All Ophtho Cards Combined

Microphthalmos

Congenitally small globe +/- abnormalities.

Microphthalmos must be differentiated from

phthisis bulbi.

True microphthalmos is association

without other ocular defects (cataracts, anterior segment dysgenesis, PHPV, retinal dysplasia).

Vision w/ microphthalmos

May or may not be present

Toxic microphthalmos

Pigs: Vitamin A deficient dams.

Griseofulvin pregnant queen (not a pig... it's a cat).

Genetic risk of microphthalmos in some spp/breeds includes

Merle ocular dysgenesis - homozygous for merle gene.

Throughbreds.

Exophthalmos

An eye that is more prominent or push forward w/in orbit.

Symptoms of exophthalmos (6)

Prominent (not enlarged) globes.

Difficult to retropulse.

Conjunctival hyperemia/chemosis.

Possible PO cavity lesions.

Elevated third eyelid.

+/- ocular discharge.

Dx for exopthalmos (6)

Palpation of the orbit/oral exam.

Chest rads and bloodwork.

Skull/dental rads.

FNA for cytology/biopsy.

U/S.

CT/MRI.

Palpation of the orbit/oral exam includes (2)

Retropulsion of the globe.

Examine PO cavity at the end of the exam (b/c it can be painful)

Chest rads and bloodwork should be done to

r/o disseminated neoplasia/infectious.

2 most common causes of exophthalmos are

masses or infections/inflammatory processes.

Etiology of Exophthalmos (12)

Retrobulbar cellulitis/abscess.

Neoplasia.

Crypto.

Eosinophilic myositis of masticatory mm.

Extraocular polymyositis.

Craniomandibular Osteopathy.

Cysts.

Hemorrhage.

Orbital fxs.

Vascular Anomalies.

Granulomas.

Tetanus.

What may you see in a P' w/ retrobulbar cellulitis/abscess

anorectic and/or febrile.

elevated WBCs.

involve FB.

involve teeth/SG.

Retrobulbar cellulitis/abscess is usually

very painful.

Tx for retrobulbar abscess

Drain.

C&S.

Appropriate ABX.

compresses.

Anti-inflam.

Remove FB/tooth.

Most common etiology of exophthalmos

Neoplasia (generally older P's)

Neoplasia pain in the eye

usually painless and slowly progressive.

What may you see with exophthalmos (2)

globe depressed by mass.

Secondary inflam can develop.

Trend for ocular neoplasia

usually primary tumors and malignant.

What condition must be differentiated from exopthalmos

buphthalmos

Buphthalmos is

enlarged eye

How do you differentiate Buphthalmos and Exophthalmos

Buphthalmos eyes usually appear to have abnormalities.

Exophthalmos eyes are healthy eyes that look displaced.

Enophthalmos is

decreased volume of orbital contents - globe sunk into orbit.

Etiologies of Enophthalmos (6)

Pain.

Atrophy of the retrobulbar fat or m. tissue.

Dehydration.

Horner's syndrome.

Phthisis bulbi/microphthalmia.

Skull Fx.

Proptosis def

Forward displacement of the globe. Lid margins are behind globe equators.

proptosis is differentiated from

exopthalmos - lid margins on surface of the globe.

Prognosis for Proptosis?

Grave for vision.

Proptosis is

an emergency

At risk breeds for proptosis

brachycephalic dogs

Proptosis Tx

Surgically replace globe or enucleate - cool compresses and may need lateral canthotomy

Post-op Rx for Proptosis (2)

Topical ABX (and atropine if ulceration).

Systemic ABX and anti-inflammatory.

Post-op Sx for Proptosis (2)

Remove sutures when swelling subsides.

Assess vision and viability of globe.

Phthisis Bulbi (3)

Globe is phthisical.

was normal at one point.

chronic, diffuse intraocular inflammation w/ contraction may result in shrunken, disorganized, or atrophic globe.

Phthisis Bulbi is usually

comfortable (globe can remain until it becomes painful)

Globe position: Exotropia

Wall eyes - lateral strabismus

Globe position: Esotropia

Cross eyed (Siamese cats)

Strabismus can be the result of (3)

m. imbalance.

n. dysfxn.

central lesion.

Enucleation def

Removal of the globe, third eyelid, lacrimal tissue and eyelid margins.

Enucleation is indicated for

blind/painful eyes or neoplasia

Enucleation techniques (2)

Subconjunctival approach.

Transpalpebral approach - harder to do and takes longer, but more ideal for containment of potential infection/neoplasia.

Post op warning to client for enucleation

blood from the nostril on the same side as the enucleated eye w/in a few days post-op is normal.

Complications of Enucleation (5)

Hemorrhage.

Pain.

Draining fistula or orbital swelling - retained lacrimal tissue.

Orbital infection (rare).

Orbital emphysema.

Orbital infections: You may not want to do enculeation

at the same time as dirty procedures (teeth and AG)

Exenteration def

Removal of globe and orbital contents (extraocular mm). Less cosmetic appearance.

Orbital Prothesis placement of (2)

trimmed silicone sphere into orbit to improve cosmetic appearance.

More difficult to perform after exenteration.

Intraocular Prothesis has (2)

more cosmetic appearance.

dark silicone sphere.

Intraocular prothesis will allow

globe to move normally, but cornea can still be injured.

Intraocular prothesis is not indicated for

infection/tumor.

Intraocular prothesis has

lengthy recovery.

More follow up.

Comfort procedures as options for blind and painful eyes

Enucleation.

Intraocular prthesis.

Chemical ciliary body ablation.

Chemical ciliary body ablation is not for

feline patients.

Neonatal Ophthalmia: Opening of the neonatal eyelids

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

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

Neonatal Ophthalmia Tx (3)

Open eyelids early.

Lavage.

Use broad spectrum topical ABX.

Eyelid agenesis is

congenital absence of part of palpebral fissure

Eyelid is more common in

cats - usually upper eyelid/lateral aspect.

Eyelid Agenesis details (2)

May have other ocular abnormalities.

May have other ocular anomolies.

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.

Entropion etiologies (4)

Enophthalmos - sensile atrophy of retrobulbar tissue.

Spastic.

Cictrical (secondary to scarring).

Anatomical.

Spastic entropion can be R/O

w/ topical anesthetics.

What should be done before moving forward with an entropion sx?

correct underlying problem before attempting a surgical repair

Eyelid tacking procedure

Surgical staples or suture to every eyelid margin.

Temporary relief or use while growing.

Eyelid tacking procedure: Suturing

Sutures should NOT go through conjunctiva.

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 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.

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.

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 glad 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.

Eyelid wedge resection results in

shortens eyelid margin.