cornea, conjunctiva Tenacious, mucoid ocular discharge Blepharospasm Crusty nares Rx Tear stimulation—cyclosporine, pilocarpine Artificial tears Client info Px is guarded for resolution Failure to treat → blindness
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KCS
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Cataracts Opacity of lens that causes reduced vision; most common disease of lens Cause Genetic 2º to: Diabetes mellitus (bilat; within 1 y of disease; ↑glucose → ↑fluid in lens) Most common cause Trauma (unilateral; HBC, thorn penetration, shotgun pellet) Lens luxation Nutritional deficiency Uveitis Hypocalcemia Electrical shock Rx Surgical removal of lens Treat underlying cause (e.g., Diabetes) Client info Most cataracts are inherited, so don’t breed affected dogs Dogs can live quality lives even with bilat. cataracts
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Cataracts Signs Dx Progressive loss of vision Opaque pupillary opening
Must be distinguished from senile nuclear sclerosis Normal old age change; graying of lens; bilat; usually does not affect sight
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CATARACTS
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Progressive Retinal Atrophy
A group of hereditary disorders causing loss of rods, cones, and/or blood supply Breeds Toy/min. Poodle, G. Ret, I. Set, C. Span, Schnauzer, Collie, Samoyed, N. Elkhound Recessive gene isolated in some breeds Signs—slow onset of blindness Loss of night vision (rods) → loss of day vision (cones) → cataracts (±) Dx r/o metabolic disorders that could cause cataracts Ophth exam gray, granular appearance of retina Hyperreflective retina Vascular attenuation, optic nerve atrophy
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PROGRESSIVE RETINAL ATROPHY
Normal canine retina PRA, optic nerve atropy and vessel attenuation
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Progressive Retinal Atrophy
Rx None Client info This is an inherited disease Avoid buying affected breeds Have ophth exam by board certified ophth to r/o PRA Blind animals adapt well Have trouble in strange surroundings Cats need well balanced diet Taurine deficiency can lead to PRA
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Anterior Uveitis Inflammation of uvea: ciliary body, iris, choroid
Causes Inflammation/infection – FeLV/FIP, fungal, bacterial Neoplasia Trauma
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Uveitis – Clinical Signs
Blepharospasm Aqueous flare – increased turbidity of aqueous humor Miosis of affected eye Iridal swelling or congestion Keratic precipitates Ciliary flush in limbal region +/- Corneal edema +/- hyphema
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Anterior Uveitis – hyphema
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Anterior Uveitis
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Anterior Uveitis – keratic precipitates
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Anterior Uveitis – Treatment
Topical steroids or Topical Anti-inflmmatory drugs (ocufen) Or systemic steroids Atropine – dilates eye, decreases pain Antibiotics – topically +/- systemically
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Anterior Uveitis – Client Info
Recheck within 3 days Secondary glaucoma is frequent complication Prognosis depends on cause Treat for 2 months regardless of cause – blood-aqueous barrier disrupted for 6 weeks
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Proptosed Globe Cause Clinical Signs Trauma Conformation
Retrobulbar abscess or neoplasia Clinical Signs Protrusion of the globe, Eyelids unable to close, may be trapped behind globe
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Prognosis Favorable Unfavorable indicators brachycephalic dog,
positive direct or consensual pupillary light response normal findings on posterior segment exam proptosed eye with vision on initial presentation Unfavorable indicators non-brachycephalic cat breed hyphema, no visible pupil facial fractures optic nerve damage and avulsion of 3 or more extraocular muscles
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Proptosed Globe
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Proptosed Globe – Treatment
Lubricate immediately Reduce the globe into the socket ASAP to reduce trauma to optic nerve Enucleation if optic nerve severed Systemic and topical antibitics +/- Steroids
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Proptosed Globe
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References http://www.vetmed.ucdavis.edu/courses/vet_eyes/
Alleice Summers, Common Diseases of Companion Animals
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