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VMCVM SAM 3 > Intraocular Non-inflammatory and Inflammatory Diseases > Flashcards

Intraocular Non-inflammatory and Inflammatory Diseases Flashcards

1
Q

What are the two important acquired non-inflammatory diseases of the ANTERIOR SEGMENT?

A
  1. hyphema

2. neoplasia

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2
Q

Causes of hyphema

A
  1. uveitis (RMSF, ehrlichia, neoplasia, etc.)
  2. trauma (blunt or sharp, rapid decompression)
  3. neoplasia (primary or systemic)
  4. hypertension
  5. coag factor abnormalities (warfarin, vWF Dz)
  6. Platelet disorders (IMTP, LSA, BM suppression, NSAIDs)
  7. hyperviscosity syndromes (multiple myeloma, FIP)
  8. congenital/genetic defects (collie eye, uveal cyst/pigmentary uveitis in Goldens, color dilute Aussies and Mini Dachsunds)
  9. Chronic glaucoma and retinal detachments
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3
Q

DX Hyphema

A
  1. Get a thorough history probing for toxins, inside-outside, tick exposure, signs of systemic illness, petechia and hemorrhage, drugs like NSAIDs
  2. PE looking for lymphadenopathy, spleno- or hepatomegaly, jaundice, petechia or echymosis
  3. look at the bad AND good eye - do thorough ocular exam
  4. CBC/Chem/UA, Coag profile (PT/PTT/ACT)
  5. Check Blood Pressure
  6. Titers for infectious causes (Bartonella, FIP, FeLV, for cats; ehrlichia, RMSF, brucella, lepto for dogs
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4
Q

TX of anterior segment disease

A
  1. you guessed it, treat underlying disease
  2. symptomatic so.. Reduce underlying inflammation (steroids or NSAIDs topical
  3. Cycloplegic agents - reduce painful spasm
  4. reduce/stop additional hemorrhage (epinephrine/phenylephrine)
  5. tissue plasminogen factor to break up clots
  6. anti-glaucoma therapy if indicated (miotics worsen uveitis, use CAIs or Beta blockers)
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5
Q

Prognosis of anterior segment disease

A

depends on underlying:
vitreal hemorrhage takes a while to resolve
retinal detachment is poor prognosis for vision and eye
glaucoma is poorer prognosis for vision

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6
Q

Canine anterior uveal melanoma

A

Large, Dark Dogs: Germans, Labs, Goldens, can be in little dogs

enlarging darkening mass; ACUTE hyphema, and/or ACUTE glaucoma.

TX: Laser or excise, if can’t can wait till gets big then enucleate

PX: good, metastasis rate is low

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7
Q

ciliary body adenoma/adenocarcinoma

A

Goldens over represented

PINK mass behind the iris, gluacoma, hyphema

TX: Enucleation best. Simple excision is low yield.

PX: good, also metastasis rate is low

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8
Q

Metastatic neoplasia

A

anterior uveitis, hyphema, hypyon, glaucoma, acute blindness, retinal detachments (Rottweilers)

TX: Chemo and symptomatic tx of uveitis

PX: POOR –> 90% of systemic neoplasia is Stage V LSA once it’s reached the eye

other neoplasia: SCC, osteosarcoma, hemangiosarc, adenocarcinomas with POOR PX’s each of them

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9
Q

Diffuse iris melanoma

A

Feline disease

progressive darkening of the iris, “blochty”, ultimately glaucoma

TX: none. Should enucleate because of potential to metastasize.

PX: watch the eye. CAN metastasize but VERY slow to do so. PIGMENT in filtration angle, PIGMENT migrating through the SCLERA and cats with glaucoma, are more likely to MET.

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10
Q

Feline metastatic neoplasia

A

LSA is not a death sentence for cats as it is for dogs

will see swollen iris, detached retina, hyphema,

TX: enucleation if primary, tx for systemic LSA

others: SCC rare in cats in eye, nasal/sinus adenocarcinoma reported

** Undifferentiated sarcoma ** – cats with puncture wound and phthisis bulbi get tumor of lens epithelial cell origin

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11
Q

Exogenous causes of uveitis

A

surface ocular disease (corneal ulcers and abscesses) - not as much of an issue in cats as in dogs

systemic dz w. release of inflammatory mediators that hematogenously spread to the eye (pyometra, abscesses, discospondylitis, bad teeth, etc.)

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12
Q

Infectious (8) and non-infectious (1) causes of uveitis in canine

A

if it is bilateral think SYSTEMIC, if not bilateral it could still be systemic but likely other

  1. Brucellosis
  2. Lepto
  3. Lyme
  4. Toxo
  5. Ehrlichiosis
  6. RMSF
  7. Systemic mycosis
  8. infectious canine hepatitis (distemper)
  9. Lymphosarcoma - hyphema, chorioretinitis, anterior uveitis, hypoyon
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13
Q

In the western united states, what is the majority of caine uveitis caused by?

A

immune mediated disease

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14
Q

In the eastern united sates, what is the majority of canine uveitis caused by?

A

infectious diseases

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15
Q

define uveitis

A

inflammation of the iris, ciliary body, and/or the choroid

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16
Q

CAT diseases that cause uveitis

A
  1. FeLV associated - all cases of feline uveitis should be FeLV screened
  2. FIV associated - “par planitis” – inflammatory precip. on posterior lens capsule, anterior vitreal debris, and “snow banking” along the pars plana near the ciliary body
  3. FIP - bilateral anterior uveitis (young cats especially), retinal detachments, hemorrhaging and exudates can be seen, dramatic Keratic Precipitates and RUBIOSIS IRIDES can be seen in kittens
  4. toxoplasmosis - uni- or bilateral, anterior segment (Flare, rubiosis and KP just like FIP but FIP isn’t unilateral) or posterior segment (multifocal areas of inactive chorioretinitis potentially potentially surrounded by active inflammation
  5. FHV-1 - rare to be a cause of anterior uveitis
  6. systemic mycosis - rare in gets, cryptococcosis if anything
  7. bartonellosis - more prevalent than used to think. treat with doxycycline and pradofloxacin
17
Q

DDX for endogenous uveitis

A
  1. lens induced in dog (phacolytic old dog cataracts or phacoanaphalycatic from lens capsular rupture)
  2. uveodermatologic syndrome (V-K-H Syndrome)
  3. immune-mediated chorioretinitis/serous retinal detachment in LARGE dogs
18
Q

uveodermatologic syndrome (V-K-H Syndrome)

A

BILATERAL autoimmune disorder against the pigmented cells of neuroectodermal origin. Can see anterior uveitis, retinal detachments, hair depigmentation, skin depigmentation periocular and facial dermatitis

AKITAS are the poster children for this disease

19
Q

lens induced in dog

A

phacolytic old dog cataracts or phacoanaphalycatic from lens capsular rupture

20
Q

immune-mediated chorioretinitis/serous retinal detachment in LARGE dogs

A

LARGE DOGS - Labs, Goldens, Germans; BILATERAL serous retinal detachment; respond well to steroids, even regain vision when retina “lays back down”

21
Q

Idiopathic uveitis in dog and cat

A

many cases of acute AND chronic cases of uveitis go undiagnosed

old cats with chronic uveitis, cataracts, luxated lenses, glaucoma (toxoplasmosis, FIV? FeLV? Bartonellosis? FeHV-1?)

22
Q

Diagnostic workup of anterior segment disease

A
  1. thorough exam (US if can’t visualize the retina)
  2. good History (regional travel- fungus, lyme disease; indoor/outdoor; other pets sick?; any signs of systemic illness; where it come from? stray? shelter?
  3. PE auscult and palpate
  4. MDB (CBC/Chem/UA
  5. abdominal US if abnormal palpation
  6. Thoracic - fungal pneumonia or lymphadenopathy
  7. titers if signs and hx fit
23
Q

TX of anterior segment disorders

A
  1. start with systemic DOXYCYCLINE; anti-fungals if indicated
  2. supportive… so topical steroids, topical atropine, topical NSAIDs (if cornea ulcerated since can’t use steroids), systemic NSAIDs (dog not cat), systemic steroids or immunosuppressives (anti-inflam or anti-immune if indicated)
24
Q

Long-term PX of the eye for anterior segment disorders

A
  1. cataract formation/lens luxation (common in cat with chronic disease)
  2. glaucoma - common with posterior synechia and iris bombe also with chronic disease and pre-iridal fibrovascular formation
  3. phthisis bulbi - due to chronic hypOtension and retinal detachments
  4. retinal detachment/degeneration - serous or exudative detachments
25
Q

Canine Posterior segment inflammatory diseases

A
  1. distemper
  2. septicemias
  3. brucellosis
  4. systemic mycosis
  5. protothecosis
  6. toxoplasmosis
  7. uveodermatologic syndrome (V-K-H Syndrome)
  8. autoimmune chorioretinitis
  9. systemic hypertension
26
Q

Canine Posterior segment DISTEMPER looks like

A

acute, multifocal chorioretinitis, optic neuritis

chronic – chorioretinal scars, “gold medallions”

27
Q

Canine Posterior segment septicemias looks like

A

may see chorioretinitis, detached retinas, etc. Seen with blastomycosis, cryptococcosis, histoplasmosis, coccidiodomycosis, and bacterial septicemias

28
Q

Canine Posterior segment brucellosis looks like

A

chorioretinitis, detachments, endophthalmitis

29
Q

Canine Posterior segment systemic mycoses look like

A

blasto (subretinal exudate/detachment with little or no anterior chamber dz; Anterior Uveitis lose eye, whereas chorioretinitis retain eye w/ tx

crypto (chorioretinitis w/ no anterior segment dz. also possibly optic neuritis)

coccidioido - severe ocular disease w/ loss of eye due to glaucoma

histo - mostly chorioretinitis, occasionally anterior uveitis

30
Q

Canine Posterior segment protothecosis looks like

A

in LA, TX, OK, TN – pretty bad bug

endophthalmitis, subretinal exudates, and retinal detachments like blasto.

Bloody diarrhea and weight loss!!

31
Q

Canine Posterior segment toxoplasmosis looks like

A

multifocal areas of inactive/active chorioretinitis

  • not common in dogs
32
Q

Canine Posterior segment U-K-H Syndrome looks like

A

acute blindness and retinal detachment; pigment will blanch out in tapetum and on face

  • blepharospastic due to the pain is what people see

AKITAS

33
Q

Canine Posterior segment autoimmune chorioretinitis and detachment looks like

A

LARGE DOGS — BILATERAL Serous retinal detachment and acute blindness

34
Q

Canine Posterior segment systemic hypertension looks like

A

first look may look like chorioretinitis with retinal hemorrhages and detachments

35
Q

DDX Feline posterior segment disease

A
  1. toxoplasmosis - classic FUNDIC lesions, multifocal chorioretinitis foci or focal chorioretinal scars, optic neuritis
  2. FIV - pars planatis
  3. FIP - chorioretinitis, retinal vasculitis, detachments
  4. systemic mycosis (crypto, histo, blasto, coccidioido)
  5. Bartonellosis

VMCVM SAM 3 (7 decks)

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