p.1

Equine Fungal Keratitis
Animal Eye Care

p.2

Uveitis - inflammation
- Inflammation means break down of the blood eye barrier
– Inflammatory cells get into the eye
– Recurrences are common
- Prolonged treatment is essential
Animal Eye Care

p.3

Uveitis - inflammation
Animal Eye Care

p.4

Uveitis - inflammation
- Topical anti-inflammatories
– Prednefrin Forte – most potent and best penetration
- Atropine
– Use TID until the pupil is dilated then once daily to once every second day
- You can use the degree of pupillary dilation as a guide to how well the uveitis is being controlled
Animal Eye Care

p.5

Uveitis - inflammation
- Oral anti-inflammatories
– Cortisone is the most effective
– Oral NSAIDs can be used in the longer term treatment and also in less severe cases
- Subconjunctival depot cortisone for severe or refractory cases
Animal Eye Care

p.6

Use the IOP as a guide to your uveitis treatment
- Normal in uveitis cases the IOP decreases
- If the eye clinically looks normal but the IOP is still low eg 5 mmHg continue treatment
– Once the IOP is normal 10-25mmHg then the uveitis has been controlled
Animal Eye Care

p.7

Uveitis - summary
- Always use systemic therapy
- Prolonged treatment
- Beware of recurrences
Animal Eye Care

p.8

Animal Eye Care

p.9

Animal Eye Care

p.10

Glaucoma
- Red Eye – deep perilimbal hyperaemia
- Blue Eye – corneal oedema
- Dilated, non responsive pupil
- Increased IOP – intraocular pressure
Animal Eye Care

p.11

Glaucoma – increased IOP
- Breed Predisposition
- Affects both eyes!!!
– One eye gets glaucoma
– The other eye will be predisposed
Animal Eye Care

p.12

Acute Glaucoma
- Prostanoids
– Latanoprost
– Travatan
- Dramatically reduces the IOP in most cases
Animal Eye Care

p.13

Glaucoma blind eye options
- Buphthalmic eye – once enlarged the eye is blind
- Eye removal
Or
- Intraocular Silicone Prosthesis - ISP
Animal Eye Care

p.14

Glaucoma
- Preventative Treatment for the remaining eye is probably the most important glaucoma
consideration
- Azarga – brinzolamide/timolol

p.15

Glaucoma = increased IOP
- Breed predisposition
– The other eye in pure bred dogs needs preventative therapy
- Beware of the red/blue eye with a non responsive pupil – check the IOP
- Buphthalmic eyes – eye removal or ISP
Animal Eye Care

p.16

Cataracts
- Cataracts can cause inflammation
- Lens induced uveitis
- Always use a topical anti inflammatory with all cataracts
Animal Eye Care

p.17

Diabetic Cataracts
- These are especially prone to LIU
- Always start topical NSAIDs
Animal Eye Care

p.18

Ocuglo & Diabetes
- Williams, D. Fitchie, A. Colitz, C. An Oral Antioxidant Formulation Delaying and Potentially Reversing Canine Diabetic Cataract: A Placebo-controlled Double-masked Pilot Study. Int J Diabetes Clin Res 2015, 2:1
Animal Eye Care

p.19

Ocuglo & Diabetes
- Mean time without change in lens opacification was
– 278 ± 184 days with OcuGLO RxTM
– 77 ± 40 days in the placebo group
- this difference being statistically significant at p=0.0005.
Animal Eye Care

p.20

Animal Eye Care

p.21

Diabetic Cataracts
- Can develop very quickly
- Within a few days they can develop from nothing to fully mature cataracts
- Initially start as vacuoles – small bubbles on the edge of the lens (equator)
Animal Eye Care

p.22

Cataracts Summary
- Cataract surgery is an option
– Ideally refer early for fundus evaluation and before LIU starts
- Cataracts will cause LIU – lens induced uveitis
- Diabetic cataracts can develop quickly
– Ocuglo
– Always start topical NSAIDs ASAP
Animal Eye Care

p.23

The Prominent Eye Signs of Orbital Disease
Animal Eye Care

p.24

Signs of Orbital Disease
- Exophthalmia
- Third eyelid prolapse
- Chemosis
– Obstruction of venous return
- Reduced retropulsion
- PLR usually normal...
Animal Eye Care

p.25

How do you approach a prominent eye?
- Signalment
– Breed Predisposition
- Brachycephalics ? globe prolapse
- German Shepherds ?eosinophillic mysositis
- Golden Retrievers ?extraocular myositis
- Bassets, Cockers, Maltese ?glaucoma ?buphthalmos
– Age
- Young dogs ?orbital cellulitis
- Old dogs ?orbital neoplasia
- Old Cats ?orbital neoplasia or orbital cellulitis
Animal Eye Care

p.26

How do you approach a prominent eye?
- Open the mouth
– Pain retrobulbar abscess, orbital cellulitis
- Focal Light examination
– Check the PLR – abnormal PLR eg dilated and non responsive pupil indicates glaucoma
– Check depth of the anterior chamber and lens position
Animal Eye Care

p.27

Is this is an enlarged eye ? Occulomotor nerve disease
Animal Eye Care

p.28

How do you approach a prominent eye?
- Palpation
– Retropulsion – push the eye back into the eye socket
- Reduced retropulsion a sign of orbital disease
– Around the eye
- Pain could suggest eosinophilic myositis or temporal myositis
– Open the mouth
- Pain on opening the jaw is suggestive (diagnostic?) of retrobulbar abscess
Animal Eye Care

p.29

How do you approach a prominent eye?
- Tonometry – measure the IOP
- Ultrasonography
– Cystic structures show up well
– US guided FNA or TruCut biopsy
- Radiology
– Bone changes suggest neoplasia
- CT/MRI scans
– The best way to image the orbit
Animal Eye Care

p.30

Animal Eye Care

p.31

Use of MRI in the investigation of orbital disease in small animals – Ruth Dennis
- Use US first
– May suggest FB or abscessation and treat accordingly
- Radiology
– If normal then MRI
– If abnormal and showing osteolysis then prognosis is poor, consider MRI to define extent and guide to biopsy
Animal Eye Care

p.32

Differential Diagnosis – Prominent Eye
1. Glaucoma
2. Retrobulbar abscess, Orbital cellulitis
3. Orbital Trauma
4. Globe Proptosis
5. Orbital mucoceles
6. Eosinophilic myositis, Extraocular myositis
7. Orbital Neoplasia
Animal Eye Care

p.33

Prominent eye Summary
- Beware of exposure keratitis
- Pain on opening the jaw suggests retrobulbar abscess
- US, X ray, MRI all useful diagnostic tools
Animal Eye Care

p.34

How to Logically Approach Vision Loss
- History
- Breed
- Presentation
- PLRs
- Fundus Examination
Animal Eye Care

p.35

Obstacle Course
Animal Eye Care

p.36

Vision Loss - history
- Does the animal bump into things
– If so, vision loss is severe
- Poor night vision
– Suggests PRA
- Poor day vision
– Suggests Cone Degeneration or nuclear cataracts

p.37

Vision Loss - breed
- PRA – progressive retinal atrophy
– Labradors, ACDs, Poodles, Cocker Spaniels
- Cataracts
– Maltese, Golden Retrievers, Rottweilers
- SARDs
– Small white dogs
Animal Eye Care

p.38

Vision Loss – slow onset
- PRA – slow progressive loss. Night blindness,day blindness and the cataracts form
- Cataracts -can be rapid with diabetes
– Diabetics consider Ocuglo

p.39

Diabetic Cataracts
- Water into the lens
– See the lens sutures Y
- Disrupts the lens fibres
– cataracts form
- Often huge lenses – very swollen
Animal Eye Care

p.40

Vision Loss - sudden
- SARDs –sudden acquired retinal degeneration
- Retinal Inflammation – IMR
– Immune mediated retinitis
- Optic Neuritis – inflammation
- Retinal Detachment
– The most cause of vision loss in older cats
Animal Eye Care

p.41

PLRs in Vision Loss Cases
- Normal PLRs
– Think retinal or central vision loss

p.42

PLRs in Vision Loss Cases
- Slow PLRs
– Think retinal
– Remember other causes of slow PLRs not associated with vision loss
Animal Eye Care

p.43

PLRs in Vision Loss Cases
- Dilated Non
Reponsive Pupils
– Optic Neuritis
– SARDs
– Feline Hypertension
Animal Eye Care

p.44

Colourmetic PLR
- Recent research has shown that the red and blue lights can be used to stimulate different parts of the retina.
Animal Eye Care

p.45

Animal Eye Care

p.46

Dilate the pupil takes 15 minutes to work

p.47

Choroidal exudates
Animal Eye Care

p.48

Small Haemorrhages
Animal Eye Care

p.49

Bullous detachment
Photos from https://www.cliniciansbrief.com/article/retinal-detachment
Animal Eye Care

p.50

Vision Loss Summary
- Cats – usually sudden vision loss
– Retinal detachment
– High Blood pressure
- Dogs – sudden vision loss
– Usually inflammatory –oral prednisolone and doxycycline
- Dogs – slow vision loss
– Cataracts
– PRA – progressive retinal atrophy
Animal Eye Care

p.51

Thanks to the AVA VIC DIV
Animal Eye Care