SMALL ANIMAL OPHTHALMOLOGY · •Cataracta complicata •eye globe atrophy –lens luxation...
Transcript of SMALL ANIMAL OPHTHALMOLOGY · •Cataracta complicata •eye globe atrophy –lens luxation...
SMALL ANIMAL OPHTHALMOLOGY
Small Animal Surgery5th study year FVM
Diseases of eye globe
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Anophthalmus, microphthalmus
• Anophthalmus– developed only eyelid fissure
• Microphthalmus– mostly with other
anomalies
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Exophthalmus
• causes– retrobulbar processes
(abscess, tumor, …)
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Neoplasia• treatment
– caudal orbitotomy
Exophthalmus
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Exophthalmus
• treatment
– drainage
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Enophthalmus
• causes
– muscle atrophy, kachexia, eosinophilic myositis, HORNER syndrome
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Proptosis of the globe
• causes
– trauma, retrobulbarmasses
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Phthisis bulbi
• causes
– situation after pathological changes
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Panophthalmitis
• causes– trauma
• treatment– ATB– exenteration
Ophthalmia neonatorum
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Operations on the eye globe
• Enucleation
• Exenteration
• Evisceration
Diseases of eyelids
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Coloboma
• signs
– congenital anomaly
– defect of eyelids in all layers
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Eyelid, corneal, scleral dermoid
• signs
– congenital anomaly
– area of abnormal tissue
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Partial agenesis of eyelid margin
• appearance
– congenital anomaly
– cats
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Abnormalities of eyelashes
• Trichiasis, distichiasis, ectopic cilia
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Trichiasis
• causes– congenital, acquired abnormalities
• treatment– resection
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Trichiasis + entropion
• treatment
– Stades procedure
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Prominent nasal fold
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Distichiasis
• from Meibomian glands;• treatment
– resection– electro-, cryoepilation
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Ectopic cillia
• signs– always with clinical problems (corneal defects)
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Abnormalities of eyelid position
• Entropion, ectropion, diamond eye
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Entropion
• e. hereditare – lower eyelid (chow-chow, bulldog, hunting hounds)
• e. spasticum – first on lower eyelid, after eye irritation
• e. cicatriceum – skin contraction after eyelid trauma
• e. bulbare – with microphthalmus, enohthalmus
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Entropion
• treatment– causal– fixation stitch – puppies– eyelid plastic
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Schleich
Hotz-Celsus (Berlin)
Entropion
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Ectropion
• e. congenitale - Boxer, Great Dane, Basset• e. cicatriceum – after pathological processes• e. mechanicum – traction, pressure on
tumors)• e. paralyticum – along with dysfunction of n. facialis,
n. trigeminus• Diamond eye
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Ectropion
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Ectropion
Kunth-Szymanowski
V-Y procedure
Kunth-Helmhold
A B
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Diamond eye
Fixation to zygomatic arch
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Blepharitis
• Blepharitis superficialis
• Blepharitis diffusa
• Blepharitis marginalis (Hordeolum)
– Hordeolum externum
– Hordeolum internum
• Chalazion
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Blepharitis marginalis – hordeolum
• H. externum – inflammation of Zeiss glands• H. internum – inflammation of Meibomian glands
• causes– Staphylococcus
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Blepharitis marginalis – chalazion
• circumscribed chronic inflammation of Meibomianglands with formation of granulation tissue
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Eyelid wounds
• without damage of eyelid margin
• with damage of eyelid margin
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Eyelid neoplasia
• mostly papiloma, lipoma,adenoma, carcinoma,melanoma, ...
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Eyelid neoplasia
• treatment– resection– cryotherapy– …
Diseases of conjunctiva and third eyelid
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• appearance– large breeds– mostly with third eyelid gland hyperplasia
Eversion, inversion of the third eyelid
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Eversion, inversion of the third eyelid
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• appearance– American Cocker, Beagle
• treatment– reposition & fixation– extirpation KCS
Protrusion of third eyelid gland
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Protrusion of third eyelid gland
„pocket“ technique of third eyelid gland fixation
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Conjunctivitis
• Conjunctivitis catarrhalis acuta, chronica
• Conjunctivitis follicularis
• causes
– mechanical, chemical, physical
– viruses (herpes), bacteria
– clinical sign of other diseases
• DIFFERENCE – dog and cat
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• differential diagnosis
– conjunctivitis
– glaucoma
• hypertension
• mydriasis
– uveitis
• hypotension
• miosis
Conjunctivitis
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Follicular conjunctivitis
• signs
– third eyelid, fornix
– enlargement of lymphatic follicles
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Chemosis
• causes
– conjunctival edema
– infection, trauma, …
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• appearance
– mostly with keratitis superficialis chronica
– German Shepherd
Plasmacelular infiltration of 3rd eyelid
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Conjunctival granuloma (collie)
• mostly with dystrophia corneae
• signs
– nodulated red tissue outgrowing to the cornea
– third eyelid swelling
• treatment
– excision
– corticosteroids
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Symblepharom
• palpebral
• conjunctival
• appearance
– cats
• causes
– congenital
– herpesvirus
Diseases of lacrimal system
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Keratoconjunctivitis sicca
• causes
– congenital (West-Highland-White, Yorkshire)
– (auto-) immune disease
– other diseases (distemper, …)
– trauma, toxins, hypovitaminosis A
– third eyelid gland extirpation
• dry cornea opacity vascularizationpigmentation ulceration
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KCS
• Schirmer tear test
< 9 mm/min
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Keratoconjunctivitis sicca
• treatment
– artificial tears
– imunosupression (ciclosporine, tacrolimus)
– acetylcystein
– corticosteroids + antibiotics
– ductus parotideus transposition (DPT)
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• ductus parotideus transposition
KCS
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Atresia punctum lacrimale
• mostly lower lacrimal punctum
• treatment
– cannulation, microchirurgical
opening of lacrimal puncta
& silicone tube
– conjunctivorhino-,
conjunctivobuccostomy
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Dakryocystitis
• inflammation of lacrimal sac
• treatment
– flushing, antibiotics, surgical revision
Diseases of cornea
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Congenital
• staphyloma, melanosis
corneae, dermoid,
PPM, corneal dysplasia
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Corneal defects
• erosion
• wound
• ulcer
• penetrating defect
• Descemetocoele
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Corneal defects
• appearance
– brachycephalic dogs
• signs
– opacity
– hypopyon
– vascularization
– fluorescein positive
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Corneal defects
• complication
– keratomalacia
– perforation and prolapse
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Corneal defects
• treatment
– debridement (mechanically, chemically)
– antibiotics (syst.), atropine, NSAIDs (syst.)
– supportive drugs (serum – fibronectin, aprotinin, EGF)
– preservatives, vitamine A, C
– antiproleolytics (ACC, EDTA)
– keratotomy, keratoplasty, wounds – suture
– soft contact lenses
– corticosteroids CONTRAINDICATED !!!
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Corneal defects
• debridement
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Corneal defects
• keratotomy – linear, punctate
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• fluorescein – debridement – soft contact lens –protective collar + antibiotics
Corneal defects
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Corneal defects
• Conjunctival pedicle graft keratoplasty
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Keratitis
• keratitis
– superficial
– deep (K. profunda)
– ulcerous (K. ulcerosa)
• Specific keratitis
– German Shepherd keratitis
– Boxer ulcer (keratitis)
– Dachshund keratitis
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Keratitis
• superficial
keratitis
• deep
keratitis
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German Shepherd keratitis
• Keratitis superficialis chronica (Überreiter)
– autoimmune
• signs
– mostly with
plasmacelullar
infiltration of
third eyelid
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German Shepherd keratitis
• treatment
– corticosteroids & antibiotics
– ciclosporine
– superficial
keratectomy
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Boxer ulcer
• Recurrent superficial defects
• treatment
– general principles of ulcer therapy
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Dachshund keratitis
• Keratitis superficialis at parenchymatosa chronicapunctata et diffusa
• signs
– vascularization
+ pannus
– pigmentation
up to KCS
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Corneal dystrophy
• corneal opacity without
inflammation
• appearance
– Collie, Huski, CKCh Spaniel
• causes
– fat dystrophy
– other diseases
– corneal irritation
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Corneal dystrophy
• signs
– symmetrical pearly appearance
• treatment
– without medication
– keratectomy – recurrences
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= Keratitis nigrum
• appearance
– Persian, Siamese cat
• causes
– herpesvirus
• treatment
– keratectomy
Corneal sequestration
Diseases of sclera
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Sclera
• Coloboma
– congenital defect – conjunctival ectasia with uveal herniation
• Staphyloma
– scleral arch due to excessive scleral extension
• Scleritis & Episcleritis
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Scleritis & episcleritis
• commonly secondary
• localized only for superficial layer
• signs
– swelling and hyperemia of
conjunctival vessels
• treatment
– causal
– corticosteroids
Diseases of anterior chamber & iris
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Anterior chamber & iris
• congenital defects of iris
– abnormalities of pigmentation
– persistent pupillary membrane (PPM)
– koloboma
– cyst
• Iritis (complex Uveitis anterior)
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Abnormalities of pigmentation
• Heterochromia iridis
• Heterochromia iridum
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Persistent pupillary membrane
• incomplete resorption of prenatal membrane
• appearance
– American Cocker, Basenji, ...
• signs
– Cataracta falsa
– Nubecula – macula
– leucoma corneae
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Persistent pupillary membrane
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Anterior uveal cyst
• from pigmented
neuroepitelium
• appearance
– Great Dane
• treatment
– perhaps punction or
extirpation
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Uveal synechias
• anterior
• posterior
• causes
– posttraumatical
– postinflammatory
• results
– Leucoma adherens
– Iris bombata – glaucoma
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• Hyphaema
– trauma, other diseases,
uveitis
• Hypopyon
– infection (ulcer), uveitis
• Fibrin
– trauma, infection, uveitis
• Foreign bodies
Content of anterior chamber
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Uveitis
• Uveitis anterior & posterior
• Iridocyclochorioiditis
• causes
– posttraumatic
– inflammation from other tissues (teeth)
– immunologic
• post vaccination (HCC)
• Uveitis phacolytica
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Uveitis anterior
• Inflammation of ciliary body and iris
• signs
– corneal edema
– changes of iris
– miosis
– effusion of anterior chamber
– hypotension
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Uveitis anterior
• consequences
– anterior & posterior synechias
• Iris bombata ( glaucoma)
• Cataracta complicata
• eye globe atrophy
– lens luxation
– vitreous opacity
– glaucoma
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Uveitis anterior
• treatment
– mydriatics
• support of exudate resorption, reduction of synechia formation, analgesic effect
– antiphlogistics
• subconjunctival
• local, systemic
– antibiotics
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Uveitis posterior
= Chorioiditis, Chorioretinitis• signs
– miosis mydriasis– Ch. disseminata– Ch. diffusa
• results– blindness, retinal
detachment
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Glaucoma
• Imbalance of production and outflow of aqueous humor
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Glaucoma
• classification
– primary, secondary
– with open angle,
with closed angle
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Glaucoma
• diagnosis
– tonometry
– gonioscopy
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Glaucoma
• systemically
– mannitol i.v., acetazolamide i.v., glycerin p.o.
• locally
Production of aqueous humor
Outflow of aqueous humor
Prostaglandins(latanoprost, bimatoprost, travoprost, tafluprost)
↑
Carboanhydrase inhibitors(acetazolamide, dorzolamida, brinzolamida) ↓
Parasympatomimetics(pilocarpine)
↑
Beta-blockers(timolol, karteolol, betaxolol, levobunolol) ↓
Alfa-2 agonists(brimonidine) ↓ ↑
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Glaucoma
• surgery
– (paracenthesis)
– ablation of cilliar body (chemo-, cryo-, laser)
– iridectomy, cyclodialysis, drainage systems
– extraction of luxated lens
– enucleation
– evisceration + prosthesis
Diseases of lens
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Lens
• congenital abnormalities
– Aphakia, Mikrophakia, Lenticonus, Coloboma, Ectopia
– Cataract
• cataract
• lens luxation
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Cataract
• abnormal metabolism of lens
• Cataract
– primary x secondary
– congenital x juvenile x adult x senile
– incomplete x complete
– capsular x sub-capsular x cortical x nuclear x polar
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• primary, secondary cataract
• hereditary eye abnormalities
– PRA, RD, PPM, PHPV/PHTVL, …
• non- hereditary eye abnormalities
• uveitis, …
• endogenous (toxic) cataract – diabetic
• exogenous cataract – traumatic
Cataract
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Cataract
• congenital cataract
– with other eye abnormalities
• juvenile cataract
– between 1st-4th year
• adult cataract
• senile cataract
– mostly bilateral
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• Cataracta incipiens
• Cataracta immatura
– separation of lens
suture Y, fluid
from surrounding
into the lens
enlargement
Cataract
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• Cataracta matura
– leak of fluid from lens
decrease, total
cloudiness
• Cataracta hypermatura (Morgagniana)
– liquefaction of cortical layer nucleus
eccentrically phacolysis (uveitis, glaucoma)
Cataract
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Cataract
• treatment
– only surgical
• ICE, ECE
• phacoemulsification
– without treatment
• lens luxation
• glaucoma
• retinal atrophy
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Lens luxation
• Luxatio lentis anterior x posterior
• causes
– trauma
– uveitis
– glaucoma
• signs
– Iridodonesis
– aphacic crescent
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Lens luxation
• signs
– corneal edema
• treatment
– ICE
Diseases of vitreous
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• Hyalosis asteroidea
• Synchisis scintillans
• PHPV / PHTVL
• vitreous opacities
Vitreous
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PHPV / PHTVL
• 6 grades of relevance
• signs
– C. polaris posterior
• treatment
– at blindness – ICE
with vitrectomy
Diseases of retina
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Retina
• congenital non-hereditary abnormalities
– optic nerve hypoplasia
• abnormalities of vision
– micropapila
• without important visual
abnormalities
• congenital hereditary abnormalities
– CEA, RD
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• hereditary abnormalities with late manifestation
– PRA – progressive retinal atrophy
– PED – pigment epithelium dystrophy
• acquired non-hereditary abnormalities
– neuroretinitis
– chorioretinitis
– retinal detachment + bleeding
Retina
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CEA – Collie eye anomaly
• abnormalities of sclera, choroidea and retina
• causes
– congenital defect
• signs
– chorioretinal hypoplasia
– coloboma, Tortuitas
vasorum, tygroid fundus,
retinal detachment
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CEA
• treatment
– without treatment
– elimination of breeding
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• appearance
– congenital, collie, cocker, yorkshire, ...
• signs
– mostly with
• corneal dysplasia
• Intraocular bleeding
• glaucoma
RD – Retinal dysplasia
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PRA – Progressive retinal atrophy
• appearance
– miniature poodle, cocker, dachshund, …
• signs
– 4 stages
– mostly with
Cataracta complicata
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PRA
• signs
– hyperreflexivity
– loss of granularity
– vascular attenuation
– dilated, pale papilla
– areas of depigmentation
• treatment
– elimination of breeding
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= CPRA
• appearance - retriever, cocker, collie, …
• signs
– impaired vision of moving objects
– pigmented areas in tapetal part
• treatment
– elimination of breeding
PED – Pigment epithelium dystrophy
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Taurine deficiency
Feline central retinal
degeneration (FCRD)
• occurrence
– cats feeded by dogs food
• symptoms
– elliptical area of hyperreflexi-
vity in area centralis
• treatment
– taurine supplementation
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Neuroretinitis
• signs
– sudden blindness
– risk of PRA
– changes of papilla
• treatment
– corticosteroids
Acquired non-hereditary abnormalities
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Chorioretinitis
• causes
– infection, intoxication, ...
• treatment
– glucocorticoids, ATB
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Retinal detachment
detachment from pigmented layer
• causes
– fluid between choroidea and retina
– fluid pulling retina to
the vitreous
– vitreous damage
– lens luxation (posterior)
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Retinal detachment
• treatment
– corticosteroids
– surgical
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Used photos and schemes
• Kottman J, Raušer P, Kecová H, Trnková P, Krisová Š 2003: Veterinární oftalmologie. Noviko, Brno, 198 s.
• Severin GA 1995: Severin´s veterinary ophthalmology notes. 2nd ed, DesignPointe™, Philadelphia, 386 p.
• Slatter D 2001: Fundamentals of veterinary ophthalmology. 3rd ed, W.B. Saunders, Philadelphia, 640 p.
• Walde I, Schäffer EH, Köstlin RG 1989: Atlas der Augenerkrankungen bei Hund und Katze. Schattauer, Stuttgart, 360 p.