SMALL ANIMAL OPHTHALMOLOGY · •Cataracta complicata •eye globe atrophy –lens luxation –vitreous opacity –glaucoma. Small Animal Surgery, 5th study year FVM 89 Uveitis anterior

SMALL ANIMAL OPHTHALMOLOGY

Small Animal Surgery5th study year FVM

Diseases of eye globe

Small Animal Surgery, 5th study year FVM

Small Animal Surgery, 5th study year FVM 3

Anophthalmus, microphthalmus

• Anophthalmus– developed only eyelid fissure

• Microphthalmus– mostly with other

anomalies


Exophthalmus

• causes– retrobulbar processes

(abscess, tumor, …)


Neoplasia• treatment

– caudal orbitotomy

Exophthalmus


Exophthalmus

• treatment

– drainage


Enophthalmus

• causes

– muscle atrophy, kachexia, eosinophilic myositis, HORNER syndrome


Proptosis of the globe

• causes

– trauma, retrobulbarmasses


Phthisis bulbi

• causes

– situation after pathological changes


Panophthalmitis

• causes– trauma

• treatment– ATB– exenteration

Ophthalmia neonatorum


Operations on the eye globe

• Enucleation

• Exenteration

• Evisceration

Diseases of eyelids



Coloboma

• signs

– congenital anomaly

– defect of eyelids in all layers


Eyelid, corneal, scleral dermoid

• signs


– area of abnormal tissue


Partial agenesis of eyelid margin

• appearance


– cats


Abnormalities of eyelashes

• Trichiasis, distichiasis, ectopic cilia


Trichiasis

• causes– congenital, acquired abnormalities

• treatment– resection


Trichiasis + entropion

• treatment

– Stades procedure


Prominent nasal fold


Distichiasis

• from Meibomian glands;• treatment

– resection– electro-, cryoepilation


Ectopic cillia

• signs– always with clinical problems (corneal defects)


Abnormalities of eyelid position

• Entropion, ectropion, diamond eye


Entropion

• e. hereditare – lower eyelid (chow-chow, bulldog, hunting hounds)

• e. spasticum – first on lower eyelid, after eye irritation

• e. cicatriceum – skin contraction after eyelid trauma

• e. bulbare – with microphthalmus, enohthalmus


Entropion

• treatment– causal– fixation stitch – puppies– eyelid plastic


Schleich

Hotz-Celsus (Berlin)

Entropion


Ectropion

• e. congenitale - Boxer, Great Dane, Basset• e. cicatriceum – after pathological processes• e. mechanicum – traction, pressure on

tumors)• e. paralyticum – along with dysfunction of n. facialis,

n. trigeminus• Diamond eye


Ectropion


Ectropion

Kunth-Szymanowski

V-Y procedure

Kunth-Helmhold

A B


Diamond eye

Fixation to zygomatic arch


Blepharitis

• Blepharitis superficialis

• Blepharitis diffusa

• Blepharitis marginalis (Hordeolum)

– Hordeolum externum

– Hordeolum internum

• Chalazion


Blepharitis marginalis – hordeolum

• H. externum – inflammation of Zeiss glands• H. internum – inflammation of Meibomian glands

• causes– Staphylococcus


Blepharitis marginalis – chalazion

• circumscribed chronic inflammation of Meibomianglands with formation of granulation tissue


Eyelid wounds

• without damage of eyelid margin

• with damage of eyelid margin


Eyelid neoplasia

• mostly papiloma, lipoma,adenoma, carcinoma,melanoma, ...


Eyelid neoplasia

• treatment– resection– cryotherapy– …

Diseases of conjunctiva and third eyelid



• appearance– large breeds– mostly with third eyelid gland hyperplasia

Eversion, inversion of the third eyelid


Eversion, inversion of the third eyelid


• appearance– American Cocker, Beagle

• treatment– reposition & fixation– extirpation KCS

Protrusion of third eyelid gland


Protrusion of third eyelid gland

„pocket“ technique of third eyelid gland fixation


Conjunctivitis

• Conjunctivitis catarrhalis acuta, chronica

• Conjunctivitis follicularis

• causes

– mechanical, chemical, physical

– viruses (herpes), bacteria

– clinical sign of other diseases

• DIFFERENCE – dog and cat


• differential diagnosis

– conjunctivitis

– glaucoma

• hypertension

• mydriasis

– uveitis

• hypotension

• miosis

Conjunctivitis


Follicular conjunctivitis

• signs

– third eyelid, fornix

– enlargement of lymphatic follicles


Chemosis

• causes

– conjunctival edema

– infection, trauma, …


• appearance

– mostly with keratitis superficialis chronica

– German Shepherd

Plasmacelular infiltration of 3rd eyelid


Conjunctival granuloma (collie)

• mostly with dystrophia corneae

• signs

– nodulated red tissue outgrowing to the cornea

– third eyelid swelling

• treatment

– excision

– corticosteroids


Symblepharom

• palpebral

• conjunctival

• appearance

– cats

• causes

– congenital

– herpesvirus

Diseases of lacrimal system



Keratoconjunctivitis sicca

• causes

– congenital (West-Highland-White, Yorkshire)

– (auto-) immune disease

– other diseases (distemper, …)

– trauma, toxins, hypovitaminosis A

– third eyelid gland extirpation

• dry cornea opacity vascularizationpigmentation ulceration


KCS

• Schirmer tear test

< 9 mm/min


Keratoconjunctivitis sicca

• treatment

– artificial tears

– imunosupression (ciclosporine, tacrolimus)

– acetylcystein

– corticosteroids + antibiotics

– ductus parotideus transposition (DPT)


• ductus parotideus transposition

KCS


Atresia punctum lacrimale

• mostly lower lacrimal punctum

• treatment

– cannulation, microchirurgical

opening of lacrimal puncta

& silicone tube

– conjunctivorhino-,

conjunctivobuccostomy


Dakryocystitis

• inflammation of lacrimal sac

• treatment

– flushing, antibiotics, surgical revision

Diseases of cornea



Congenital

• staphyloma, melanosis

corneae, dermoid,

PPM, corneal dysplasia


Corneal defects

• erosion

• wound

• ulcer

• penetrating defect

• Descemetocoele


Corneal defects

• appearance

– brachycephalic dogs

• signs

– opacity

– hypopyon

– vascularization

– fluorescein positive



Corneal defects

• complication

– keratomalacia

– perforation and prolapse


Corneal defects

• treatment

– debridement (mechanically, chemically)

– antibiotics (syst.), atropine, NSAIDs (syst.)

– supportive drugs (serum – fibronectin, aprotinin, EGF)

– preservatives, vitamine A, C

– antiproleolytics (ACC, EDTA)

– keratotomy, keratoplasty, wounds – suture

– soft contact lenses

– corticosteroids CONTRAINDICATED !!!


Corneal defects

• debridement


Corneal defects

• keratotomy – linear, punctate


• fluorescein – debridement – soft contact lens –protective collar + antibiotics

Corneal defects


Corneal defects

• Conjunctival pedicle graft keratoplasty


Keratitis

• keratitis

– superficial

– deep (K. profunda)

– ulcerous (K. ulcerosa)

• Specific keratitis

– German Shepherd keratitis

– Boxer ulcer (keratitis)

– Dachshund keratitis


Keratitis

• superficial

keratitis

• deep

keratitis


German Shepherd keratitis

• Keratitis superficialis chronica (Überreiter)

– autoimmune

• signs

– mostly with

plasmacelullar

infiltration of

third eyelid


German Shepherd keratitis

• treatment

– corticosteroids & antibiotics

– ciclosporine

– superficial

keratectomy


Boxer ulcer

• Recurrent superficial defects

• treatment

– general principles of ulcer therapy


Dachshund keratitis

• Keratitis superficialis at parenchymatosa chronicapunctata et diffusa

• signs

– vascularization

+ pannus

– pigmentation

up to KCS


Corneal dystrophy

• corneal opacity without

inflammation

• appearance

– Collie, Huski, CKCh Spaniel

• causes

– fat dystrophy

– other diseases

– corneal irritation


Corneal dystrophy

• signs

– symmetrical pearly appearance

• treatment

– without medication

– keratectomy – recurrences


= Keratitis nigrum

• appearance

– Persian, Siamese cat

• causes

– herpesvirus

• treatment

– keratectomy

Corneal sequestration

Diseases of sclera



Sclera

• Coloboma

– congenital defect – conjunctival ectasia with uveal herniation

• Staphyloma

– scleral arch due to excessive scleral extension

• Scleritis & Episcleritis


Scleritis & episcleritis

• commonly secondary

• localized only for superficial layer

• signs

– swelling and hyperemia of

conjunctival vessels

• treatment

– causal

– corticosteroids

Diseases of anterior chamber & iris



Anterior chamber & iris

• congenital defects of iris

– abnormalities of pigmentation

– persistent pupillary membrane (PPM)

– koloboma

– cyst

• Iritis (complex Uveitis anterior)


Abnormalities of pigmentation

• Heterochromia iridis

• Heterochromia iridum


Persistent pupillary membrane

• incomplete resorption of prenatal membrane

• appearance

– American Cocker, Basenji, ...

• signs

– Cataracta falsa

– Nubecula – macula

– leucoma corneae


Persistent pupillary membrane


Anterior uveal cyst

• from pigmented

neuroepitelium

• appearance

– Great Dane

• treatment

– perhaps punction or

extirpation


Uveal synechias

• anterior

• posterior

• causes

– posttraumatical

– postinflammatory

• results

– Leucoma adherens

– Iris bombata – glaucoma


• Hyphaema

– trauma, other diseases,

uveitis

• Hypopyon

– infection (ulcer), uveitis

• Fibrin

– trauma, infection, uveitis

• Foreign bodies

Content of anterior chamber


Uveitis

• Uveitis anterior & posterior

• Iridocyclochorioiditis

• causes

– posttraumatic

– inflammation from other tissues (teeth)

– immunologic

• post vaccination (HCC)

• Uveitis phacolytica


Uveitis anterior

• Inflammation of ciliary body and iris

• signs

– corneal edema

– changes of iris

– miosis

– effusion of anterior chamber

– hypotension


Uveitis anterior

• consequences

– anterior & posterior synechias

• Iris bombata ( glaucoma)

• Cataracta complicata

• eye globe atrophy

– lens luxation

– vitreous opacity

– glaucoma


Uveitis anterior

• treatment

– mydriatics

• support of exudate resorption, reduction of synechia formation, analgesic effect

– antiphlogistics

• subconjunctival

• local, systemic

– antibiotics


Uveitis posterior

= Chorioiditis, Chorioretinitis• signs

– miosis mydriasis– Ch. disseminata– Ch. diffusa

• results– blindness, retinal

detachment


Glaucoma

• Imbalance of production and outflow of aqueous humor


Glaucoma

• classification

– primary, secondary

– with open angle,

with closed angle


Glaucoma

• diagnosis

– tonometry

– gonioscopy


Glaucoma

• systemically

– mannitol i.v., acetazolamide i.v., glycerin p.o.

• locally

Production of aqueous humor

Outflow of aqueous humor

Prostaglandins(latanoprost, bimatoprost, travoprost, tafluprost)

↑

Carboanhydrase inhibitors(acetazolamide, dorzolamida, brinzolamida) ↓

Parasympatomimetics(pilocarpine)

↑

Beta-blockers(timolol, karteolol, betaxolol, levobunolol) ↓

Alfa-2 agonists(brimonidine) ↓ ↑


Glaucoma

• surgery

– (paracenthesis)

– ablation of cilliar body (chemo-, cryo-, laser)

– iridectomy, cyclodialysis, drainage systems

– extraction of luxated lens

– enucleation

– evisceration + prosthesis

Diseases of lens



Lens

• congenital abnormalities

– Aphakia, Mikrophakia, Lenticonus, Coloboma, Ectopia

– Cataract

• cataract

• lens luxation


Cataract

• abnormal metabolism of lens

• Cataract

– primary x secondary

– congenital x juvenile x adult x senile

– incomplete x complete

– capsular x sub-capsular x cortical x nuclear x polar


• primary, secondary cataract

• hereditary eye abnormalities

– PRA, RD, PPM, PHPV/PHTVL, …

• non- hereditary eye abnormalities

• uveitis, …

• endogenous (toxic) cataract – diabetic

• exogenous cataract – traumatic

Cataract


Cataract

• congenital cataract

– with other eye abnormalities

• juvenile cataract

– between 1st-4th year

• adult cataract

• senile cataract

– mostly bilateral


• Cataracta incipiens

• Cataracta immatura

– separation of lens

suture Y, fluid

from surrounding

into the lens

enlargement

Cataract


• Cataracta matura

– leak of fluid from lens

decrease, total

cloudiness

• Cataracta hypermatura (Morgagniana)

– liquefaction of cortical layer nucleus

eccentrically phacolysis (uveitis, glaucoma)

Cataract


Cataract

• treatment

– only surgical

• ICE, ECE

• phacoemulsification

– without treatment

• lens luxation

• glaucoma

• retinal atrophy



Lens luxation

• Luxatio lentis anterior x posterior

• causes

– trauma

– uveitis

– glaucoma

• signs

– Iridodonesis

– aphacic crescent


Lens luxation

• signs

– corneal edema

• treatment

– ICE

Diseases of vitreous



• Hyalosis asteroidea

• Synchisis scintillans

• PHPV / PHTVL

• vitreous opacities

Vitreous


PHPV / PHTVL

• 6 grades of relevance

• signs

– C. polaris posterior

• treatment

– at blindness – ICE

with vitrectomy

Diseases of retina



Retina

• congenital non-hereditary abnormalities

– optic nerve hypoplasia

• abnormalities of vision

– micropapila

• without important visual

abnormalities

• congenital hereditary abnormalities

– CEA, RD


• hereditary abnormalities with late manifestation

– PRA – progressive retinal atrophy

– PED – pigment epithelium dystrophy

• acquired non-hereditary abnormalities

– neuroretinitis

– chorioretinitis

– retinal detachment + bleeding

Retina


CEA – Collie eye anomaly

• abnormalities of sclera, choroidea and retina

• causes

– congenital defect

• signs

– chorioretinal hypoplasia

– coloboma, Tortuitas

vasorum, tygroid fundus,

retinal detachment


CEA

• treatment

– without treatment

– elimination of breeding


• appearance

– congenital, collie, cocker, yorkshire, ...

• signs

– mostly with

• corneal dysplasia

• Intraocular bleeding

• glaucoma

RD – Retinal dysplasia


PRA – Progressive retinal atrophy

• appearance

– miniature poodle, cocker, dachshund, …

• signs

– 4 stages

– mostly with

Cataracta complicata


PRA

• signs

– hyperreflexivity

– loss of granularity

– vascular attenuation

– dilated, pale papilla

– areas of depigmentation

• treatment



= CPRA

• appearance - retriever, cocker, collie, …

• signs

– impaired vision of moving objects

– pigmented areas in tapetal part

• treatment


PED – Pigment epithelium dystrophy


Taurine deficiency

Feline central retinal

degeneration (FCRD)

• occurrence

– cats feeded by dogs food

• symptoms

– elliptical area of hyperreflexi-

vity in area centralis

• treatment

– taurine supplementation


Neuroretinitis

• signs

– sudden blindness

– risk of PRA

– changes of papilla

• treatment

– corticosteroids

Acquired non-hereditary abnormalities


Chorioretinitis

• causes

– infection, intoxication, ...

• treatment

– glucocorticoids, ATB


Retinal detachment

detachment from pigmented layer

• causes

– fluid between choroidea and retina

– fluid pulling retina to

the vitreous

– vitreous damage

– lens luxation (posterior)


Retinal detachment

• treatment

– corticosteroids

– surgical


Used photos and schemes

• Kottman J, Raušer P, Kecová H, Trnková P, Krisová Š 2003: Veterinární oftalmologie. Noviko, Brno, 198 s.

• Severin GA 1995: Severin´s veterinary ophthalmology notes. 2nd ed, DesignPointe™, Philadelphia, 386 p.

• Slatter D 2001: Fundamentals of veterinary ophthalmology. 3rd ed, W.B. Saunders, Philadelphia, 640 p.

• Walde I, Schäffer EH, Köstlin RG 1989: Atlas der Augenerkrankungen bei Hund und Katze. Schattauer, Stuttgart, 360 p.

Documents

SMALL ANIMAL OPHTHALMOLOGY · •Cataracta complicata •eye globe atrophy –lens luxation –vitreous opacity –glaucoma. Small Animal Surgery, 5th study year FVM 89 Uveitis anterior