Cognition & Senses 2: Conjunctiva

Question 1

= what is the CONJUNCTIVA?

what is the difference between PALPEBRAL and BULBAR CONJUNCTIVA?

Answer 1

= the PINK MUCOUS MEMBRANE that LINES UNDERSIDE of UPPER & LOWER EYELID and the THIRD EYELID

PALPEBRAL conjunctiva = part of conjunctiva FACING THE LID

BULBAR conjunctiva = part of conjunctiva FACING THE GLOBE/EYE

Question 2

what are 2 reasons we can see the eyes looking RED?

Answer 2

1. CONJUNCTIVAL HYPEREMIA
2. EPISCLERAL VESSELS become ENGORGED due to GLAUCOMA

Question 3

CHEMOSIS definition

Answer 3

EDEMA of the CONJUNCTIVA

Question 4

what are the 2 MOST COMMON causes of CONJUNCTIVITIS in CATS? (what is this OVERALL category?)

what about in DOGS? what is the MOST COMMON CAUSE of CONJUNCTIVITIS?

Answer 4

CONJUNCTIVITIS in CATS is usually INFECTIOUS
1. CHLAMYODPHILA FELIS
2. HERPESVIRUS

CONJUNCTIVITIS in DOGS is usually NON-INFECTIOUS = most commonly KCS

Question 5

what is the MUCIN LAYER?

how is this mucin produced?

Answer 5

= the INNER LAYER of the TRILAMINAR TEAR FILM that acts as a MUCIN LAYER to KEEP FILM ADHERED TO CORNEA

mucin is produced by GOBLET CELLS in the CONJUNCTIVA

Question 6

three ways how we DIAGNOSE conjunctivitis?

Answer 6

1. PE findings
2. CYTOLOGY
3. BIOPSY (snipped after TOPICAL ANESTHETIC)

Question 7

can we do a CULTURE to DIAGNOSE CONJUNCTIVITIS? why or why not?

Answer 7

there’s FEW ORGANISMS in the eye that COULD CAUSE IT, so if you DO A CULTURE you’ll FIND ORGANISMS THAT MIGHT NOT BE PATHOLOGIC

Question 8

ID LESION (2)

Answer 8

1. CONJUNCTIVAL HYPEREMIA
2. CHEMOSIS (conjunctival edema)

Question 9

what are 4 common DDxs for FELINE CONJUNCTIVITIS?

Answer 9

1. FHV-1
2. CHLAMYDOPHILA/CHLAMYDIA
3. CALICIVIRUS
4. +/- MYCOPLASMA

Question 10

why can it be hard to DIAGNOSE FHV-1 if we suspect it in a cat with FELINE CONJUNCTIVITIS?

Answer 10

MANY cats are EXPOSED TO FHV-1 at some point in their life, so ON PCR even on the EYE it COULD COME UP FALSELY POSITIVE

Question 11

if a cat comes in with FELINE CONJUNCTIVITIS, which of the COMMON DDxs would we suspect if we also see…

1. CHEMOSIS?
2. CONJUNCTIVAL HYPEREMIA & OCULAR DISCHARGE
3. KERATITIS
4. ORAL ULCERATION & PTYALISM

Answer 11

1. CHEMOSIS = suspect CHLAMYDIA
2. CONJUNCTIVAL HYPEREMIA & OCULAR DISCHARGE = FHV-1
3. KERATITIS = FHV-1
4. ORAL ULCERATION & PTYALISM = CALICIVIRUS

Question 12

MYCOPLASMA & FELINE CONJUNCTIVITIS…

why is this a +/- DDx?

tx?

Answer 12

+/- because MOST CATS HAVE MYCOPLASMA, and UNSURE IF IT’S CAUSING CONJUNCTIVITIS

tx is SAME AS CHLAMYDIA

Question 13

CHLAMYDOPHILA/CHLAMYDIA FELIS…

unilateral vs. bilateral? (hint: give a range)

4 clinical signs? which is a PROMINENT feature for this dz?

this disease is USUALLY ___-____

3 diagnostics?

treatment? (2, one is +/-)

Answer 13

can start as UNILATERAL but usually BILATERAL WITHIN 7-10 DAYS

4 clinical signs?
1. MILD RHINITIS
2. FEVER
3. LYMPHADENOPATHY
4. CHEMOSIS –> prominent

this disease is USUALLY SELF-LIMITING

diagnostics?
1. clinical signs/history of EXPOSURE
2. CYTOLOGY
3. PCR

treatment?
1. TETRACYCLINE (oral doxy is common)
2. +/- TOPICAL ANTIBIOTIC

Question 14

ID LESION & suspected DZ

Answer 14

LESION = CHEMOSIS (edema of CONJUNCTIVA)

DZ = CHLAMYDIA FELIS

Question 15

FELINE VIRAL CONJUNCTIVITIS…

most commonly caused by WHAT?

3 clinical signs?

after a cat is infected, HOW LONG does infection last? (2, hint: one is a range)

Answer 15

most commonly caused by FHV-1

3 clinical signs?
1. CONJUNCTIVAL HYPEREMIA
2. OCULAR DISCHARGE
3. KERATITIS

after a cat is infected…
1. establishes LIFELONG LATENT or CARRIER STATE
2. PRIMARY DZ usually SELF-LIMITING in 1-3 WEEKS

Question 16

3 common causes of CANINE CONJUNCTIVITIS?

what is are 2 UNCOMMON?

Answer 16

common causes?
1. KCS
2. JUVENILE FOLLICULITIS (young dogs have ENLARGED FOLLICLES
3. IMMUNE-MEDIATED

what are 2 UNCOMMON? = VIRAL or BACTERIALLY caused

Question 17

DERMOID definition

painful?

tx? (2 options)

Answer 17

= ABNORMAL TISSUE on the SURFACE OF THE EYE (could be on CONJUNCTIVA or CORNEA)

often NON-PAINFUL

tx? –> only if it BOTHERS ANIMAL, then…
1. CONJUNCTIVECTOMY
2. KERATECTOMY

Question 18

ID LESION

Answer 18

DERMOID

Question 19

ID LESION

Answer 19

CONJUNCTIVAL NEOPLASIA

Question 20

CONJUNCTIVAL NEOPLASIA…

signalment? (1)

if it’s SMALL, tx?

commonality?

Answer 20

signalment = OLDER PATIENTS

if it’s SMALL, can use TOPICAL ANESTHETIC to SNIP IT OFF EYE SURFACE

commonality = RARE

Question 21

THIRD EYELID GLAND PROLAPSE…

“aka?”

= definition?

what 3 breeds are predisposed?

why is SURGICAL tx recommended? (2)

what does it mean if this gland is PIGMENTED?

Answer 21

aka “CHERRY EYE”

= TURNING OUT of the THIRD EYELID GLAND due to LYMPHOID HYPERPLASIA

what 3 breeds?
1. ENGLISH BULLDOG
2. BOSTON TERRIER
3. COCKER SPANIEL

why is SURGICAL tx recommended?
1. it can INTERFERE with ability to CLOSE EYES (LAGOPHTHALMOS)
2. could DECREASE TEAR PRODUCTION and cause KCS

if gland is PIGMENTED, it means that the issue is CHRONIC

Question 22

MORGAN POCKET technique

this is used to treat WHAT?

steps? (3)

at the end, MAKE SURE TO…

the BEGINNING & ENDING KNOT should be on the ___ side of the eye BECAUSE…

Answer 22

used to treat THIRD EYELID GLAND PROLAPSE (cherry eye)

steps?
1. grab LEADING MARGIN of THIRD EYELID & PULL IT OUT, then FOLD IT DOWN
2. make 2 CURVILINEAR INCISIONS
3. close DISTAL SIDES OF INCISIONS to make a POCKET via CONTINUOUS suture

at the end, MAKE SURE TO LEAVE BOTH ENDS A LITTLE OPEN so that WHEN GLAND IS NO LONGER INFLAMED, we DO NOT WANT TO MAKE A CYST & allow for DRAINAGE

the BEGINNING & ENDING KNOT should be on the PALPEBRAL side of the eye BECAUSE we DO NOT WANT TO SCRATCH CORNEA

Question 23

ANCHORING..

used to treat WHAT?

2 steps?

disadvantages? (2)

Answer 23

used to treat THIRD EYELID GLAND PROLAPSE (cherry eye)

steps?
1. ENCIRCLE gland with SUTURE
2. using NONABSORBABLE SUTURE, make INCISION ON FACE and ANCHOR IT TO ORBIT’S PERIOSTEUM or RECTUS MUSCLE

disadvantages?
1. THIRD EYELID CANNOT MOVE
2. can PERFORATE THE GLOBE if ANCHORED TO RECTUS MUSCLE

Question 24

SIGNALMENT for THIRD EYELID PROLAPSE? two things, three examples for second

Answer 24

1. YOUNG DOGS
2. BREEDS = BRACHYCEPHALIC, cocker spaniels/beagles too, GIANT BREED DOGS

Question 25

SCROLLED THIRD EYELID CARTILAGE

= what is it?

what is often present CONCURRENTLY?

treatment? (overall, 3 steps but 2 has 2 options)

Answer 25

= in GIANT BREED DOGS, there’s SO MUCH LAXITY that T-SHAPED CARTILAGE in THIRD EYELID will FLOP OVER

THIRD EYELID PROLAPSE/CHERRY EYE often present CONCURRENTLY

treatment? = SURGERY
1. 2 point fixation of THIRD EYELID, PULL OUT & FOLD OVER
2. make 2 INCISIONS in CONJUNCTIVA to CUT OUT CARTILAGE
2. could also CAUTERIZE IT

Question 26

PLASMOMA..

= definition

treatment? (2 options)

Answer 26

= CONSTELLATION of LYMPHOID FOLLICLES on the INSIDE OF THIRD EYELID

treatment?
1. TOPICAL ANTI-INFLAMMATORY like NEOPOLYDEX
2. or IMMUNOSUPPRESSIVE tx

Question 27

ID DZ

Answer 27

PLASMOMA

Question 28

THIRD EYELID NEOPLASIA…

commonality?

prognosis?

2 most common in DOGS?

3 most common in CATS?

why can this be hard to diagnose?

Answer 28

commonality = RARE

prognosis = POOR to GRAVE

DOGS?
1. HSA
2. ADENOCARCINOMA (glandular tumor)

CATS?
1. SCC
2. FIBROSARCOMA
3. LYMPHOSARCOMA

hard to diagnose because THIRD EYELID USUALLY HIDDEN, so BY THE TIME IT’S BIG ENOUGH FOR US TO SEE then IT’S LIKELY ADVANCED DZ

Question 29

ID LESION

Answer 29

THIRD EYELID NEOPLASIA

Question 30

the THIRD EYELID LACRIMAL GLAND produces WHAT % of ___ tears?

so, if we needed to remove it then…

Answer 30

produces 20-30% OF AQUEOUS TEARS

so, if we needed to remove it, then HIGH RISK OF KCS

Question 31

how do we VISUALIZE the THIRD EYELID during an exam?

Answer 31

put TOPICAL ANESTHETIC ON THE EYE & RETROPULSE THE GLOBE DIRECTLY to bring it up