Conjunctivitis and KCS

Question 1

Describe the conjunctiva

Answer 1

Delicate membrane lining the eyelids and covering the eyeball

Question 2

Deacribe medical canthal pocket syndrome

Answer 2

occurs in dolichocephalic breeds with naturally deep set eyes
mucus accumulates at medial canthus
no treatment indicated

Question 3

List the clinical signs of acute conjunctivitis

Answer 3

hyperaemia (rednes)
chemosis (oedema)
swelling/ thickening
discharge
mild irritation/ blepharospasm
occasionally pruritis

Question 4

List the clinical signs of chronic conjunctivitis

Answer 4

hyperpigmentation
thickening due to squamous metaplasia of epithelium
follicular hyperplasia

Question 5

List some differentials for a purulent discharge in a eye

Answer 5

Bacterial conjunctivitis
Grass seed FB in conjunctiva
KCS (dry eye)

Question 6

List some differentials for thich/ tenacious discharge in eye

Answer 6

KCS (dry eye )

Question 7

List 2 possible differentials for haemorrhagic discharge in eye

Answer 7

trauma
coagulation problem

Question 8

List 2 possible causes of serous (watery) discharge in eye

Answer 8

Increased lacrimation due to ocular pain
Tear overflow (‘epiphora’) due to reduced nasolacrimal drainage

Question 9

what is the most common cause of canine infectious conjunctivitis

Answer 9

secondary bacterial infection

Question 10

List 4 possible unlying causes for conjunctivitis

Answer 10

FBs
Adnexal disease- (disorders of the eyelids, tear drainage and orbital tissues)
Irritants- e.g. smoke, sand
Allergic e.g. atopic dermatitis

Question 11

what is adnexal disease

Answer 11

disorders of the eyelids, tear drainage and orbital tissues.

Question 12

What is entropion

Answer 12

inversion of the eyelid margin

Question 13

Describe treatment for entropion

Answer 13

Hotz-celsus surgery: removal of elliptical piece of skin

Question 14

what is ectropion

Answer 14

eversion/ outward turning of the eyelid margin

Question 15

List 3 possible aetiologies of canine conjuctivitis

Answer 15

Infectious
non-infectious
secondary to adnexal disease or other ocular disease

Question 16

describe how to treat eyelid masses

Answer 16

wedge resection

Question 17

what is distichiasis

Answer 17

extra eyelashes emerge from the meibomian gland orifices
May cause irritation/conjunctivitis, but can be incidental – don’t always need treating

Question 18

Describe how to treat distichiasis

Answer 18

only treat is causing problem
options= cryotherapy and electrolysis - referral

Question 19

what are ectopic cilia

Answer 19

Arise from follicle inside/near meibomian gland – emerge through conjunctiva at right angles to cornea
always causes irritation +/- corneal ulcer - need treatment

Question 20

describe how to treat ectopic cilia

Answer 20

surgical excision

Question 21

Describe keratoconjunctivitis sicca

Answer 21

dry eye
Local immune-mediated destruction of lacrimal tissue: lacrimal gland and third eyelid (nictitans) gland
common cause of canine conjunctivitis

Question 22

other then immune-mediated list 5 other possible causes of KCS in the dog

Answer 22

congenital
neurogenic
toxic
endocrine disease
iatrogenic

Question 23

List the clinical signs of KCS

Answer 23

• Recurrent conjunctivitis that improves with any topical therapy as anything lubricates eye!
• Tacky mucoid-mucopurulent discharge stuck to ocular surface
• Blepharospasm
  +/- Corneal ulceration

Question 24

List 2 corneal changes that occur with chronic KCS

Answer 24

corneal vascularisation, fibrosis and pigmentation
reduced vision

Question 25

Describe how to diagnose KCS

Answer 25

Schirmer tear test 10-15mm/min = borderline <10mm/min= KCS

Question 26

You are presented with a dog with recurrent conjunctivitis in both eyes. The right eye is shown below. Schirmer tear test readings are 13mm/min in the right eye and 9mm/min in the left eye. What is the most likely diagnosis?

Answer 26

KCS in both eyes

Question 27

Describe how to treat KCS (immune-mediated)

Answer 27

Tear substitutes tear stimulant - cyclosporine broad spec ABs to treat secondary infection

Question 28

what is the most common cause of conjunctivitis in rabbits

Answer 28

Dacryocystitis Underlying cause: overlong molar roots pressing on nasolacrimal duct

Question 29

List 3 ocular conditions with which 'red eye' can be seen

Answer 29

uveitis glaucoma scleritis/ episcleritis don't assume it is just conjunctivitis

Question 30

what is the most common cause of subconjunctival haemorrhage

Answer 30

due to blunt trauma check for intraocular damage other differentials: coagulopathies, systemic hypotension and vasculitis

Question 31

What parts of the ophthalmic examination are most relevant in an animal presenting with conjunctivitis?

Answer 31

Hands off exam Hands on exam Schirmer tear test Fluorescein stain- check for ulcer General clinical exam including the skin

Question 32

Describe how to treat canine conjunctivitis

Answer 32

treat/ remove underlying cause Topical Ab therapy- fusidic acid OR chloramphenicol

Question 33

describe the etiology of feline conjunctivitis

Answer 33

Infectious common non-infectious- less common extension from other ocular disease conjunctival involvement in systemic disease

Question 34

List the 2 most common causes of primary infectious conjunctivitis in cats

Answer 34

Chlamydophila felis (bacterium) Feline herpesvirus-1 (FHV-1) (virus)

Question 35

List the clinical signs of Chlamydophila felis

Answer 35

Unilateral conjunctivitis, becomes bilateral within a few days Chemosis often marked, hyperaemia No corneal signs Absent or mild upper respiratory disease

Question 36

Describe how to diagnose chlamydophila felis

Answer 36

clinical signs +/- conjunctival swab for PCR test

Question 37

Describe how to treat C felis

Answer 37

Systemic treatment indicated as organism affects respiratory tract, GIT and reproductive tract as well as eye Doxycycline antibiotic of choice Treat in-contact animals

Question 38

List the clinical signs of feline herpesvirus in kittens/ young cats

Answer 38

Bilateral conjunctivitis in conjunction with upper respiratory signs (cat flu) +/- corneal ulceration

Question 39

List the clinical signs of feline herpesvirus 1 in adult cats

Answer 39

Unilateral ocular discharge with mild conjunctivitis History of previous upper respiratory infection Wide range of other conditions, e.g. corneal ulceration, sequestrum, entropion, eosinophilic keratitis

Question 40

Describe how to diagnose FHV-1

Answer 40

history and clinical signs conjunctival swab for PCR- interpret carefully

Question 41

Decsribe how to treat FHV-1

Answer 41

Nursing broad spec Abs - topical unless resp involvement then use systemic anti-virals

Question 42

what are the form forms of conjunctiva

Answer 42

palpebral and bulbar

Question 43

where does the conjunctiva attach

Answer 43

at the limbus and eyelid margins

Question 44

describe the sensory innervation to the eye

Answer 44

opthalmic branch of the trigeminal nerve (CN5)

Question 45

how can we tell episcleral congestion

Answer 45

will be larger thicker blood vessels- compared to conjunctival congestion only