Feline Ophthalmology!

Transcription

1 The Vet Education International Online Veterinary Conference 2013 Feline Ophthalmology! With Dr Anu O Reilly Specialist in Veterinary Ophthalmology July2013 Vet Education is proudly supported by Hill s Pet Nutrition (Australia) and Merial Animal Health

2 Feline Ophthalmology Dr Anu O Reilly 7/25/2013 Animal Eye Care 1

3 Feline Ophthalmology Eyelid disease Conjunctivitis Viral keratitis Corneal sequestrum Eosinophilic keratitis Uveitis Iris melanoma Lens luxation Cataracts Glaucoma Hypertension Retinal disease 7/25/2013 Animal Eye Care 2

4 Eyelid disease Congenital anklyoblepharon the upper eyelid missing Entropion more common than 5 years ago Squamous cell carcinoma more common Symblepharon often FHV-1 infection as kittens FHV-1, Dermatophytosis, Sporotrichosis 7/25/2013 Animal Eye Care 3

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11 Apocrine hidrocystoma Persians and Himalayans Surgical excision and laser the base Cryotherapy Can be extensive in the ear Mainly older cats No sex prediliction 7/25/2013 Animal Eye Care 10

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13 Conjunctivitis Unilateral or bilateral Infectious causes are more common than allergic causes Feline Herpes Virus usually in kitttens - Milder form in adults as a recurrence Chlamydia Chlamydophilli psitticai Mycoplasma not very common Allergy Eosinophillic conjunctivitis 7/25/2013 Animal Eye Care 12

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17 Chlamydial psittici Doxycline at 5mg/kg BID for 6-8 weeks or 10 mg/kg SID for 4 weeks minimum Treat all the cats in the household If the cat goes out a lot need to warn the owner of the recurrences Azothromycin (Zithromax) 5mg/kg given orally every 5 to 7 days for 3 to 4 treatments or 20mg/kg as a once off dose unproven efficacy but may be useful in cattery situations 7/25/2013 Animal Eye Care 16

18 FHV-1 7/25/2013 Animal Eye Care 17

19 FHV-1 Conjunctivitis Keratitis Scarring of the nasolacrimal ducts Facial dermatitis Uveitis Inflamed and ulcerated areas near the nares 7/25/2013 Animal Eye Care 18

20 FHV-1 in kittens Kittens Severe bilateral conjunctivitis with marked chemosis and hyperaemia Blocked nasolacrimal ducts that can permanently scar Symblepharon formation Corneal ulceration 7/25/2013 Animal Eye Care 19

21 FHV-1 in kittens Supportive treatment Lysine powder safe in kittens 1/8 of a teaspoon twice daily = 250 mg BID Bathing the eyes with warm compresses Famiclovir 125 mg ¼ of a tablet twice daily for a short period 10 days (3-4 week old kittens) 7/25/2013 Animal Eye Care 20

22 FHV-1 Surgical treatment of flushing the ducts can be frustrating and if too aggressively done can lead the duct rupture Surgical resection of the symblepharon is unrewarding as the conjunctiva can reattach very quickly post surgery 7/25/2013 Animal Eye Care 21

23 Thanks to veterinary vision Animal Eye Specialist 7/25/2013 Animal Eye Care 22

24 FVH-1 Adults usually get a keratitis Early dendritic ulceration Geographical ulceration Superficial ulceration Indolent in appearance Vascularisation is variable Painful 7/25/2013 Animal Eye Care 23

25 FHV-1 7/25/2013 Animal Eye Care 24

26 FHV-1 7/25/2013 Animal Eye Care 25

27 FHV-1 - treatment Original dose 90mg/kg q 8 hours Maggs Famiclovir large cats ½ a 250mg once to twice daily Famiclovir small cats 1/2 of a 125mg once daily (3.5-5 kgs Malik ) Transdermal formulations can made Famiclovir Kittens (25-50 mg/kg q 8-12 hours Malik ) 7/25/2013 Animal Eye Care 26

28 FHV-1 treatment Cidofovir eye drops Compounded 5 mls $200 Very effective 7/25/2013 Animal Eye Care 27

29 FHV-1 - treatment Idoxuridine hourly for the first 24 hours and the 6-8 x daily compounded by Richard Stenlake in Sydney Zovirax ophthalmic ointment 6 times daily Interferon injections painful but seem to have a better response - twice weekly subcutaneously 7/25/2013 Animal Eye Care 28

30 FHV-1 - treatment Lysine 250 mg twice daily Mushai powder 1/8 th of a teaspoon twice daily Doxycyline 5mg/kg once daily 7/25/2013 Animal Eye Care 29

31 Geographical ulcers 7/25/2013 Animal Eye Care 30

32 Polish Journal of Vet Ophthal Animal Eye Care 31

33 Complications of FHV-1 Eosinophilic keratitis Corneal sequestrum Dry Eye 7/25/2013 Animal Eye Care 32

34 Corneal sequestrum Light tan to black lesion on the cornea Vascularisation may be present Degree of pain is variable No specific age Breed specific oriental breeds 7/25/2013 Animal Eye Care 33

35 Picture of sequestum 7/25/2013 Animal Eye Care 34

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41 Corneal sequestrum treatment Very early light tan lesions use topical interferon. Dark to black lesions need surgery. Keratectomy + third eyelid flap Keratectomy + pedicle flap Clear corneal-conjunctival sliding graft Doxycycline 5mg/kg SID 7/25/2013 Animal Eye Care 40

42 Eosinophilic keratitis White cottage cheese plaques on the cornea Variable degree of vascularisation Cytology is very rewarding Numerous eosinophils Mast cells are also present 7/25/2013 Animal Eye Care 41

43 Eosinophilic keratitis 7/25/2013 Animal Eye Care 42

44 Eosinophilc keratitis treatment Best resolution is with megoestrol acetate Must warn the owners of the side effects 2.5 mg once daily for most cats for 4 days then 2.5 mg every second day for 4 doses then stop Prednefrin forte recommended treatment Oral cortisone? Interferon orally/topically Cyclosporin eye drops 1-2 % 7/25/2013 Animal Eye Care 43

45 Bullous lesions Etiology unknown Young adult cats years Immune-mediated endothelitis? No inflammatory cells Link with immune- mediated anaemia? And high dose steroids? Third eyelid flap acts as an barrier 7/25/2013 Animal Eye Care 44

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48 Uveitis The uvea is the vascular tunic of the eye Between the fibrous layer and the neurosensory layer Anterior uveitis = iris and ciliary body Posterior uveitis = choroid Posterior uveitis usually gives us changes in the retina as this lies on top of the choroid 7/25/2013 Animal Eye Care 47

49 Uveitis Young animals environmental antigenic stimulation FIP, FeLV, FIV, Toxoplasmosis, Cryptoccoccus, Histoplasmosis, Bartenllosis, Onchocerca E-cunniculi can lead to cataracts Rare Aspergillous, Candidiasis Neoplastic metastatic uveal Adenocarcinoma Neoplastic Uveal based iris melanoma, oculars sarcoma and ciliary body adenoma, adenocarcinoma Lymphoma 7/25/2013 Animal Eye Care 48

50 Diagnosis? Even with a complete diagnostic workup 70 % of cases have an undetermined cause. Exogenous vs endogenous Acute vs Chronic Unilateral vs Bilateral Not ONE sign is pathogonomic Anterior chamber paracentesis Serologic testing PCR Goldmann-Witmer Coefficient 7/25/2013 Animal Eye Care 49

51 Diagnosis CBC, Serum biochemistry, urinalysis, FeLV and FIV Imaging (eye, thorax, abdomen + additional serology +/- extra ocular aspirates Ocular aspirates aqueocentesis, subretinal aspirates and vitreocentesis 7/25/2013 Animal Eye Care 50

52 Complications Darkening of the iris Rubeosis irides Anterior or posterior synechiae Changes to the iris shape Cataracts Lens luxation Glaucoma Retinal atrophy/degeneration 7/25/2013 Animal Eye Care 51

53 Aqueous flare can settle out hypopyon 7/25/2013 Animal Eye Care 52

54 Complications Darkening of the iris Anterior or posterior synechiae Hyphaema Abnormal iris shape Glaucoma Lens luxation Retinal 7/25/2013 Animal Eye Care 53

55 Causes of hyperlipidaemia Diabetes High fat diet Burmese cats 7/25/2013 Animal Eye Care 54

56 Iris Pigmentation 7/25/2013 Animal Eye Care 55

57 Iris pigmentation Cats can have pigmented spots on the iris They may never change Monitor these every 3-6 months If they change and the lesion is focal consider lasering 7/25/2013 Animal Eye Care 56

58 Iris melanosis Cats can also get increased pigmentation over time When does it become neoplastic? Intraocular pressure Changes to pupillary margin or the iris topography posterior surface affected Scleral invasion Examine the drainage angle 7/25/2013 Animal Eye Care 57

59 Iris melanoma Eye removal and hope the lesion has not spread Tumour hunt should always be offered Pathology sent to a person confident in reading it. (Dr Christina McCowan ASAP) 7/25/2013 Animal Eye Care 58

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63 Glaucoma Primary Siamese, Burmese and Persian Secondary % Chronic uveitis 10% Lens luxation Tumous anterior uveal melanoma>lymphoma Aqueous mis-direction syndrome Congenital 7/25/2013 Animal Eye Care 62

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66 Corneal oedema is reduced Perilimbal hyperaemia is reduced Pain is not as evident as it is in cats Optic disc changes are harder to see 7/25/2013 Animal Eye Care 65

67 Cats tolerate glaucoma much better because it comes on more slowly IOP is higher at night (diurnal variation) Older cats have lower IOP Cats in oestrus will have IOP 7/25/2013 Animal Eye Care 66

68 Glaucoma medications Topical dorzolamide (Trusopt) BID-TID Xalatan not effective or NOT?? One study of 9 cats showed no changes to IOP Continued use of xalatan >>> Inc IOP Topical Steroids >>>Inc IOP 7/25/2013 Animal Eye Care 67

69 Lens luxation 7/25/2013 Animal Eye Care 68

70 Lens Luxation Commonly follows a chronic history of uveitis Advise surgery to remove the lens Not the same emergency type presentation as in dogs Cats can be managed medically 7/25/2013 Animal Eye Care 69

71 Lens luxation Control the uveitis topical and systemic steroids Use topical NSAIDS and systemic NSAIDS Control the glaucoma with topical dorzolamide 7/25/2013 Animal Eye Care 70

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76 Hypertension Older cats Kidney disease Hyperthyroidism connected to kidney disesase Blood pressure greater than 170 mm Hg using a Doppler on the tail Question the reliability of the automatic blood pressure monitors in smaller patients 7/25/2013 Animal Eye Care 75

77 Old cat suddenly blind 7/25/2013 Animal Eye Care 76

78 Retinal Haemorrhages 7/25/2013 Animal Eye Care 77

79 Bullous detachment 7/25/2013 Animal Eye Care 78

80 Hypertension Sudden onset of blindness one or both eyes Haemorrhage in the anterior chamber Haemorrhage in the vitreous Retinal detachment 7/25/2013 Animal Eye Care 79

81 Hypertension - treatment Amlodapine 5mg Give 1/4 of a tablet once daily This can be increased to ½ a tablet once daily Can also add other anti-hypertensive medications enalpril Luetin 12 mg once daily Dr Carmen Colitz 7/25/2013 Animal Eye Care 80

82 Hypertension Even cases where the retinal detachment has been present for some days may get some vision back. Do a general health profile 7/25/2013 Animal Eye Care 81

83 Animal Eye Care Dr Anu O Reilly Tel: (03) Fax: (03) /25/2013 Animal Eye Care 82