Transcript Ophthalmic Diseases - Dr. Brahmbhatt`s Class Handouts

BE YOUR BEST
“A star is a forever light. Like
a star, let your wisdom shine.”
Glaucoma
______________________ provides nourishment to lens and cornea
Increased intraocular pressure; → Blindness
Normally, the amt of fluid produced = amt of fluid leaving eye
Normal: Dog/Cat— _____________________
• Causes
– Inherited (C Span, Basset, Chow)
– Secondary—obstruction of drainage angle
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Neoplasia
Luxation of lens
Hemorrhage
Uveitis : (ciliary body,
iris, choroid)
• Signs
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Ocular pain
Episcleral injection
Corneal edema
Dilated pupil (unresponsive
to light)
– Blind (±)
Glaucoma
• Dx
– IOP> _________
• Rx
– Acute (this is an __________; 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
Ulcerative Keratitis
(Corneal Ulcers)
Ulcers usually heal within a few days
• Causes
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Trauma
Chemical burns
__________________
KCS (Keratoconjunctivitis Sicca)
Conformational abnormalities
Herpes virus (cats)
• Signs
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Pain
Epiphora
_____________________ (eyelid spasm)
Hyperemia of conjunctiva
• Dx—Fluorescein dye to cornea
Herpes virus
Ulcerative Keratitis
(Corneal Ulcers)
• Rx
– Topical atropine (1%) ointment (Debate over benefits and how
long to use)
• Decrease pain, blepharospasm
– Topical broad-spectrum ___________________
– Viral ointments or solutions (Viroptic for cats with herpes virus)
– Surgery
• Eyelid flap, conjunctival flap
– Serum (autologous)
• Blocks _____________ released from leukocytes and bacteria
(helps prevent continued collagen loss)
– keep in refrigerator (throw out after 72 hours)
Deep Corneal Ulcer
• Desmetocele – erosion to____________
Ulcerative Keratitis
(Corneal Ulcers)
• Client info
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Most ulcers heal quickly with treatment
Avoid using ________________ medications
Rx with cortisone will _______________ healing of ulcer
Do not touch eye with ointment applicator
Chronic Superficial Keratitis (Pannus)
Pannus—_____________________________________/scar tissue
Progressive, bilateral, can result in blindness
• Cause
– Thought to be immune-mediated
(Infiltration of cornea with_____________, _________________)
– Increased ultraviolet light/high altitudes increases incidence
• Signs
– Opaque lesions that begin at ______________ and extend into
cornea
• Milky, pink, or tan
Chronic Superficial Keratitis (Pannus)
Chronic Superficial Keratitis (Pannus)
• Breeds
– Ger. Shep, B. Collie, greyhound, Sib. Husky
• Dx
– r/o KCS, corneal ulcers
• Rx
– _______________ often lifelong
– _____________ often lifelong
– Antibiotic eye ointment
• Client info
– No cure
– If Rx is stopped, disease will return and progress
– High altitudes and ↑sun predispose animals
DOGGLES!!!!
Keratoconjunctivitis Sicca (KCS)
Lack of tear production; tears lubricate, nourish, ↓bacteria, aid in healing
Tears from 2 glands: 70%--___________________; 30%--Nictitans gland
• Signs
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Recurrent conjunctivitis, corneal ulcers, keratitis
Dull, dry, irregular cornea, conjunctiva
Tenacious, _____________________
Blepharospasm
Crusty nares
• Rx
– Tear stimulation—cyclosporine, pilocarpine
– Artificial tears
• Client info
– Px is guarded for resolution
– Failure to treat → _________________________
KCS
Cataracts
Opacity of lens that causes reduced vision; most common disease of ____________
• Cause
– Genetic
– 2º to:
• Diabetes mellitus (bilat; within 1 y of disease; ↑glucose → ↑fluid in lens)
– _______________________________________
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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
Cataracts
• Signs
– Progressive loss of vision
– _____________ pupillary opening
• Dx
– Must be distinguished from senile _________________
• Normal old age change; graying of lens; bilat; usually does not affect
sight
CATARACTS
Progressive Retinal Atrophy
• A group of hereditary disorders causing loss __________,
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
PROGRESSIVE RETINAL ATROPHY
Normal canine retina
PRA, optic nerve atropy and vessel
attenuation
Progressive Retinal Atrophy
• Rx
– None
• Client info
– This is an ___________ 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
• _____________ deficiency can lead to PRA
Anterior Uveitis
• Inflammation of uvea: ___________,
___________, _______________
• Causes
– Inflammation/infection – FeLV/FIP, fungal,
bacterial
– Neoplasia
– Trauma
Uveitis – Clinical Signs
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Blepharospasm
Aqueous flare –_______________ of aqueous humor
_____________ of affected eye
Iridal swelling or congestion
Keratic precipitates
Ciliary flush in limbal region
+/- Corneal edema
+/- hyphema
Anterior Uveitis – hyphema
Anterior Uveitis
Anterior Uveitis – keratic precipitates
Anterior Uveitis – Treatment
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Topical ___________ or
Topical Anti-inflmmatory drugs (ocufen)
Or systemic steroids
___________ – dilates eye, decreases pain
Antibiotics – topically +/- systemically
Anterior Uveitis – Client Info
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Recheck within 3 days
________________ is frequent complication
Prognosis depends on cause
Treat for 2 months regardless of cause – bloodaqueous barrier disrupted for 6 weeks
Proptosed Globe
• Cause
– Trauma
– Conformation
– Retrobulbar abscess or neoplasia
• Clinical Signs
– Protrusion of the globe,
– Eyelids unable to close, may be trapped behind
globe
Proptosed Globe
Proptosed Globe – Treatment
• Lubricate immediately
• Reduce the globe into the socket ASAP to
reduce trauma to ________________
• _______________ if optic nerve severed
• Systemic and topical antibitics
• +/- Steroids
Proptosed Globe