01:08:10

Common Misconceptions in Veterinary Ophthalmology

https://d360v0nslzk1hl.cloudfront.net/thumbnail_images/100/thumbnail_100_20200108045116.png?Expires=1749529622&Signature=Gj~bFfMf46xTqsfcwIep6Kbhdoaw-63MXKjDxBok5InbFIJsKGxdbL6PpD1L4ZBc9~Qpr5YdKupAlwbQK5LJ9RfMDRAMtA6djUGAxP6CKzoshh5Y95bXRe8mG3ad6zO4wFJ7AX8zg~xKak0zhwKJKDIb7WV0xdKIEySBQ21CKEQt2fv0pfKczy6MnQfMU-TRmBWB4fFgk8jXvN7zr8TbotOza3PAZChJw6g1Zy6PQP~1UpcuR~Z03~STSivyk~Gxay9lIwFH5OKzt813QpF9cdbg-msQ4b0jE1zte6mjxvZ7HLqRi~T~9YyjCDM7FB-ryPXpPu9zm9KYDZqEwQOrbA__&Key-Pair-Id=APKAJYRCU5335P523QIQ

Robin Stanley, BVSc. Hons., MANZCVSc (Surgery), FANZCVSc (Ophthalmology) VetScope 2020-01-08

字幕未対応

スライド

関連動画

全て表示

p.1

p.1

Common Misconceptions in Veterinary Ophthalmology
Robin G Stanley, Jane Whitley Matt Sanders, Heather Kaese
Animal Eye Care, Melbourne

p.1
p.2

p.2

The Animal Eye Care Team
• Robin Stanley – Veterinary Eye Specialist
• Jane Whitley – Professional Interest Practitioner in Ophthalmology
• Matt Sanders- Resident in Veterinary Ophthalmology
• Heather Kaese - Veterinary Eye Specialist

p.2
p.3

p.3

The Animal Eye Care Team
• Nicole T
• Nicole R
• Mari
• Danijela
• Michelle
• Jayde
• Sierra
• Harriet
• Ellie

p.3
p.4

p.4

No need to worry about the Breed

p.4
p.5

p.5

No need to worry about the Breed

p.5
p.6

p.6

Consider the Breed
- Breed predisposition is very important in veterinary ophthalmology
- Most of the eye problems – apart from trauma are breed related
- Always check the breed predisposition lists in all pure bred dogs and their primary crosses

p.6
p.7

p.7

Eye diseases that occur by breed

p.7
p.8

p.8

PRA – progressive retinal atrophy
- Labradors
- Australian Cattle Dogs
- Poodles
- Cocker Spaniels

p.8
p.9

p.9

Eye Diseases by Breed

p.9
p.10

p.10

Lens Luxation
- Terriers
- Terriers
- Terriers
- Terriers
- Australian Cattle Dogs

p.10
p.11

p.11

STT Schirmer Tear Tests are overrated
They take at least 2 minutes of my valuable time!!

p.11
p.12

p.12

STT Schirmer Tear Tests are overrated

p.12
p.13

p.13

STT – Schirmer tear tests are underused
- Many cases referred to us have not had a STT done
- Do a STT is all cases of
– Conjunctival Disease
– Corneal Disease
– And Ocular Discharge
– watery and mucky

p.13
p.14

p.14

Dry eye is commonly overlooked
- Dry eye treatment is more successful when treated early.
- Do a STT with chronic conjunctivitis cases as allergic conjunctivitis can lead to dry eye.

p.14
p.15

p.15

Why do a STT here?

p.15
p.16

p.16

Use NSAIDs in ocular trauma, severe uveitis cases, hyphaema cases

p.16
p.17

p.17

We lose most eyes to uveitis
- Uveitis in ocular trauma cases is usually severe
- Use oral prednisolone in most cases
– Prednisolone
- 1mg/kg BID for 3 to 5 days then
- 1mg/kg SID for 5 to 7 days then
- 1mg/kg EOD then slowly reduce
– Consider subconjunctival depot cortisone injections in severe cases

p.17
p.18

p.18

Use oral cortisone and topical cortisone eg Prednefrin Forte

p.18
p.19

p.19

Amacin
is a good choice in these cases

p.19
p.20

p.20

Amacin
is a good choice in these cases

p.20
p.21

p.21

Amacin
- A useful ointment for acute bacterial conjunctivitis
- Not potent enough for uveitis, ocular trauma cases
- Use potent cortisone drops eg Prednefrin Forte or Maxidex eye drops for uveitis cases

p.21
p.22

p.22

Don’t bother with a PLR It’s too basic

p.22
p.23

p.23

Don’t bother with a PLR

p.23
p.24

p.24

PLRs can be very useful
- Do PLRs on every eye case you see

p.24
p.25

p.25

Small pupil suggests Uveitis

p.25
p.26

p.26

Image

p.26
p.27

p.27

The Consensual/Indirect PLR is one of the most useful tests in Ophthalmology

p.27
p.28

p.28

Yes!
The Consensual/Indirect PLR is one of the most useful tests in Ophthalmology

p.28
p.29

p.29

Image

p.29
p.30

p.30

Image

p.30
p.31

p.31

Use the largest possible suture in cherry eyes and eyelid surgery

p.31
p.32

p.32

Use the largest possible suture in cherry eyes and eyelid surgery

p.32
p.33

p.33

Cherry eye surgery
- Larger, abrasive suture (eg. PDS) will rub on the cornea and cause deep corneal ulcers
- Use 6/0 vicryl – soft, fine, absorbable
- Continuous pattern for closing incision with pocket technique
- Tie knots on the palpebral surface

p.33
p.34

p.34

Eyelid surgery
- Entropion surgery, eyelid tumour removals
- Use soft, fine, absorbable suture – eg. 6/0 Vicryl or 5/0 Maxon
- If corneal ulcer and blepharospasm – consider placing lateral TT suture at same time as entropion correction

p.34
p.35

p.35

Useful suture materials for eye surgery
- 6/0 Vicryl – cherry eyes, eyelid surgery
- 5/0 Maxon – entropion, eyelid tumour removals
- 4/0 nylon – Temporary tarsorrhaphy, third eyelid flaps

p.35
p.36

p.36

Large dogs are really easy to do cherry eye surgery

p.36
p.37

p.37

Large dogs are really hard to do cherry eye surgery

p.37
p.38

p.38

Large dogs are really HARD to do cherry eye surgery
- Commonly have BOTH cherry eye and third eyelid cartilage eversion –WARN OWNERS!
- Saint Bernards, Great Danes, German Shepherds, Newfoundlands
- Need to replace prolapsed third eyelid gland and assess cartilage
- Bend in cartilage must be corrected
- Consider referral in these cases

p.38
p.39

p.39

Topical NSAIDs - use on an ulcer

p.39
p.40

p.40

Topical NSAIDs - use NEVER on an ulcer

p.40
p.41

p.41

Topical NSAIDs - use on an ulcer – NO!
- Significantly delays epithelialization – slows healing
- Risk of stromal melting +/- corneal perforation
- Only use topical anti-inflammatory drops on eyes with an intact epithelium

p.41
p.42

p.42

Indications for topical NSAID drops Voltaren or Acular eye drops
- Lens induced uveitis – cataracts
- Vascular keratitis – reduce vascularization/fibrosis once an ulcer has healed
- Uveitis in cats
- Post-operative inflammation after cataract surgery

p.42
p.43

p.43

Treatment for corneal ulcers
- Prophylactic topical antibiotic
- Oral NSAIDs
- Doxycycline - may help with healing by inhibiting MMPs.
- +/- Additional pain relief eg. gabapentin or oral buprenorphine

p.43
p.44

p.44

- Indolent ulcers = superficial ulcers will require cotton tip debridement +/- anterior stromal procedure e.g. Grid keratotomy or diamond burr debridement to encourage healing
- Third eyelid flap alone will not speed up healing

p.44
p.45

p.45

Once ulcer has epithelialised!
- Use topical NSAID to reduce vascularization/fibrosis

p.45
p.46

p.46

Older dogs - white spots => lipidosis, not a problem!

p.46
p.47

p.47

Older dogs - white spots => lipidosis, not a problem!

p.47
p.48

p.48

Causes of corneal lipid deposits
- Corneal lipid dystrophy
– Inherited – CKCS, shelties, beagles, huskies, rough
collie
– No inflammation (no blood vessels)
– Non-responsive to treatment
– Topical anti-inflammatories will EXACERBATE

p.48
p.49

p.49

Causes of corneal lipid deposits
- Corneal Degeneration
– Secondary to pathologic changes in cornea
• Ocular disease or systemic disease
– Opacities consist of lipid, cholesterol or calcium
• Preceded by keratitis, vascularisation
– Vascularisation is hallmark clinical feature of CD
– Presence of Calcium delays healing

p.49
p.50

p.50

Corneal degeneration
- May be secondary to systemic disease - altered lipid metabolism
– General physical exam!
– +/- diagnostic tests

p.50
p.51

p.51

Age related Lipid + Calcium

p.51
p.52

p.52

Corneal lipidosis/degeneration
- Topical anti-inflammatories may worsen degeneration
– Don’t use topical NSAIDs or corticosteroids
– Decrease vascularization => can’t clear the lipid
– Will attract/bind calcium
- Fragile deposits can crumble – leaving deep corneal defect or corneal perforation => requires CCT graft!

p.52
p.53

p.53

Image

p.53
p.54

p.54

Corneal degeneration/lipid keratopathy treatment
- Treat underlying cause
- Low fat diet eg. Hills w/d
- Optimmune or Tacrolimus 0.02% drops BID- TID
- If ulcerated, or calcium preventing healing
– can use diamond burr to remove the gritty
material

p.54
p.55

p.55

Image

p.55
p.56

p.56

Indolent Ulcers in Cats must be gridded

p.56
p.57

p.57

Indolent Ulcers in Cats must never be gridded

p.57
p.58

p.58

Gridded Feline corneas will form corneal sequestrums

p.58
p.59

p.59

Superficial Ulcers in cats are usually viral
TRUE

p.59
p.60

p.60

Feline superficial Ulcers - viral
- Topical anti-virals
– Aciclovir – Zovirax eye ointment – human – Cidofovir eye drops – compounded
- Oral Famciclovir 40-90mg/kg BID
- Doxycycline 5 mg/kg BID

p.60
p.61

p.61

Feline superficial Ulcers - viral
- Oral meloxicam
- Hylo-Forte these eyes can go dry for up to 6 weeks after infection
- Reduce stress

p.61
p.62

p.62

Conjunctivitis in cats = doxycycline deficiency
True

p.62
p.63

p.63

Older cats get iris pigment changes so do not worry

p.63
p.64

p.64

Older cats get iris pigment changes so do not worry

p.64
p.65

p.65

Iris Pigment in Older Cats

p.65
p.66

p.66

Iris Pigment – be concerned
- Growing quickly
- Darker black lesions
- Distorted pupil – tumour is growing through the posterior iris epithelium
- Increased IOP – intraocular pressure

p.66
p.67

p.67

This old cat has good vision so no need to do a fundus examination

p.67
p.68

p.68

This old cat has good vision so no need to do a fundus examination in ALL older Cats

p.68
p.69

p.69

Most older cats have hypertension You can see changes in the fundus way before systemic signs of hypertension

p.69
p.70

p.70

Small Haemorrhages

p.70
p.71

p.71

Image

p.71
p.72

p.72

Image

p.72
p.73

p.73

Image

p.73
p.74

p.74

Serum Heals All Ulcers

p.74
p.75

p.75

No – Serum only helps with Malacia

p.75
p.76

p.76

Serum and Ulcer Treatment
- Indolent Ulcers
– Need debridement
– +/- Linear Grid Keratotomy
– +/- Superficial Keratectomy
- Topical Prophylactic Antibiotic
- Oral NSAID
- Pain Control
- Prevent Self Trauma

p.76
p.77

p.77

Serum and Ulcer Treatment
- Infected Ulcers
– Antibiotics
- Systemic
- Topical
– Anti-inflammatories
– Pain Control
– Prevent Self Trauma
– Hygiene

p.77
p.78

p.78

Malacic /Melting Corneal Ulcer
- Release of Collagenases/Proteases
– Bacteria
– White blood cells
– Corneal stromal cells
- Breakdown > Repair
- Common in Brachycephalic
- In Cats – Burmese seem to be over-represented

p.78
p.79

p.79

Serum and Ulcer Treatment
- Malacic/Melting Ulcers
– Topical Antibiotics
- Ofloxacin/Chloramphenicol
- Frequently during the first hour/24 hours
– Systemic Antibiotics
- Doxycycline 5mg/kg bid
- Cephalexin 25mg/kg
- Enrofloxacin 5mg/kg
– Systemic Anti-inflammatory
– Pain Control
– Prevent Self Trauma
– Hygiene
–Oh yes – SERUM WILL HELP

p.79
p.80

p.80

Latanoprost: First Choice for Glaucoma

p.80
p.81

p.81

Latanoprost – Not a First Line of Defense Drug

p.81
p.82

p.82

No - Complicates Glaucoma Secondary to Lens Luxation

p.82
p.83

p.83

Latanoprost – Not in cases of Lens Luxation
- Causes Pupillary Constriction
– Can trap the lens in Anterior Chamber
– Can trap the lens in Pupil
- Pupillary Block Glaucoma
– Aqueous can not get from behind the iris to the drainage angle
- If you are not sure – Don’t risk it!
You can always call Animal Eye Care

p.83
p.84

p.84

No – Complicates Glaucoma Secondary to Uveitis

p.84
p.85

p.85

Latanoprost – Not in cases of Uveitis
- Latanoprost = Prostaglandin Analog
– Can Increase inflammation
– Resulting in Higher Pressures

p.85
p.86

p.86

Glaucoma - First Line of Defense Brinzolamide and Dorzolamide

p.86
p.87

p.87

Recheck IOP in 1-2 Weeks After starting Anti-Glaucoma Treatment

p.87
p.88

p.88

No Recheck the pressures in 90 minutes

p.88
p.89

p.89

Thanks for attending
Animal Eye Care
181 Darling Rd
East Malvern, 3145, Victoria
Phone (03) 9563 6488
www.animaleyecare.com.au

p.89

コンテンツの閲覧にはログインが必要です

アカウントをお持ちでない方はこちら