2011 Review slides

False, the pic shows fluroscein stain done, but the next step after visual assessment should actually be schirmer tear test (SST). The dx for this pic is a corneal ulcer Normals for SST: DOGS: 15-25 mm/min Variable in cats Horses-variable: >20mm/min in

Practice quiz

distichia
Hair from meibomian gland
Can cause corneal ulcer

This can also be ectopic cilia

Practice quiz

Spastic entropion
Eye retracts in skull d/t pain Can be secondary to painful cornea Use topical anesthetic to see if eye returns to normal position Over time scarring occurs may need corrective sx

Practice quiz

Eyelid masses in dogs are usually benign

Dogs- benign *always send in for histo* Meibomian adenoma Benign melanoma / melanocytoma Squamous papilloma Cats-malignant (SqCCa, Mast cell tumor, fibrosarcoma) Horses and cattle-malignant (SqCCa)

Practice quiz
What are reasonable differentials for this patient?
KCS Trichiasis Imperforate punctas Meibomian gland Dysfunction Normal for white Poodle

 KCS- no, obviously lots of tears are being produced Triachiasis- possible, hair in normal place but going in abnormal direction cancause irritation and excessive tearing Imperforate punctas- possible since tears are draining down face instead of down punta Meibomian gl dysfunction- possible since oil component to tear film cannot be made right and thus tears wont be kept on eye Normal for white poodle- NO!

Practice quiz
What is your primary differential for this patient with chronic conjunctivitis?

KCS!
Chronic conjunctivitis think KCS Cant see the tear film in this patient

Practice quiz
This dog presented for excessive tearing and blepharospasm-what are your Differentials?

 Distichia- hair from meibomian gland

This will irritate the cornea

Meibomian gland should be oily- theyre inspissated in this patient

Practice quiz

P is 1 yr oldfollicular conjunctivitis
Diet change Tapering steriods Will resolve with age Long-term tx until older

Practice quiz: DfDxs?

DfDxs:
Straight blood vessels, episceral injection
Therefore origin is intraocular Think glaucoma, KCS, allergies, FB, etc

Clin findings and DfDxs?

 Redblood present (black=pigment, white=WBCs, protein) Diffuse hemorrhage with underlying conjunctiva epithelium in tact (since blood not oozing everywhere) Think trauma or toxin ingested This dog ate rat poison.

What do you see? What are you thinking?

 White and swollen

Think systemic dz

Anemic with hyperproteinemia

What is this?

Dermoid!
Dermoid normal skin growing in an abnormal location Tx: Surgical excision superficial keratectomy

What is this?

Looks like lipid in cornea, occurs in purebreds (esp Siberians)

Corneal subepithelial dystrophy

Hereditary Bilateral Non-painful Progressive Cholesterol-Crystal deposits Tx: Feed low-Fat diet

Practice quiz

Pannus!
See german shepherdthink pannus!

Practice quiz

 This german shepherd has pannus Plan:

Get dogglesavoid the sun Start special diet (z/d) Topical steroids (Pred AC) Oral doxy (d/t immune modulating) Dz will never go away so tx is for life

Practice quiz

Answer is c)look for distichia or FB

Should have healed within 3-5 days (or 57 days of older patient) Do NOT change abx Look for other cause, ie FB or distichia

Practice quiz

 Look for cause of ulcer Eyelid mass removal Sx was done 5 wks ago suspect suture rubbing or eyelids not lined up when closed. Plan:
get rid of poor sx job since tissue acts like FB Get rid of loose corneal epith (use Q-tip) Stain to see how deep Debride ulcer if not deep Tx w/topical abx

Practice quiz

This is flare
Diagnostic for uveitis Say flarethink uveitis

Practice quiz

 Iris sphincter degeneration/atrophy (aging muscle)

What do you see? What causes it?

Hyphema =blood in the anterior chamber

Caused by trauma, neoplasia, coagulopathy, or hypertension

Whats so special about cougars?

they have a round pupils

NOT normal for cats

Practice quiz
Owner and dog went out hiking. Dog had blepharospasm when she got home. What do you think is going on?

Dog got poked in eye. Need to do exam. Stain strip to sclera. Check for ulcers.

Diabetic cataracts
Acute onset ERG to see if dog is really blind Start preventative tx for LIU Refer for surgery

Nuclear sclerosis
Night vision blindness Can see fundus therefore not cataract Normal fundus therefore not PRA ***may become cataract so treat preventatively

 Check IOP Retropulse to R/O tumor

Can also ultrasound

Perform enucleation

Glaucoma treatment chart

 Right eye is HUGE, edematous, and not visual DfDx: glaucoma Plan: check IOP, retropulse, look at retina Give meds if not blind and painful If blind and painful then enucleate the eye! OD=right eye, OS=left eye, OU=both eyes
Right eye is Dominant

 Fresh hemorrhage d/t light red color This is likely bilateral Think systemic causehypertension
Check blood pressure

 SARDS
Fixed Dilated pupils (non-responsive) No menace or cotton following Need bloodwork done

Optic neuritis
Fixed dilated pupils- non-responsive Use ERG to distinguish btw the two

Answer is E.
Suspect PRA
Hard time doing downstairs at night Night vision loss Bilateral Retinal degeneration seen in fundus:
vascular attenuation (thinning), hyperreflective tapetum (as the over lying nerve layers of the retina thin) and optic nerve atrophy

Patient otherwise normal

No PUPDPP SST and IOP normal

This is hereditary and progressive. Need to give supp vit A and omega FAs

This cat has?

Retinal degeneration
Blindness Dilated pupils R/O retinal detachment Can see floaters

Whats wrong w/this cat? (hint:OS)

Feline hypertensive retinopathy

causes of hypertension:
Hyperthyroid Renal failure Cardiac primary

What??

Herpes!
Could also be:
Trichiasis Imperforate puncta Meibomian gland dysfunction

Answer is D
Hypertension caused fresh hemorrhage

Bulging eye but normal shapeDfDx?

Sinus masscauses exopthalmus

ERU- active uveitis

See pigment om anterior lens capsule See flare See posterior synechia Think past and present uveitis Prognosis: never going to go away can progress to blindness

Answer is C- normal fundus

Myelination noted around ON- normal Tapetal spots are capillaries- normal

Trigeminal nerve- sensory input

 What is the tx?

 Doxycycline (oral systemic) and terramycin (topical)