SAM3.2: Optho Eyelid

Neonatal Ophthalmia: Opening of the neonatal eyelids

normal: 7-10d (feline, canine).

Delayed opening may occur due to Staphylococcus infections - usually from dams genital tract.

Neonatal Ophthalmia Tx of delayed opening (3)

Open eyelids early.

Lavage.

Use broad spectrum topical ABX.

Eyelid agenesis is

congenital absence of part of palpebral fissure

Eyelid agenesis is more common in

cats - usually upper eyelid/lateral aspect.

Eyelid Agenesis details (2)

Usually bilateral

May have other ocular anomalies (e.g. iris to cornea PPM)

Tx for Eyelid Agenesis

Ophthalmic lubricants.

Surgical repair: cryosurgery of offending hairs, grafts.

Entropion def

Inward rotation of part, or all of the eyelid margin.

Pathophys of entropion

Periocular skin/fur rub against the cornea and conjunctiva leading to irritation scarring.

Symptoms of entropion

Ocular discomfort (blepharospasm - squint, epiphora - tearing, rubbing)

Secondary corneal ulceration

Mucopurulent ocular discharge

Rolling in of eyelid margin

Chronicity can lead to pigment loss of eyelid

Entropion etiologies (4)

Enophthalmos - senile atrophy of retrobulbar tissue.

Spastic.

Cictrical (secondary to scarring).

Anatomical.

Spastic entropion can be R/O

w/ topical anesthetics.

Entropion: before doing sx repair

correct underlying problem

Eyelid tacking procedure for entropion

Surgical staples or suture to every eyelid margin.

Temporary relief or use while growing.

Eyelid tacking procedure: Suturing

Sutures should NOT go through conjunctiva.

Hotz-Celsus surgical tx

“pinch” technique

use small suture and place closely tgt

avoid overcorrection!

good for older dog when staples cannot be used

Post-op for Entropion (5)

Rigid E-collar.

Cold eye compresses.

Gently clean ocular discharge.

Topical/systemic ABX.

PO anti-inflammatory and PM.

Post-op swelling for entropion

can take up to 6wks to resolve.

Ectropion is

eversion of the eyelid margin

Ectropion primary symptom

conjunctivitis

Etiology of Ectropion (4)

Congenital.

Cicatricial.

Intermittent/physiology (some hunting dogs late in the day).

Other - facial n. paralysis.

Most Ectropion dogs

do not require Sx.

Ectropion Tx - general (2)

Medical management.

Surgical.

Surgical options for Ectropion

Modified Kuhnt-Szymanowski procedure - wedge resection near lateral canthus.

Wharton-Jones V to Y blepharoplasty - for Cicatricial Ectropion (esp central lid)

Cilia disorders include (3)

Distichia.

Ectopic cilia.

Trichiasis/nasal folds.

Cilia Disorders CS

Symptoms may be similar to entropion.

Distichia is an

extra cilia growing out of the meibomian gland opening at the eyelid margin.

Most distichia are

asymptomatic (epiphora could be due to other factors)

Distichia Tx

Pluck hair.

Slight eversion of eyelid margin (done if there are multiple).

Electroepilation.Í

Cryosurgery at base of meibomian gland, on conjunctival surface.

What tx do we avoid w/ Distichia

lid splitting technique or laser Sx.

Ectopic cilia are

additional cilia arising from meibomian gland, but exiting through palpebral conjunctiva.

Ectopic cilia are much more

likely to produce symptoms due to direct contact w/ cornea.

P's w/ ectopic cilia are

typically young and may also have distichia.

Trichiasis

Cilia or hair from periocular fur directed towards the cornea (nasal folds can produce particular problems)

Tx of Trichiasis (4)

Trim offending hairs.

Opthalmic ointment (as hair gel).

Cryosurgery.

Nasal fold resection.

Chalazion def

Enlargement of meibomean gland due to blockage of ducts and collection of secretory products.

Chalazion - blockage may be due to

small lid tumor

Chalazion are generally

painless. yellow/white swelling through skin or bulbar conjunctiva.

Chalazion in cats

more of a problem in lightly pigmented cats.

Tx for Chalazion - general

conservative and/or Sx.

Chalazion Sx (3)

Chalazion clamp.

Incise bulbar conjunctiva and express material.

Cryosurgery.

Infection at eyelid margin (2)

Red swollen, painful area at lid margin.

Can be external or internal hordeolum.

Def of external, internal hordeolum

external hordeolum (stye) - infection of eyelash follicle

internal hordeolum - infected chalazion

Tx for infection at eyelid margin (4)

Warm compresses.

ABX/anti-inflam.

May need to lance and drain.

Do not express manually.

Blepharitis is

inflammation of the eyelid

Blepharitis - staphylococcus HS CS

Pustules, swelling, discharge.

Tx for Blepharitis staphylococcus HS (5)

warm eyelid compress.

Gentle eye cleansing (baby shampoo).

cool rinse/compress.

Topical ABX/steroid

+/- systemic ABX/steroids.

Eyelid masses include (7)

Meibomian gland tumor - Adenoma/adenocarcinoma.

Papilloma.

Benign melanoma/melanocytoma.

Malignant melanoma.

SCC.

MCT.

Sarcoid.

Meibomian gland adenoma/adenocarcinoma are the

most common eyelid mass in canine, usually middle to older. Are clinically benign.

Tx for Meibomian gland adenoma/adenocarcinoma

Tx if there is corneal/conjunctival irritation.

Excision at eyelid margin alone is temporary solution - will grow back.

Surgical debulk and cryo.

Eyelid Wedge Resection

Surgical Debulking and Cryo for Meibomian gland adenoma/adenocarcinoma

will preserve and does not shorten eyelid margin.

may have pigment loss of fur/skin

Eyelid wedge resection results in

shortens eyelid margin.

When performing an eyelid wedge resection, ensure that you

avoid nasolacrimal puncta.

Eyelid wedge resection: suture placement

Place the suture second from the edge first, then place the edge suture.

Eyelid wedge resection complications (2)

Eyelid notch.

Dehiscence.

SCC eyelid mass is the most common tumors of

equine, bovine, and feline.

SCC eyelid masses are most promblemactic

in non-pigmented tissues

SCC of the eyelid is associated w/

UV light exposure - sunny area w/ high elevation. generally are low malignancy.

Melanoma of the eyelid

typically benign, but may become locally invasive.

MCT of the eyelid is seen in

felines - can FNA but pre-tx

Other tx of eyelid tumor (4)

Excision of mass and advancement flaps.

RT (implants).

Chemo.

Immunotherapy.

Blepharitis other etiologies (5)

Self trauma.

Infectious.

Allergic.

Autoimmune.

Other (juvenile cellulitis, solar, zinc deficiency, seborrhea)

Infectious blepharitis (4)

mites - sarcoptes and demodex.

Ticks and flies.

fungal - ringworm.

bacterial.

Autoimmune cause to Blepharitis

Uveodermatological syndrome (UDS)

UDS is generally

ulcerative.

UDS Dx and Tx (2)

consider skin biopsies (due to multiple catergories - pemphigus and lupus.

response to immunosuppressive meds.

Blepharitis caused by juvenile cellulitis appearance

pustules, nodules, fistulous tracts.

Affects eyelids, periorbital area, ears, and muzzle.

Puppies are sick - fever, lymphadenopathy.

Juvenille cellulitis Tx

Steroids and ABX.

Idiopathic Facial Dermatitis of Persian Cats (IFDPC) Tx

Send to the dermatologist.

consider PO pred or topical tacrolimus.

Eyelid trauma considerations (4)

Eyelid tissue generally heals well.

Lavage and minimal debridement.

tx swelling.

Assess nasolacrimal puncta.

Eyelid trauma may get

scarring and contracture leading to entropion.

When there is a full thickness eyelid lac

act quickly to maintain fxn.

Lagophthalmos def

Decreased or absent ability to blink.

Lagophthalmos test to eval

palpebral reflex - CN5 and CN7.

Observe spontaneous blinking.

Discuss client observation of animal when its sleeping.

Lateral canthotomy (2)

cutting of the lateral canthus.

Done for proptosis, prior to other ocular Sx, or as the first step of subconjunctival enucleation.

Lateral canthotomy closure (2)

two layer - make sure knots do not abrade the cornea.

might use single temporary tarsorrhaphy suture to relive tension.

Tarsorrhaphy

suturing of the eyelids closed.

Temporary tarsorrhaphy is useful

if unable to blink.

Temporary Tarsorrhaphy - sutures

do not extend full thickness through eyelid.

Permanent partial tarsorrhaphy is done to

permanently reduce size of palpebral fissures (reduces risk of proptosis).