Eyelid Agenesis
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Terms in this set (113)
Hypertensive RetinopathyCauses Hyphema, Vitreal hemorrhage, Retinal hemorrhages, Retinal detachment, and Retinal vessel tortuosityHypertensive RetinopathyIn cats, mostly due to idiopathic, chronic kidney disease (more commonly), hyperthyroidism, and occasionally DM, Primary aldosteronism, Pheochromocytoma, Chronic anemiaHypertensive Retinopathy--> targets eye, brain, kidney, and heart systolic BP will be over 160 mmHg TX = amlopidine SID to get BP under 150 vision prognosis depends on how far along, +/- PLREnrofloxacin Retinal ToxicityAcute retinal degeneration due to drug metabolism, in most cases is permanentDiffuse Iris MelanomaMost common feline primary intraocular tumorDiffuse Iris MelanomaSlow, progressive, often multifocal areas of pigmentation of the iris, can cause secondary glaucomaIris Nevusalthough you would need histopath to confirm this is not the malignant neoplasm There is progressive growth, Exfoliating cells in the anterior chamber, Involvement of the iridocorneal angle, and secondary glaucomaDiffuse Iris MelanomaTX = monitor progression (take pics), enucleation, chest rads, abd USExophthalmosdue to Neoplasia, abscess/cellulitis, hemorrhage, vascular anomaly, mucocoele, cyst, myositis, etc. --> increased orbital volumeExophthalmosa Normal sized globe displaced anteriorly/rostrally within the orbitBuphthalmosis a normally-positioned globe that is enlarged due to elevated intraocular pressureEnophthalmosNormal sized globe displaced posteriorly/caudally within the orbitEnophthalmosDue to globe retraction, decreased orbital volume or pressure anterior to the equator of the globe --> such as with pain, muscle wasting , horners syndrome, etcPhthisis bulbiShrunken eye (post inflammatory change)Skull Radiographsuseful for Bony lysis or proliferation, Sinus or nasal disease, Radiodense foreign bodies. Usually needs anesth --> difficult to intepretUltrasoundUseful for Cysts and abscesses, Vascular anomalies, sampling +/- Foreign bodies With topical anesthComputed Tomography (CT)Useful for Orbital fracture, Bony lysis, and 3D imaging (ie for sampling). Needs anesthesiaMagnetic Resonance Imaging (MRI)Useful for soft tissue study and 3D imaging. Needs anesthesia. Do not use in metallic FBsDivergent strabismusExotropia --> Mainly brachycephalic dogs. Usually no clinical significanceConvergent strabismusEsotropia --> Inherited in cats especially SiameseOrbital Cellulitis/AbscessYou have a 2 year old super shredder MN lab. He is presenting with decreased appetite. Upon exam you notice elevated third eyelid, painful when retropulsed, pain on opening mouth. TPR is 30 RR, 100 HR, 103.5 F What is a top ddx?Orbital Cellulitis/AbscessOrbital Cellulitis/Abscesssurgical TX = Incise oral mucosa caudal to last upper molar with #15 Bard- Parker blade --> Insert closed hemostat, advance slowly, then open --> Collect samples --> leave open +/- remove FB/toothOrbital Cellulitis/Abscessmedical TX = systemic abx (cephalosporins and enrofloxacin), systemic NSAIDs, eye lube, soft food --> response in 2-3 daysSalivary Mucocele/CystUsually due to trauma --> can have Exophthalmos and TEL elevation +/- pain need sample collection to DX TX: surgical excision or drainageMasticatory Muscle MyositisA 7 year old MN golden presents with Acute onset bilateral exophthalmos, painful and restrictive jaw movements, fever, lethargy, anorexia. You tr4eat with systemic immunosuppression. What is the DX?FalseT/F: Orbital Neoplasia's are normally painful and have guarded to poor prognosisInflammatoryThink _______ disease If younger animal, painful, rapid onset, and febrileNeoplasiaThink _______ disease If older animal and slow onsetOcular ProptosisGlobe moves anterior and eyelids become "trapped" behind equator --> True ophthalmic emergency!!!Ocular Proptosiscaused by trauma (more common in brachycephalic) --> prognosis is poor in horses, cats, dolichocephalic dogsOcular ProptosisTX = eye lube, e-collar, assess other injuries, globe replacement +/- enucleationEnucleation___ should be done if 3 or more EOMs are torn, Optic nerve is transsected, or Globe (cornea and/or sclera) rupturedOcular Proptosis______ prognosis: good in brachycephalic, guarded with intraocular trauma. Pupil size does not indicate prognosis, but present PLR has good prognosisOcular ProptosisComplications include blindness, strabismus (esp lateral), Lagophthalmos (inability to fully blink), decreased corneal sensation, dry eye, glaucomaOcular ProptosisRapid globe replacement if possible --> when in doubt --> replace globeEnucleationSurgical removal of globe, third eyelid & gland +/- silicone orbital prosthesisEviscerationRemoval of intraocular contents and placement of a silicone prosthesis in corneo-scleral shell --> cosmetic alteration Contraindicated in cases of neoplasia/infectionExenterationRemoval of globe and all orbital contents. Generally performed for orbital neoplasiaTranspalpebral EnucleationIndications: surface ocular infection or neoplasia Suture eyelids closed --> Incise skin around lids and dissect down to sclera, then work posterior (type of approach)EnucleationPost op should do a cold compress BID-TID for 10-15 minutes. Systemic NSAIS/analgesia, e-collar, suture removal in 2 weeks some bleeding from incision/ ipsilateral nostril is normal for a few daysEnucleationComplications include bleeding, infection, cyt formation (uncommon), contralateral irreversible blindness (due to traction on optic nerve-more common in cats)EviscerationNot recommended in cats - increased implant extrusion riskAnatomic entropionEntropion seen in young dog and certain breeds such as shar peisSpastic entropionLid spasm associated with pain (foreign body, corneal ulcer, etc.) --> Vicious cycle! *Evaluated by use of topical anestheticCicatricial entropionentropion that is less common --> Associated with previous surgery, trauma, or chronic inflammation of eyelids --> do not eyelid tackEntropiontemporary surgical correction includes placing Non-absorbable Lembert-type (interrupted) sutures --> leave for 3 weeks or longerEntropionpermanent surgical correction is the Hotz-Celsus procedureFalseT/F: You should always treat ectropion surgically +/- medicallyTrichiasisNormal facial hairs that contact the cornea/conjunctiva Ex. Entropion, Nasal folds, Medial caruncleTrichiasisTX = Nasal fold excision, Medial canthoplasty or local cryotherapy, or fixing entropion (depending on the location)DistichiasisHairs emerge from Meibomian gland openings --> Sometimes cause problemsDistichiasisTX = benign neglect (if no problem --> don't leave alone), manual/cryo-epilation (hair removal)Ectopic ciliaHairs emerge through the palpebral conjunctiva --> Very commonly cause problems (i.e., ulcers!)Ectopic ciliaTreatment: en bloc excision +/- cryotherapyHordeolum (stye)painful suppurative infection of eyelid glands of Zeis or MollChalazionfirm, non-painful swelling of Meibomian gland caused by accumulation of lipid secretions and granulomatous reactionHordeolum (stye)seen usually in young dogs, TX = hot compresses, topical/systemic abx, +/- culture and curettageChalazioncan be seen in any age, TX = surgical incision and curettage + topical abxBlepharitisinflammation of eyelids, my or may not have more extensive dermaitisJuvenile Pyoderma/Cellulitisyoung puppies that get Acute pyoderma of the head due to Bacterial (Staphylococci spp.) hypersensitivityBlepharitisseen in adult dogs due to staph or strep --> take an Impression smear, skin scraping, and hair pluck cytology +/- cultureTrueT/F: Systemic drugs are usually more effective than topical medications treating eyelid diseaseEyelidWhen doing a _______ Laceration Repair, you should do minimal debridementEyelidWhen doing a _______ Laceration Repair or tumor removal, you should do a 2 layer closure with figure-of-8 margin sutureFalseT/F: Most common canine eyelid tumors are squamous cell carcinomas (malignant)FalseT/F: Most common feline eyelid tumors are Meibomian gland adenoma (benign)Pre-corneal Tear FilmFunctions include: Lubrication between lids and ocular surface, Aids corneal refraction, Antimicrobial properties, Primary corneal oxygen source, and Removal of debris through tear drainageTrilaminar Tear Filmhas 3 layers of lipid, aqueous, and mucinLipidOuter most trilaminar tear film layer Produced by Meibomian glands --> Stabilizes and prevents evaporation of the aqueous layerAqueousMiddle trilaminar tear film layer Produced by the orbital lacrimal gland & third eyelid gland --> Provides corneal nutrition and Removes waste productsMucinInner most trilaminar tear film layer - Produced by conjunctival goblet cells (Thickest layer) --> Immunoglobulins (IgA) and Interface of tear film with hydrophobic corneal epitheliumTrueT/F: The orbital lacrimal glands produce more basal and stimulated tears than the 3rd eyelid glandFalseT/F: Tear film drainage goes: canaliculi --> lacrimal sac --> puncta --> nasolacrimal duct --> nasal punctumNasal punctum50% of dogs have their __________ opening into the oral cavity as well as the ventral lateral nasal meatusQuantitative____ tear film deficiency is decreased aqueous tear production --> Keratoconjunctivitis siccaQualitative____ tear film deficiency is a disorder of the mucin or lipid tear components --> tear film instability< 10 mm/minSTT for KCS - no pain/ulcer>25 mm/minSTT for KCS with pain/corneal ulcer15-25 mm/minSTT for Qualitative Tear Deficiency15-25 mm/minNormal STT for dogTrueT/F: KCS Conjunctival hyperemia can be misdiagnosed as conjunctivitisKeratoconjunctivitis siccaA 4 year old FS boxer presents with mucopurulent ocular discharge, Blepharospasm, dull corneal surface, and positive fluorescein on the corneal. What is the most likely cause for this corneal ulcer?Keratoconjunctivitis siccaThe most common cause of ________ is immune mediated --> lacrimal gland adenitis or breed predispositionKeratoconjunctivitis siccaTrauma, drugs (such as sulfas), metabolic disease, neuro dysfunction (CN V or VII) can cause ______Keratoconjunctivitis siccaTX = Tear stimulation (life long --> lacrimostimulants) and Tear replacement (lacrimomimetics) and client education --> rechecks of STTLacrimostimulantsCyclosporine and tacrolimus are ____, they are given ID for life with KCS --> only use reputable compounded pharmaciesLacrimostimulantsPilocarpine is a ______, caution with oral dosing --> effects = Salivation, Lacrimation (desired!), Urination, and DefecationLacrimomimeticsOTC --> Optixcare, etc --> imcreased viscosity not wettign drops Use 4-6 times dailyTrueT/F: It is important to clean ocular discharge before applying the lacrimostimulantParotid duct transpositionSurgery to treat KCS --> Saliva is used to lubricate the cornea in place of tears --> will still need some medical treatment post-op>20 secNormal tear breakup time in dogs>17 secNormal tear breakup time in catsNictitating MembraneFunction includes: Production of aqueous tears, Distribution of pre-corneal tear film, and Protection of the ocular surfaceNictitating Membranepain, neuro disease, exo/enopthalmos, tranquillizers, and haws syndrome can cause an abnormally placed __________Prolapsed Gland of the Third Eyelid "Cherry Eye"You have a 6 month old bulldog puppy presenting with an eye problem. You do a Morgan Pocket surgery to fix it. What eye problem does the puppy have?"Scrolled" Third Eyelid CartilageYou have a 1 year old mastiff puppy presenting with an eye problem. You surgically excise the abnormal tissue. What eye problem does the puppy have?Prolapsed Gland of the Third Eyelid "Cherry Eye"usually in puppies, uncommon in catsNictitans NeoplasiaYou have a 12 year old lab mix presenting like. Given the age, what should be on your ddx?EpiphoraOverflow of tears onto eyelids/faceEpiphoraUsually due to overproduction of tears (pain/intraocular disease), can also be due to inadequate drainage (abnormal puncta, functional obstruction- little dog syndrome)EpiphoraDX = Jones test (fluorescein eye --> nostril), Nasolacrimal duct flush, imaging --> find out if dt overproduction or inadequate drainageDacryocystitisYou have a dog presenting with Mucopurulent discharge, epiphora, swelling or draining fistulas in medial canthal region but NO blepharospasm,