Neurology 2 – OphthalmologyOphthalmic examination 1. Normal variations eg. exp sclera pugs, colours of eyes relate to coat, iris, fundus. Subalbinotic=red. 2. In a unilateral condition look at normal eye first eg. corneal ulcer, but bilat dry eye 3. Signalment: westies=dry eye, terriers lens luxation. 12y dog with hyphaema=blood in anterior chamber from intraocular neoplasm, 12y cat=from systemic hypertension. General exam: entire female w/uveitis pyo? 4. Hx: vacc, worming, multi-pet (cats, herpes!), indoor/outdoor, travel, diet, medications, general health 5. Eye hx: when did the problem start, sudden/gradual onset? Progressive? One eye/both? Pain – blepharospasm, rubbing eye. Vision in unfamiliar surroundings (‘sudden onset’ in new envir), change in appearance. 6. Hands off exam first inc symmetry, aerial view. 7. Discharge: water=lacrimation=pain, muco-purulent=bacteria, bloody=trauma. Copious black discharge after globe rupture from intraocular melanoma 8. Open/closed? Size of palpebral fissure (horner’s), position of third eyelid 9. Hands-on: ext anatomy, palpation, look under upper lid, anterior surface 3rd eyelid, retropulsion. Purkinje image/corneal ‘reflex’ – tear film and surface contour. 10.Remember corpora nigra (granula iridica) normal in horse 11.Third eyelid: jaundice, site for FB, SCC 12.Palpebral reflex: afferent CNV (trigem), ophthalmic branch for medial canthus, maxillary branch for lateral canthus. Efferent CNVII. 13.Menace: afferent II, efferent VII, involves cerebellum. Cover contralat eye. Only present in puppy/kitten 12w+, foals 1-2d, absent normal in rabbits. Cats get bored. 14.Dazzle: subcortical (under GA). Afferent II (via retina), efferent VII. Very bright light, blink +/- head withdrawal. 15.PLR: afferent II, efferent PNS in III to pupillary constrictor muscle. Direct PLR for same side, indirect/consensual for contralat. False –ve if light source dim, stress (high SNS), iris atrophy. 16.Also vestibulo-ocular reflex (dolls head – physiological nystagmus), visual placement, tracking (aff II, eff III, IV, VI, VIII), maze 17.Schirmer tear test: quant measurement tea production, aqueous part of tear film (other parts lipid and mucin), measures basal and reflex tear pro (reflex response to paper on cornea). Place lower eyelid lat third, leave one min. Normal=12-25mm/min, <10DRY EYE, 10-15 w/ signs=dry eye. Cats variable, 5-10 common 18.Distant direct ophthalmoscopy from distance showing tapetal fundus, highlight visual axis, show FB/ulcer/cataract, asses pupil size. Tapetum dorsal in fundus 19.Indirect w/ light source and condensing lens. Shows upside down and back to front! Good for general view, then close direct for lesions in detail 20.Fluorescin dye: orange turns green in alkaline eg. stroma. Touch strip to bulbar conjunctiva, allow blink, flush 21.Tonometry – measure IOP: 15-25mmHg dog/cat, 17-28mmHg horse, 1520mmHg rabbit. Difference >10 between eyes abnormal. Digital (forefinger through skin upper eyelid), applanation (very expensive, LA Also viral (distemper). hyperaemia. sand (both eyes). NB Sharpeis get mucinosis. rebound (new. mimics chemosis but is normal for breed. no pain. head too elevated. don’t just give AB drops! Non-inf=irritants inc.Eletroretinography – flas light at eye. Cannulate upper. Space between=conjunctival sac. 27. see how retina responds. mucoid. 25. Follicular hypertrophy is non-specific. Charcoal medium. 22. Aff=V ophth. primary=uncommon. Conjunctiva: thin. 24. other ocular dz (uveitis. orbital and periorbital problems .VOR: normal eyes move together. follicles 5.first.inflam +/. tear duct infection (dacryocystic). Rich vascular supply. radiation induced. 28. Fast phase in direction of movement. Inf=staph/strep.infection tear duct common in rabbits (only lower punctum). esp brachC.Gonioscopy – assessment iridocorneal drainage angle 31. False –ve common (dog licks nose. chemosis. sparse nerve supply (V ophth. lines inner upper/lower lids (palpebral con). 7. Conjunctivitis signs: mild irritation.Lab: swab (bacteriology. no LA). tracking. LA first. 5-20min horse. limbus (junction cornea/sclera). Cattle exaggerated – roll head down to make eye turn up 30. flattens corneatranslate to pressure).Imaging MRI/CT/US Conjunctivitis and KCS 1.Slit-lamp biomicroscopy (like portable microscope) 32. passage dye to nostril.Corneal reflex assess corneal sensation (STT does to some extent). susp perforated corneal ulcer 26. smoke. look for fluid at ipsilateral nostril. systemic 9. fungal (rare in UK). extension from local eg. sedation/GA if inexperienced. lights on/off (photopic/scotopic). occlude lower.Jones’ test=fluorescein dye passage – patency of tear duct. slow phase opposite.Nasolacrimal flush – conscious? Cats need GA as small punctal opening. Lines both sides TEL 2. hyperpigmentation. Only lymphatic drainage (CALT) 3. orbital abscess. corneal laceration. easy to LA in minor sx). Roll swab gently in front of TEL or cornea for ulcer. Also subconjunctival haemorrhage. Puffy conjunctiva 4. allergic (?). Acute conjunctivitis: hyperaemia. PCR (FHV1. tear film problem (dry eye). Causes of 2o – eyelid/eyelash. indentation tonometry (old fashions schiotz tonometer. cumbersome).Additional visual tests: obstacle course around consult room. Independent of vision. thickening (squamous metaplasia of epithelium). can be on back of TEL 6. IM (pemphigoid). transparent pink MM. FB. Horses – do retrograde from nostril 29. C felis)). flush and look for fluid at lower. insuff time). ERG normal in sudden onset blindness may = brain problem. Conjunctivitis: inf vs non-inf. Chemosis=conjunctival oedema. purulent). covers globe (bulbar con). glaucoma). Medial canthal pocket syndrome in long-nosed dogs – normal 8. parasitic (thelazia). accessory openings in mouth. 23. Discharge variable (serous.Dacryocystitis . insuff dye. ligneous con in Doberman. Normal=globe retraction (VI). change no# goblet cells. 3-5min dog. stairs. Chronic conjunctivitis is hyperaemia. oedema (chemosis). blink (VII). uni/bilat. eff=VI/VII. Use following corneal FB removal. For PCR cut off swab place in dry sterile tube. 33. leaking aqueous humour detected by fluid pushing dye away).Seidal test=corneal integrity (fluorescein dye applied. 15. 21. lhasa apso. Avascular – BVs if path change. Tx systemic tx – doxycycline (NB teeth discolouration/oesophagitis). topical AB tetracyclines 24. Bulldog. see discharge stick to eye. Weak attachment to periorbital. feline conjunctivitis. 13. swab for PCR (superseded culture). hypoT). amoxyclv in pregnant/kitten. systemic eg. polyarthritis. no crater. Not drops. When barrier layer breached. Tx doxycycline.Cherry eye=prolapse TELG. 2. famicyclovir hard to obtain/expensive. Dx swab PCR (not useful if vacc). Other causes: congenital a/hypoplasia. FCV. .KCS=keratoconjunctivitis sicca – IM destruction lacrimal tissue (lac gland and TEL gland). Path=oedema – inc water content distorts collagen fibrils opacity.Dx STT. conjunctivitis. lipid swelling mibomian gland. Dz signs.Also masses eg. 2 o bact w/ staph/strep. no ulcers). tear drainage (fluorescin passage).FCV: upper resp dz. FB (check under TEL). ACSp.Dx eyelid conformation eyelid margins. aqueous humour). FHV1. Non-inf from eyelid prob or tear film disorder 19. Epithelium>stroma (90%)>Descemet’s membrane/basement membrane of epithelium. class by depth/cause. AVs tx ineffective as FCV RNAv 23. shih tzu.FHV1 = signs according to age. Corneal ulcers 1. <1yo. Herpes self-limiting 22.Feline conjunctivitis – infectious most common. 4. gel. no corneal signs (cf herpes.10. Tropism for corneal epithelium – dendritic ulcers common. endocrine (DM. ointment). Topical AVs out-of-fashion. No pigment.Agents: chlamydophila felis (bact). Excision not recommended 18. shows w/fluoroscin. Sx replacement – pocket technique or tacking. Ulcers=loss tissue. tear production. mycoplasma felis. Corneal ulceration. Kittens/young cats. Tx nursing BSAB px/tx 2obact inf – topical for eyes – fusidic acid/chloramphenicol.Ectropion is everted eyelid margin. mastiff. Vascularisation superficial or deep in-growth BVshealing (scarring!). Hx previous URTI. Dx culture and/or PCR. marked chemosis/hyperaemia. 17. general exam 11. Endo pump maintains cornea in dehydrated state – surrounded by water (tear film. Hotz-Celsus sx – remove elliptical piece of skin 12. Pigmentation=response to insult. Westies. affects resp tract. broad spec AB tx 2o staph inf. neurogenic (PSNS destruction + dry nose). zoonosis rare. bordetella bronchiseptica 20.2% (optimmune).C felis = obligate intracellular. unilatbilat in days. dx PCR. ectopic=wrong place.Cilia issues – distichia=wrong direction.Mycoplasma sp: normal cats. bilat. pug. toxic (sulphonamide drugs). Dogs can infect cats. bull dog. 3. Young dogs. Nerves epi/stroma (superficial=more pain). Topical lubes and/or sx 14. iatrogenic (removal TELG) 16. oral ulceration.Bordetella bronchiseptica: g-. tear stimulants (lacrimogenic) – cyclosporine 0. stops destruction (don’t wait until STT 0). Adult cats unilat discharge w/ mild conjunctivitis. shih tzu. Tx lifelong tear substitutes (drop.Entropion (lat 2/3 lower eyelid). absent/mild upper resp dz. Sys for resp (amyoxyclav). Superficial ulcer = epi and basement membrane. Bilat conjunctivitis w/ UR signs. trauma.iris prolapse 7. Enzymes from bact inf or eye. blepharospasm. fungal (common. systemic BSAB. ulcer. FB. EDTA – freeze a stock!). Canperforated ulcer +/. Perforated – animal yelps at rupture. Stromal ulcer = loss stroma. cannot see lesion.Causes multi-factoral:adnexal problem (conformation.Tx remove cause. Reflex uveitis/axonal uveitis – mild transient anterior uveitis – axon reflex in trigem (ophth) 13. conjunctival pedicle graft. corneal transplant. mydriatic (atropine).Sx mx: TEL flap. Leave alone as will clot – grey gelatinous plug 8. monitor (check 48hr) 16. Quick. phenol (caustic. 2. Underrunning w/ fluorescein. corneoconjunctival lamellar transposition (more scarring in dogs than cats). Descemets elastic=limited repair. Use LA (not before STT) 9. poor drug penetration. systemic NSAID. denatures protein).Idolent – recurrent epithelial erosion (REE). chloramphenicol)heals in days. sarcoids. 10. 3. EndoT poor ability. Dendritic pattern with EHV 5. analgesia (systemic NSAID meloxicam. Malacia=liquefying corneamilk=infected. face wet/bloody (humour). Medical mx=NSAID. simple. BVs enter. Slit lamp to see 6. eyelash). + oedema. Combo cautery/grid? ONLY DO THESE IN INDOLENT! 19. Can also put ventromedially. 14. ABs topical/systemic. contact lens. Trauma. keratitis. Rapid progression w/imminent corneal perforation – emergency. Subpalpebral catheter through skin of eyelid for constant infusions or to add drops. suture complication. STT. superficial stromal ulcer. Epi grows but does not adhere – no hemi-desmosomes. No fluorescin stain. inf 12.Debride if non-adherent epithelium. Dx ulcer: fluorescein dye stains stroma.Descemetocoele – surgical management + stromal tx 17. deep stromal ulcer. reg from fibroblasts (weeks). pain variable. buster collar. Horses basically the same as smalls. carprofen). uveitis.TELF: sutured across globe to DL upper lid or DL bulbar con. 23. systemic NSAID. trauma. Perception of curedisappointment LA ophthalmology 1. . Descemetocoele – all absent except descemet’s – ocular emergency! Coughrupture. photophobia. bact inf. Stromal healing once covered. 11. irregular shape. mydriatic.Cat ulcers: FHV1.Simple: topical AB (fusidic acid. mydriatic (tx reflex uveitis.Debride loose/non-adherent +/. 18. 15.Melting cornea – digestion stroma. Topical anticollagenase (serum. No nerves=comfortable. BSAB (topical+systemic).Pain: lacrimation w/ high STT. cleanse periocular region 20.Horse ulcers common: trauma.5. mass. keratectomy (excision w/ operating microscope).keratotomy (conscious w/ LA – punctate v grid). Vascularisation variable. 21. keratomycosis) – mixed bact/fungal in horses! 22. FHV1=superficial or dendritic. Superficial ulcer affecting middleaged. mydriatic. but GA.Stromal: topical BSAB (chloramphenicol. carcinoma/melanoma 4. dilate pupil reduce prolapse risk). eye shuts. boxer ulcers. 360 degree conjunctival graft. topical AB. spontaneous chronic corneal epithelial defect (SCCED). Corneal healing: epi – cells slide across defect (hr-d) by mitosis. ofloxacin). Conjunctivitis uncomfortable not painful. lymphoma. CLAWS 2. Younger cats seen w/ sneezing.Blue tongue (N!) canconjunctivitis. IBK.New Forest dz = IBK – dz internal eye. globe prolapse.Bovine fundus has larger vessels. Cat flu (FHV. Cattle do well with enucleations 17. FCV). KCS. Tropism for conjunctiva. can thenremove whole eye 20. Cats particularly – corneal wounds. 14. occluded puncta. Chlamydophila felis – chemosis. chlamydia. uveitis: red eyes. can get secondary bact inf. bright blindness (vit A def). linear keratopathy. .IBR by herpes. otherwise self-lim 6. Orf. herpes keratitis. ant chamber in tact? Look if pupil intact? Careful US to assess sclera rupture – if soenucleation 4. Mg. enlarged LNs. cataracts 9. periocular swelling (more in sheep). ruminal stasis. bigger/thicker. uveitis (FeLV. Preg tox can present w/ blindness 23. Herpes=FHV1.6.Gid – cyts from tapeworm – blindness from central lesion in brain 24. IM. hypertension. diffuse iris melanoma. Sarcoids. looks like allergy 12. 15. occasional CNS signs. Dogs=inflam. vasculitisIM dz. tx trifluorothymidine. 22. corneal sequestrium. affect value? Unilat blind can function well 8.Peterson nerve block into orbit. Nasal/ocular discharge. calici. will it get worse.SCC – can remove TEL if neoplasia – or cryo with N2 after sx debulk 21. Eosinophili keratitis (chalky cottage cheese) – more in cats than horses. pathognomic dendritic ulcers.Allergies – photosensitisation. infectious – chlamydia. FIV). 5. ringworm. Dx PCR. For purchase exam: affect vision now. Neonatal ophthalmia. conjunctivitis (chlamydia. chemosis. cost money. Lipogranulomatous conjunctivitis – localised inflam mybomian glands ass w/sunlight in lighter breeds.Sudden death – can take aqueous +/. malignant catarrhal fever).Young stock/calves: neuro dzs covered. New Forest Eye. Neonates can present as quite ill. BHB 11. iris coloboma. subcon haemorrhage. nee topical CS (anti-inflam) 7. Globe prolapse – beyond lip margin=lots of force. also CNN (thiamine def)blindness. herpes). Optic nerve swells if vit A def from feed.Sheep: pink eye=new forest eye. rhinitis. Follicular conj seen 7. mycoplasma. veal melanoma. Corneal conditions: herpes keratitis (acute ocular pain). trauma. urea. Form of inflam. prolif/eos keratitis. is the horse safe. Blunt trauma.MCF by herpes. corneal oedema. eye not priority! 3. eyelid masses. cataracts 10.Entropion in lambs – clip back until lamb grows Feline ophthalmology 1. Herpes can be fatal in neonates. heterochromia.Conjunctival injection=better than drops – AB or CS for bovine iritis (silage eye) 19. symblepharon. entropion. Medical tx w/AIs or sx 8. Oral doxy. hypopyon.Silage eye/bovine iritis (form of uveitis) – presented too late when won’t come in parlour! 16. cats=inf. chronic uveitis. death 18. corneal sequestrum 9. iris atrophy. Cattle: systemic (IBR. constipation. silage eye/bovine iritis/listeriosis. SCC. head and eye form. 13.vitreous samples – Ca. eosinophilic keratitis. colic. Unknown cause. pericarditis) . ehrlichiosis. Pigmented area. Big 4 = FeLV. Black/brown lesions on eye 99% likely to be necrosis (on dog=other ddxs eg inflam).Choroidal mets: angioinvasive tumour mets from pulmonary. Entropian from chronic spasms from herpes. 19. Endogenous causes too. feline infectious peritonitis. immunodeficiency virus.Retina more uniform than dog.Geriatric medicine: hypertension from retinal exam! The eye and systemic dz 1. brucellosis. Gridssequestrum! 12. dorsolaterially in eye. malignant catarrhal fever. Vascular dz: breakdown blood-ocular barrier. rickettsia. lymphoma. disc smaller and circular surrounded by pigment ring. See granulomatous inflammation in anterior chamber. generalised degen and blindness. 13. mastitis. Also can be idiopathic. Iris melanoma – lase sx ablate the iris. primary or triggered eg herpes. interferon. later cansarcoma due to lens tissue replication – enucleate early? 14. no venous circle. plaques – white colour like cottage cheese. immune mediated thrombocytopenia.Corneal necrosis=sequestrum. Bartonella. hypertension. FIV. Variable neovascularisation. 11. Characteristic exudate – unilat. Responds to CS or cyclosporine. thromboembolic meningoencephalitis. ganciclovir. band-shaped lesion dorsal to optic disc. toxoplasmosis. ill-defined tea stains of stromademarcated black plaques.Neoplasia: primary=diffuse iris melanoma. Secondary=FeLV. iris hyperaemia. leptospirosis. Can happen in immune meditated thrombocytopenia.In case of toxoplasma.Real world: exam. multiple myeloma. or lacrimal function impaired. 17.Eosinophilic (prolif) keratitis – IM dz. oral lysine. progresses and gets thicker. Tapetum more uniformly green/yellow. lymphoma/lymphosarcoma. vascularisation. Also post-traumatic ocular sarcoma – if lens split in trauma. Uveitis-associated dz Dogs o Infectious canine hepatitis. Horses o Equine recurrent uveitis. leptospirosis. toxoplasmosis.Chronic anterior eveitis: insidious onset. 15. nodules. blood dyscrasias. leptospirosis Cattle o Bacterial septicaemia (metritis. toxoplasmosis. free blood should not enter eye. FIP. ulceration=pain. Diffuse corneal oedema.Taurine deficiency: retinal degen. hypertension Cats o Feline leukaemia virus.famcyclovir. Bleeding at back of eye=hypertension in cats . metastases. TB. ocular nematodes. give clindamycin orally. Recognise pattern and radiograph chest! 20. mets. Granulomatous inflam on exfoliative cytology w/ eosinophils.Cataracts: can be caused by E cuniculi (more common in rabbits). 16. RBCs exit by normal pathways. needs sxtx 10. 18. systemic mycoses. best guess dx. a bit like a big scab. keratitic precipitates (KPs). ‘Silage eye’ 2. uveodermatological syndrome. Blood around eye could look like trauma – pale mms = warfarin toxicity? 4. response to tx. leishmaniasis. empirical tx. 3 arterioles. 3. 4. be aware of link to KCS. fungal. warfarin poisoning. Look in mouth! Access ST floor of orbit via mouth. ass w/Ca met probs. Multiple myeloma. artery forceps blindly into retrobulbar space (most eyes 2cm . Optic neuritis with vit A def. malignant melanoma. move when dogs moves. Improves prog for vision. helminth/parasites. Pathophys of globe prolapse – immediate oedema of conjunctiva and orbital ST exacerbated by eyelid spasm – venous drainage obstructedswelling. Gentle pressure w/wet swab to push back in. dystrophic calcification. majority eyes blind.Angiostrongylus vasorum – can enter eye 19. mammary adenocarcinoma etc. do not refer! Keep globe moist (wet swab ointment). Prolapse vs exophthalmos (aka proptosis). mycosis fungoides. needle emerge from eyelid margin. rickettsial. idiosyncratic drug eruptions! Eye emergencies 1. Corneal calcification – chalky and thick. not solid masses. Cushing’s? 10.Hyperparathyroidismsmall white focal cataracts. ruptured diaphragm=no GA!). Pull eyelids forwards (hooks. lipids entered eye. 20. Can suspect as melanoma but you can see through them and they float cf melanoma 17. Can be transient – put on low fat diet 8. protozoal. Corneal lipidosis=lipids in stroma. sx in dog=success. prevent selftrauma (collar). bact. mets: haemangiocarcoma.Drug reactions: KCS and sulphonamides – good cheap AB for skin. Lipids crystallised compared to lipid-laden aqueous 9. TEL protrusion/swelling. Can be primary but look for secondary. seen in dog with hypoT. 13. dog’s eye ‘filling up’ – eaten fatty meal. Blind and pain free=acceptable. unilat. enucleation to control 14. scalpel incision. ocular discharge. 7.Uveal cysts can float through the iris. sedation/analgesia. More common in brachycephalic and easier to replace. Can do horizontal mattress w/ plastic tubing to reduce pressure. Then desiccation of surfaceulcer. Cats=deep orbit=lots of force=poor prog 2. Prx guarded even with prompt tx. Optic neuritis seen on retinal exam – find cause of neuritis. pain. Tarsorrhaphy: simple interrupted. allis tissue forceps.lat canthotomy (red pressure). Neuro dz: chorioretinitis – in canine distemper virus.Hisiotcytosis can happen in eye – benign and malignant form (malig in Burmese mountain dogs) can be in eye. globe. corneal sensation loss. stay sutures. 11. Ocular may be first change seen 12. Endocrine: diabetic cataract = very common cause blindness in dogs. Retrobulbar abscess/cellulitis behind globe: acute onset.Neoplasia: lymphoma – dx from aspiration aqueous. CSF tap? 6.Melanoma seen on iris. Traction on optic npermanent blindness. medial rectus muscle rupture.Neoplasia can spread from oral cavity 16. algae 18.Cloudy eye could also be lymphoma 15.Also infections: viral. Systemic NSAIDs. exophthalmos.Toxicity: clotting disorders. low level vasc damage. pain on opening mouth. Post-op will see damage eg. Globe prolapse tx: immediate tx needed. Enrofloxacin-induced blindness in cats (fluoroquinolones). S/O 10-14d 3. GA for replacement (other problems first eg. Temp tarsorrhaphy prevents reprolapse. ABs. +/.5. controlled w/ topic steroids. Lipid-laden aqueous=not cataract. low freq admin). Melting=emergency! 13. Aminoglycasides (neomycin. urine dipstick. Delivery vol 50ul. often 40+. Seek advice. retinal detachment. Oxfloxacin (exocin) ointment. suspensions. head shy. can get 60-80). 5. intensive med mx indicated 11. enrofloxacin). melting ulcer. Fluoroquinolones (ofloxacin. then NSAIDs. perforated. gentamycin=Clinagel. Tiacil. toxicity (ivermectin.5). Gentle to epithelium! Drops and ointment. severe laceration. Good for ocular surface. Alkali=caustic. plaster). only if large+painful. Red eye=episcleral congestion. 7. systemic ABs. Pressure cantemp blindness/perm blindness. ciprofloxacin (ciloxan) solution/gel. descemetocoele. +/ yelp.Corneal FB – urgent for all FB but most not true emergency. ciprofloxacin.Corneal laceration common cat/horse – sharp=better than blunt. Then med mx for ulceration: alkalis maymelting/liquefactive necrosis. 6. Terriers with acute lens luxation and 2o glaucoma 8. 10. dilated pupil/fixed.cornea to sclera). high freq admin). 15. Majority not licensed. 3. moxifloxacin). Signs: pain (triad. Topical ABS: fusidic acid (good g+ esp staph. Anterior lens luxation – obstruction flow of aqueous through pupilsudden inc IOP. Corneal emergency: chemical injury. topical lubricants until normal blinking. poor against C felis and pseudomonas. Neomycin AB w/ topical steroid=Maxitrol drops/ointment. Dx tonometry (normal 15-25. penetrating corneal trauma. Spaniels. emulsions. consider referral. intra-ocular haemorrhage. prolonged corneal contact. 5. BS but some staph/strep resistant! 6. most common dog. Systemic steroids. release pus. FB. spirit-based skin prep. lime burns (cement. Aminoglycosides g. intracranial lesion Ocular pharmacology 1. delayed healing. blue eye=corneal oedema (when IOP >40mmHg). Tx irrigation. Test pH conj sac to determine nature eg. ocular sx. dull/quiet – migraine esque). Prog variable. dep cause. sublux?). tap water fine! Saline/hartmann’s if in practice. SARD (sudden acquired retinal degeneration). Canirritancy.and some aerobic g+. . no PLR. Canperm blind in hr. short DOA. 500ml-1L until pH normal (7. retrievers. one of few licensed.Ulcers: deep. basset hound. 12. reduced vision/blindness. Acute glaucoma – acute rise IOP. Chloramphenicol is BS. easy to apply). Acid=bleach. Formulations=drops (solutions. Siberian husky. Cholramphenicol. ointment (paraffin-based. Emergency sx removal lens.Causes: acute glaucoma. poor against C felins and pseudomonas. Use fusidic acid as first line except in brachycephalic dogs as too narrow – use chloramphenicol or oxfloxacin) 4. acute uveitis.Chemical: acid/alkali=immediate loss. cloxacillin. good corneal penetration.Sudden onset blindness: can use ERG (electroretinogram) for retinal function. Usually bilat (contralat eye earlier stage eg. Tx reduce IOP: can give PG analogue eye drops? Analgesia essential! Ideally referral ASAP. 14. gels (liquefy on contact w/oc surface. Fucithalmic isathal). Oral NSAID and opioid! 9. gentamycin). optic neuritis. sedation. iris prolapse – urgent not emergency. MRI. Only 20ul retained (>1dropreflex tearingdilution!) 2. enrofloxacin. safe with an ulcer 23. can perm blindness due to retinal tox. Equine keratomyosis.Sulphonamides canKCS. 20.Dex phosphate good for ocular surface eg.Immunomodulatory drugs: calcineurin inhibitiors reduce TH Lo activation. Topical best 26. 11.Dorzolamid: Trusopt – first choice in cats. not in cats. Systemic often used 19.Brinzolamine: Azopt – first choice in dogs.Topical NSAIDs for uveitis and intraoc sx. Q6-8. ciclosporin – optimmune TM (£60 a month!) – explain how it works. CleocinTM 12. Oxytetracycline. pannus – Maxidex. Epitheliotoxic to cornea! Superceded by topical fluoroquinolones? 8. Doxy for feline chlamydial inf. Topical steroids. v effective in dogs.Carbonic anhydrase inhibitors (CAIs) – carbonic anhydrase catalyses reaction in ciliary bodyaqueous humour (CO2+H2OHCO3-+H+) – CAIs inhibit.Anti-virals: for FHV1.) 9.Anti-glaucoma – reduce aqueous production or increase outflow.Cyclosporine=AI type=Optimmune – T cell suppression. 3w course can eradicate ie cure – can discolour.2%=licensed 24. unless deep/melting ulcer).bact. virostatic not cidal so 5-6x daily! Topical=ganciclovir for FHV.Systemic w/ ophthalmic relevance=clindamycin. Intraocular: uveitis. Cloxacillin=orbenin.Fluoroquinolones – enrofloxacin (baytril/xeden)=narrow therapeutic index in cats.Anti-fungals – horses get fungal +/. give w/water. or acyclovir but 5x daily.Adrenergic agents – B-blockers. delayed healing ulcers but not as bad as topical steroids…Ketorolac trometamol – most common= Acular. Rare but serious! NB not all fluoros. brings down big inc in pressure! Intense miosis dollows. 13. epitheliotoxic.Topical steroids: GCs – anti-inflam or IM doses. feline eosinophilic keratoconjunctivitis. contraindicated in uveitis and anterior lens lux. canoesophagitis. can systemic toxicity. No commercial topical preps! 16. Beta-lactamase-resistant penicillin (bacteriacidal). Genatmycin for pseudomonas (causes melting ulcer). Combo w/ ABs – Maxitrol. Q6-8 28. no need to take off systemic steroids if already on them. 25. Latanoprost – Xalatan . increases tear production. unnecessary polypharmacy? 21. marbocyl ok! 15. reduces scar tissue on surface. 27. 22. timolol – bradycardia. 17. AntirobeTM. not in cats. can combine with others. uveitis – Pred forte. tetracyclines.Clindamycin=good for toxoplasma gondii (causes uveitis). Proxymetacaine=LA eye drop 10. topic AB for IBK. Pred acetate for intraoc eg. gland makes own tears rather than replacing! 0. reduces aqueous humour production. Also peniciilin G.Anti-inflam drugs: IM dz: Extraocular: KCS. Contra-indicated in ulceration! Exacerbate collagenolysisperforation! (NB.Prostaglandin analogues – mainstay of emergency glaucoma tx. increases aqueous outflow. Good for small increases in pressure. effective in dogs. chronic superficial keratitis (pannus). not that effective and IBK self-limiting! (NB ideal IBK tx=long-acting oxytet but expensive! Given subconjunctival under bulbar conjunctiva. Produce bleb. Flurbiprofen =Ocufen.Tetracyclines=Doxycycline (Ronaxan).Oral famciclovir – genertic now available 18. monitor STT 14.7. mild miosis. SID/BID. sulphonamide. Use with CAI? 29. topical NSAIDs. With corneal dx there is reflex arc involving corneal sensation and uvea reflex uveitis. mucin layer by mucinomimetic.Drops: methylcellulose.Atropine=parasympatholytic drug. osmotic diuresis and dehydration. carbomer 980. 40.30. Hyperconc blood to dehydrate eye – mannitol IV over 30min. reduction corpora nigrans (role of CN is to . Remend is a corneal repair gel 34. Mimic 3 layers of the tea film. Repeat=depth and duration inc. orbital anaesthesia for enucleation. Equine uveitis: uvea=iris. polyacrylic acid. 35. mineral oil – prevent evaporation tear film. 2. constipation. Many drugs have both actions 37. Possible sequelae: synechiae (iris adheres to cornea). needle at medial canthus. mydriatic and cycloplegic effects. check renal/cardiac function! 31.LAs: weak bases reversibly block aff/eff nerve impulses. susceptible breeds (german WB’s. lubrithal=trade name for licensed. change in irir pig. iris rests (pigment spot remaining). lipid layer by lipid-based ointments. S-QID.Injectable LA – lignocaine (lidocaine) acts in 10m. LA along vent/lat aspect bony orbit 4. direct medial. Can combine w/ aqueous. petrolatum.Mydriatics and cycloplegics: mydriatics dilate (dx to examine. lasts 30m (repeat beneficial!) good for biopsy. 36. Lacrimal nerve block dorsal to lat canthus. frothing. viscoelastics (hyaluron derivative). sx).Tear substitutes – essentially lubricants. injectable for nerve blocks (periorbital block in horse. use for blocks. tachycardia. polyinylpyrrolidone. Infratrochlear block. more mydriatic than cycloplegic. replace one/more parts: Aqueous layer by aqueous drops. lacrilube. monitor faeces) 39. polyvinyl alcohol. colic in horses (listen to gut every day. corneal oedema. Short acting. Long acting. ciliary body. Desensitised medial eyelid 3. do not use before STT. tropical LA used for analgesia (dx. Zygomatic nerve block desensitises remainder lower lid. medium duration. Epitheliotoxic (do not use as tx).Gels: dextran. dz decreasing vision. now infrequent except Mannitol. tx for sx or uveitis). short duration – use for dx. 33. lasts up to 24hr. cycloplegics relax ciliary body musculature (relieve spasm from anterior uveitis). appaloosas. coloured horses) 7. tx only. Rapid onset. lasts 60m. monitor hydration/electrolytes. USA/Europe: equine recurrent uveitis – leptospirosis Pomona/grippotyphosa. systemic effects – hypersalivation bitter taste. increased IOP (contraindicated in glaucoma). choroid (BS to retina). tumours (SCC) 5. Eg. chorioretinitis. cycloplegic paralyses muscle.Proxymetacaine (proparacaine) LA – rapid. when pupil miotic it hurts. used for post-op analgesia Equine ophthalmology 1. SE reduced tear prod. 38. 15s.Tropicamide=mydriacyl=parasympatholytic drug. In conjunction w/ lacrimostimulant eg. strong for both! Slow onset (60min).Lipid-based ointments: lanolin. Look for congen dz. fibrin in ant chamber. In UK 2o to trauma. Can be sight limiting if not dx and aggressively tx 6. Bupivicaine acts in 45m and lasts for 6hr. Signs: pain. Viscotears liquid gel. 41.Osmotic diruretics: traditional first line. Pre-purchase exam part of pre-purchase exam. long duration (60-120h). IM post infection. cyclosporine 32. toxicity. retinal/choroidal inflam. glaucoma. warn of recurrence. Uneven at 6 o’clock where disc folds.Optic nerve disorders: atrophy (uveitis. esp if CS). blindness 8. CS with care (never if ulcer). habronema (parasite that can invade eye pers conjunctivitis). porphyrin metabolites (blood).Front of the eye: slit lamp biomicroscopy. viral keratitis (non-ulcerative/punctate). appropriate personality for mx post sx. band at level TF/NTF 16. optic disc pink. infarction. post-inflam 12. SCC. limited signs w/ulcers) . concurrent uveitis 10. ulcerative keratitis (bacterial – corneal abscess. congen abnormalities.Acquired cataracts: 2o to uveitis. blood loss). Occasionally senile cataracts. Can also be traumatic.Normal foal low tear prod. Prgx good if swift/aggressive. can be associated w/ microphthalmus. usually 20y+. Anaesthesia/recovery risk! ERG and US to eval retina first 13.Retinal detachment from uveitis. no menace. vision normal). non-tapetal fundus dark brown except in albinos. minimal post-op uveitis. 15. blood loss. acquired 2o to uveitis). intact retina (PLR/menace.Hereditory disorders=retinal colobomas. Sx is phaecoemulsification – good progx if <6m/o. depends on choroid for BS. most bilat. ischaemic ON neuropathy (int carotid occlusion for tx GPM (guttural pouch mycoses). Dark yellow/brown pig. reduces risk of sequelae). keratacomycosis (fungal). traction bands (tugs retina and detaches). Slow PRL for first 5d. blood loss 18. Butterfly-shaped lesion in uveitis. trauma. Tx: NSAIDs (systemic). melanoma. Sx if cataracts w/o uveitis. Can head shaking rarely 20. penetrating ocular wounds 17. glaucoma 22. Cataract sx controversial if 2o to uveitis as prone to complications. vision impairment. normal US).Posterior segment: variation in normal! Normal retina has paurangiotic vessels. trauma. trauma. eosinophilic etc).Lens: cataracts (congen. ox damage. prominent Y shaped sutures on lens.improve constriction in bright light). 2 o to uveitis. congen retinal detachments. coat colour dep.EMND retinopathy from vit E def. stars of windslow end on choroidal vessels 14.Eyelid injury and entropion. atropine (topical. 19. Nuclear lendicular sclerosis in older horses (onion rings thorugh retina. Conditions anterior segment: fibrin in chamber. head trauma. sarcoids. tapetal yellow-green. chorioretinitis (2o to in utero EHV1). Hypopyon: inflam cells in ant chamber usually neonates. can restrict vision.Vitreitis – vitreal opacities – fibrin. ABs (topical. 2 o issues include cataracts. retinal detachment.Congen cataracts: heritable. glaucoma. not big BVs. Bullet-hole lesion in retina. If sight limiting wait until bilat. Visible changes will cause horsefail PPE 9. requires sedation romifidine and butorphanol 21. reduced corneal sensitivity (canself trauma. 2o to sepsis. Diffuse lesions can be hyper-reflectivity of NTF. nutrtitional. provide lubrication if ill. desensitisation (by supraorbital/corneal nerve) can be supplemented by topical analgesia with tetracine/promethcaine 23. BS.Exam: use sedation. Hyaloid artery remnants (hours). cataracts.Vitreal floaters are age related. perineural analgesic – akinesis (blocks motor function by auriculopalpebral nerve of trigem). lens luxation/subluxation: trauma 11. Resistant cases: enucleation. 38. keep in fridge.Glaucoma uncommon.Horses don’t need third eyelids – SCC 29. early fungal dz multifocal lesions.Melanomas in grey horses – excision. facial paralysis. use cotton swab w/ local. Tonometry 25.24.Melting ulcer – normal defence to remove bacteria. res to gentamycin). collagenases by some paths. strep. aspergillus. Combo these for severe. 2o uveitis (congen or neoplasia blocking). more likely to leave defects 27. Signs=dilated pupil. keratectomy (needle/grid) for cases which are/at risk of indolence. fungus on descemets so need biopsy and for viral).Viral keratitis – has rose Bengal retention. corneal band opacities. temp tarsorrhaphy. equine herpes virus.Fungal: miconazole.Ulcers – give NSAIDs. topical antiviral. Also use horse’s own plasma. optic nerve atrophy. scrapes (bact superficial. subpalpebral lavage system.Ulcers: chloramphenicol (not food prod). often ass w/ granuloma in medial canthus. sys NSAIDs. mucin defects. blepharitis. debridement (remove inflam mediators +/paths. uveitis.Corneas=slow to heal 31. may exacerbate uveitis initially beforefungal death 35. or fucidic. some scarring.Sxtx: bandage contact lens. Melting: ciprofloxacin (fluoroquinolones. . or corneal perforation. or iodine (painful but useful). fusarium.Common pathogens: staph. pseudomonas g-. Tx ivermection. emaciation 26.Entropion 2o – dehydration. enucleation 28. use in acutely painful eye. TELF for superficial. nasolacrimal duct catheter (foot plate sits limbus – dorsal or ventral fornix. more complications ventrally) 39. Always consider infection! 33. Implants for cosmesis. Or acetylcysteine. topical NSAIDs 37. Pedical flap for deep melting or large superficial. plus proteinases by some bact. don’t debride excessively. lid reconstruction and cryotx. maybe bitlat. Maintain for 1-3m.Dx: swabs. 32. fly control 30.Habronemiasis (summer sores) – granulomatous lesions. Or EDTA from tube (add saline) this binds calcium. poor vision. Hourly medication for 12-24hr to stabilise cornea 34. itraconazole. fresh every 5d. amniotic membrane flaps but cosmetic issue (large white scar) 36. Rose Bengal ID pre-corneal tear film defect.Tx strategies: spray with insulin needle.