Chronic Superficial Keratitis (Pannus)

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Chronic Superficial Keratitis (Pannus)

• Pannussuperficial corneal vascularization/scar
  tissue
• Progressive, bilateral, can result in blindness
• Cause
• Thought to be immune-mediated
• (Infiltration of cornea with lymphocytes, plasma
  cells)
• Increased ultraviolet light/high altitudes
  increases incidence
• Signs
• Opaque lesions that begin at limbus and extend
  into cornea
• Milky, pink, or tan

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Chronic Superficial Keratitis (Pannus)
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Chronic Superficial Keratitis (Pannus)

• Breeds
• Ger. Shep, B. Collie, greyhound, Sib. Husky
• Dx
• r/o KCS, corneal ulcers
• Rx
• Corticosteroids often lifelong
• Cyclosporine often lifelong
• Antibiotic eye ointment
• Client info
• No cure
• If Rx is stopped, disease will return and
  progress
• High altitudes and ?sun predispose animals

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DOGGLES!!!!
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Keratoconjunctivitis Sicca (KCS)

• Lack of tear production tears lubricate,
  nourish, ?bacteria, aid in healing
• Tears from 2 glands 70--Lacrimal gland
  30--Nictitans gland
• Signs
• Recurrent conjunctivitis, corneal ulcers,
  keratitis
• Dull, dry, irregular cornea, conjunctiva
• Tenacious, mucoid ocular discharge
• Blepharospasm
• Crusty nares
• Rx
• Tear stimulationcyclosporine, pilocarpine
• Artificial tears
• Client info
• Px is guarded for resolution
• Failure to treat ? blindness

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KCS
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Cataracts

• Opacity of lens that causes reduced vision most
  common disease of lens
• Cause
• Genetic
• 2º to
• Diabetes mellitus (bilat within 1 y of disease
  ?glucose ? ?fluid in lens)
• Most common cause
• 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 dont breed
  affected dogs
• Dogs can live quality lives even with bilat.
  cataracts

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Cataracts

• Signs
• Progressive loss of vision
• Opaque pupillary opening
• Dx
• Must be distinguished from senile nuclear
  sclerosis
• Normal old age change graying of lens bilat
  usually does not affect sight

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CATARACTS
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Progressive Retinal Atrophy

• A group of hereditary disorders causing loss of
  rods, cones, 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
• Signsslow 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

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PROGRESSIVE RETINAL ATROPHY
Normal canine retina
PRA, optic nerve atropy and vessel attenuation
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Progressive Retinal Atrophy

• Rx
• None
• Client info
• This is an inherited 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
• Taurine deficiency can lead to PRA

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Anterior Uveitis

• Inflammation of uvea ciliary body, iris, choroid
• Causes
• Inflammation/infection FeLV/FIP, fungal,
  bacterial
• Neoplasia
• Trauma

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Uveitis Clinical Signs

• Blepharospasm
• Aqueous flare increased turbidity of aqueous
  humor
• Miosis of affected eye
• Iridal swelling or congestion
• Keratic precipitates
• Ciliary flush in limbal region
• /- Corneal edema
• /- hyphema

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Anterior Uveitis hyphema
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Anterior Uveitis
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Anterior Uveitis keratic precipitates
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Anterior Uveitis Treatment

• Topical steroids or
• Topical Anti-inflmmatory drugs (ocufen)
• Or systemic steroids
• Atropine dilates eye, decreases pain
• Antibiotics topically /- systemically

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Anterior Uveitis Client Info

• Recheck within 3 days
• Secondary glaucoma is frequent complication
• Prognosis depends on cause
• Treat for 2 months regardless of cause
  blood-aqueous barrier disrupted for 6 weeks

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Proptosed Globe

• Cause
• Trauma
• Conformation
• Retrobulbar abscess or neoplasia
• Clinical Signs
• Protrusion of the globe,
• Eyelids unable to close, may be trapped behind
  globe

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Prognosis

• Favorable
• brachycephalic dog,
• positive direct or consensual pupillary light
  response
• normal findings on posterior segment exam
• proptosed eye with vision on initial presentation

• Unfavorable indicators
• non-brachycephalic
• cat breed
• hyphema,
• no visible pupil
• facial fractures
• optic nerve damage and avulsion of 3 or more
  extraocular muscles

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Proptosed Globe
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Proptosed Globe Treatment

• Lubricate immediately
• Reduce the globe into the socket ASAP to reduce
  trauma to optic nerve
• Enucleation if optic nerve severed
• Systemic and topical antibitics
• /- Steroids

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Proptosed Globe
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References

• http//www.vetmed.ucdavis.edu/courses/vet_eyes/
• http//vanat.cvm.umn.edu/carnLabs/Lab24/Lab24.html
  
• Alleice Summers, Common Diseases of Companion
  Animals
• http//www.vetmed.wisc.edu/Data/CourseMaterial/Mil
  ler/Emergencies.pdf