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what are 4 broad categories of disease pertaining to the sclera?
- neoplasia (melanoma, SCC, fibrosarcoma)
- immune mediated (nodular granuloma)
how can you distinguish cataract (lens opacity) from nuclear sclerosis (normal aging change)?
- w/ retroillumination: cataract is black vs. NS clear
- w/ direct illumination: cataracts is white vs. NS is hazy/translucent
- (need complete dilation!)
what type of cataract has <10% lens affected with smokey appearance and smooth lens capsule?
what type of cataract has nearly 100% lens affected that is sparkley w/wrinkled lens capsule?
- -including morgagnian type
how do you distinguish mature from hypermature?
- both 100% affected (immature 10-90% involved)
- mature: smokey and smooth capsule
- hyper: sparkly and wrinkled
what is #1 cause of cataracts in the dog? Cat? what happens if cataracts is left untreated?
- dog: inherited (diabetes #2)
- cat/horse: secondary to uveitis
- untreated = 100% failure --> enucleation
Surgery is the only real known cure for cataracts. What are 3 sx options and which removes the lens + capsule?
- extracapsular extraction (older method; capsule stays)
- intracapsular extraction (remove entire lens + capsule)
- phaco-emulsification (capsule stays
what other tests are done on cataracts patient? what are you concerned could also be a problem as result of cataracts?
- MODB (general health/night vision)
- gonioscopy (glaucoma)
- electroretinogram (retinal function)
- ultrasound (retinal detachment)
what meds do you want to use pre-op for cataracts? what do you add post op?
- dilation + NSAIDS + Abs
- post op: same +/- glaucoma meds + ecollar
what are 3 main post op complications?
- retinal detachment
what are the 2 types of lens induced uveitis?
- phacoclastic (catastrophic - ruptured lens capsule - lose eye)
- phacolytic (leaking but capsule still intact- can lead to glaucoma and then lose eye)
what is pseudophakia, aphakia, microphakia, and lenticonus?
- P:prosthetic lens
- A: absent lens
- M: small lens (congenital anomaly)
- L: protrusion of lens (congenital anomaly)
what age is nuclear sclerosis usually present? how is it described?
- always bilateral, pearly, translucent, normal fundic detail
what breeds are prone to lens luxation? what do you see on ophtho exam? is this surgical emergency?
- terriers and shar pei (zonular abnormality)
- ***surgical emergency***
- aphakic cresent (space where lens should be)
what can lead to secondary lens luxation? is this a surgical emergency?
- glaucoma (buphthalmos)
- uveitis (cat/horse)
- rarely trauma
- 2ndary/chronic luxation is NOT sx emergency but primary is!
do cats get primary or secondary lens luxation? does this make them good or bad candidate for sx?
- poor candidate for sx (tx w/topical dorzolamide and for uveitis if present)
what is medical tx plan for anterior lens luxation? what drugs should you avoid?
- decrease IOP (mannitol, CA inhibitors-dozolamide topically)
- decrease inflammation (prednisolone topically, oral NSAIDS)
- ***avoid pilocarpine, atropine/tropicamide, demacarium B-blockers, PGE analogs(can use these if posterior lux)***
what are congenital conditions of the uvea?
- heterochromia iridis/iridium
- iris coloboma
- persistent pupillary membranes
- pupil abnormalities (dyscoria/anisocoria/corectopia/polycoria)
- anterior segment dysgenesis (merle ocular dysgenesis)
what congenital problems are associated with merle ocular dysgenesis?
- anterior segment dysgenesis
- iris coloboma
- corectopia (displaced pupil0
- persistent pupillary membrane
- retinal dysplasia/optic n. hypoplasia
what is a degenerative change of the uvea that is spontaneous progressive thinning of iris stroma or pupillary portion? young or old patient?
- iris atrophy
- middle aged to older
how do you distinguish iris cyst from melanoma?
melanoma will NOT transilluminate
what is most common primary tumor of uvea? 2nd most common? Most common met to the uvea?
- #1: melanoma (cats have worse prognosis)
- #2: ciliary adenoma
- met #1: lymphosarcoma
You need a dark room to evaluate uveitis. What are some findings assoc. w/anterier uveitis?
- aqueous flare (tyndall effect)
- ciliary flush
- corneal edema
- conj. hyperema
- decr. IOP
- darker iris (rubreosis iridis)
- keratic precipitates
- pain/decr. vision
what are signs of posterior uveitis?
- tapetal hyoreflectivity
- retinal detach/hemorrhage/edema
- vitreous opacity
what are some common infectious causes of canine uveitis? what is presumptive tx until diagnosis made?
- viral (distemper; CAV-1)
- tickborn (RMSF)
- fungal, bacterial
- parasitic (Dirofilaria)
- algal, protozoal (toxo, neospora)
- Tx: doxy
What are some common infectious causes of feline uveitis? what is presumptive tx until primary diagnsosis can be made?
- FIV;FIP;FeLV; Fungal (blasto/histo/coccidio)
- Tx: clindamycin (for toxo)
what are tx options for uveitis?
- control inflammation w/ topical NSAIDs, steroids (*prednisolone acetate*), or immunosuppressive agents
- systemic pain meds; darken environment; mydriatic/cycloplegics (atropine)
can you give topical or systemic steroids for ulcerative keratitis?
Can you give topical or systemic steroids for deep mycotic disease?
- No systemics (controversial)
- but topicals ok
with glaucoma, what happens as result of increased IOP?
retinal and optic nerve damage --> blind
why is glaucoma one of the most misdiagnosed eye condition? what are clinical signs?
- owners/clinicians don't recognize til late
- ciliary flush
- corneal edema
- vision loss
- dilated pupil
- ocular pain
what are signs of chronic glaucoma?
- acute signs + haab's striae (breaks in descement memb) + buphthalmos + blind + lens lux (aphakic crescent) +
- cupped optic n. and retinal degeneration
tonometry should be performed in every patient who presents with what?
- *red eyes* (with INTACT cornea and sclera)
- no tono in perforated/nearly perforated
what is normal IOP of dog? cat? horse?
- dog: 12-25mmHg
- cat: 12-27mmHg
- horse: 17-28mmHg
- (should have <5 variation between eyes of patient)
what does fundoscopy tell you regarding glaucoma?
acute (optic n. hyperemia) vs. chronic (gray/cupped optic n + retinal degen)
What types of drugs can be used to decrease aqueous production as tx for glaucoma?
- CA inhibitors
- beta blockers
- alpha2 agonists (adrenergic agonist)
what types of drugs can be used to increase aqueous outflow as tx for glaucoma?
- epinephrine derivatives (adrenergic agonist)
- cholinergic agonists
how do cholinergic agonists tx glaucoma? what are examples?
- increase aqueous outflow via miosis (improves iridocorneal angle)
- carbachol, demecarium, pilocarpine
how do adrenerigc drugs tx glaucoma?
- alpha agonist: (alpha1 stimulation --> pupil dilates) but alpha2 stim decreases aqueous production
- Beta antagonists: blocks conversion of ATP to cAMP --> cant produce aqueous humor
what are some examples of adrenergic meds for glaucoma?
- alpha agonist: Dipivefrin (prodrug for epinephrine)
- Beta antag: timolol, betaxolol
what drugs are used for short term tx of glaucoma for emergency reduction of IOP?
- osmotic diuretics like mannitol and glycerol/glycerine
- (contraindicated in renal/cardiac disease and dyhydration; no glycerine if diabetic)
what are carbonic anhydrase inhibitors for tx of glaucoma? (they have NO effect on pupil size)
- topical: dorzolamide, brinzolamide
- oral: methazolamide, acetazolamide
- (decreases aqueous humor production)
- *beware of side effects from oral CAIs in kidney/GI
what is latanoprost and how does it help with glaucoma? what are side effects?
- prostaglandin analog that increases unconventional outflow
- SE: miosis, exacerbates uveitis, conj. hyperemia
what is sx option for glaucoma?
- laser cyclophotocoagulation (ablation of ciliary body to reduce aqueous production)
- goniovalve (to increase outflow)
- enucleation or evisceration/prosthesis
Feline glaucoma is relatively uncommon. Are most cases primary or secondary? what is first line therapy?
- secondary (95%) due to neoplasia, uveitis or aqueous misdirection syndrome
- CA inhibitors as first line therapy