Lecture 1

Question 1

12 yo FS black lab, mass OD for 3 months, squinting and rubbing at it. All eye tests are normal. What is the most likely diagnosis? What treatment options are available?

Answer 1

meibomian gland adenoma (eyelid neoplasia)

95% are benign masses

option 1: monitor as long as there is no corneal irritation
option 2: surgical removal under GA, using wedge resection technique, 100% effective at preventing recurrance.
option 3: resection and cyrotherapy: local anesthetic, triple freeze thaw cycle, usually for OLDER patients or high risk GA patients, 80-90% effective at preventing reoccurance

Question 2

what is this procedure?

Answer 2

cyrotherapy for a meibomian gland adenoma. use follow up cauterization to minimize bleeding

Question 3

what is this and what are the common 2 clinical presentations?

Answer 3

melanocytoma, second most common eyelid skin neoplasm in the dog, usually slow growing

1: individual pedunculated heavily pigmented tumors
2: multiple pigmented tumors extending along eyelid margin

Question 4

what is this and what is the appropriate treatment?

Answer 4

**make sure to take photos to monitor growth

1: surgical removal is curative: may have to do extensive blepharoplasty if lots of the eyelid is involved
2: cryotherapy

Question 5

what is this likely? how would you treat this?

Answer 5

histiocytoma: common benign cutaneous neoplasm in young dogs

these will regress spontaneously

Question 6

you can remove a maximum of ______ of the eyelid margin in most dogs without requiring blepharoplastic procedures to recreate additional eyelid length

Answer 6

25%

Question 7

wot dis? what is the most appropriate treatment?

Answer 7

squamous cell carcinoma

1: cryotherapy
2: surgical removal (not very successful)

Question 8

the most common eyelid mass in cats is

Answer 8

squamous cell carcinoma

Question 9

does eye SCC in cats metastasize?

Answer 9

not usually, there are just locally invasive and erosive

Question 10

what is this and what is the recommended treatment?

Answer 10

SCC

cryotherapy

or surgery (not successful)

Question 11

what is this and what is the recommended treatment?

Answer 11

eyelid mass + chalazion (blocked meibomian gland)

the chalazion is the bigger swelling covered in hair, the eyelid mass is the little nubbin

treatment: leave it alone if it’s not causing any problem, or lance through conjunctival surface and curettage

Question 12

what is blepharitis?

Answer 12

inflammation of the eyelid

Question 13

what is a chalazion?

Answer 13

a chronic lipid granuloma due to blockage of the meibomian gland, usually presents as a firm non painful swelling

Question 14

what is this?

Answer 14

focal blepharitis

Question 15

what is a Hordoleum? how do you treat?

Answer 15

infection of the meibomian gland(s) creating a mass which can be painful

treatment: lance, warm compress, maybe consider anti-inflammatories and antibiotics

Question 16

what is this

Answer 16

diffuse blephariti

diffuse hyperemia and thickening, ulcerative upper and lower eyelids

Question 17

what are some causes of diffuse blepharitis ?

Answer 17

bacterial: juvenile cellulitis or pyoderma, most common in puppies, marked enlargement of draining facial LNs and ducts, pathogenesis not known (maybe a bacterial hypersensitivity)

parasitic: demodex or sarcoptes

autoimmune: SLE, pemphigus, etc

Question 18

how to treat diffuse blepharitis of bacterial origin?

Answer 18

systemic pred with systemic antibiotics like cephalosporin (you need pred, just the antibiotics doesn’t do enough)

Question 19

what is this and what is the appropriate treatment?

Answer 19

eyelid agenesis

lack of normal lateral 3/4 of upper eyelid margin with corneal blood vessels

usually upper eyelid is affected

treatment: ocular lubricants, cryoepilation to destroy hair follicles so hair does not irritate the cornea, create a new eyelid margin via surgery to protect the cornea

**do NOT do entropion surgery (hotz celus)

Question 20

what are some sequale of eyelid agenesis?

Answer 20

trichiasis, exposure, KCS, severe keratitis and vascularization and ulceration

some don’t have any clinical signs

Question 21

what is the problem here? treatment?

Answer 21

entropion–>see hairs touching the cornea and an associated corneal ulcer from irritation

Hotz celus procedure surgery

Question 22

if entropion is severe enough, it can lead to…

Answer 22

pigmentation, scarring, corneal vasculaization

Question 23

what are the 3 types of entropion and what are treatment options for each?

Answer 23

1)primary/developmental
- most common, often breed predisposition like bulldogs, great danes, etc
-treatment: temporary tacking in puppies and recheck in 2 weeks, modified hotz-celus surgery in adults

2) spastic
- secondary to ocular pain and the dog retracts the globe and the eyelids roll in ex: a corneal ulcer
- treat the underlying problem

3) cicatricial
- secondary to scar formation from trauma or chronic spastic
- very uncommon
-treatment: advancedreleasing techniques

Question 24

what is this?

Answer 24

distichiasis: hairs coming from the eyelid margin/meibomian gland orifice

usually bilateral, doesn’t always cause problems

with stifer/coarse hair it will irritate the cornea

Question 25

an owner brings Stuffy, a french bulldog to you and asks shes heard about the term trichiasis. what are you going to tell the owner?

Answer 25

trichiasis: normal hair in a normal follicle that rubs on the eye rarely a problem, usually seen in brachy's like Stuffy do don't worry unless he seems bothered by his eyes

Question 26

what is the treatment of choice for distichiasis?

Answer 26

cryoepilation

Question 27

what is this and how should you treat this?

Answer 27

ectopic cilla (where the cilia emerges from palpebral conjunctiva) can be associated with corneal ulceration tx: surgical removal (en bloc)

Question 28

what is this and what causes it?

Answer 28

prolapsed gland of the nictitans membrane weak connective tissue

Question 29

a dog comes to you with cherry eye and the owner wants to know why they should treat her. You explain why and you also explain treatment which is....

Answer 29

the gland of the NM produces lots of tears, and a chronically prolapsed gland will become inflammaed and tear production will decrease, leading to a whole other list of problems like infections and ulcers, etc. treatment: morgan pocket technique surgery

Question 30

what is this?

Answer 30

scrolled cartilage: vertical aspect of the T cartilage is bent 180 degrees rostrally, common in giant breeds dogs, mostly a cosmetic issue, but the abnormal cartilage can be removed and cauterized.

Question 31

8yo english bulldog with 1 month OU hx of discharge. what do you see? most likely dx?

Answer 31

dry cornea, hyperemic conjunctiva, blood vessels in the cornea, corneal cloudiness, thick mucopurlent discharge KCS

Question 32

what causes KCS and how do you diagnose it?

Answer 32

due to lack of aqueous portion of the tear film use schirmer tear test: normal is more than 15mm/min, and with KCS it will be less than 10 mm/min

Question 33

clinical signs of KCS include

Answer 33

blepharospasm (squinting), conjunctivities (hyperemic), mucopurulent discharge, keratitis with ulcers and pigmentation sometimes

Question 34

what is this?

Answer 34

corneal ulcer (descmetocele), corneal vessels, thick discharge this is KCS

Question 35

what are the 3 layers to the tear film?

Answer 35

mucin layer produced by conjunctival goblet cells, acts as a surfactant to help spread aqueous tear film on the corneal epithelial cells aqueous layer produced by the lacrimal gland and gland of the nictitans membrane, and makes up the majority of the tear film lipid layer produced by the meibomian gland and is the outer layer to decrease evaporation of the aqueous layer

Question 36

an owner with a frenchie you just diagnosed with KCS is confused as to what has caused this. you say...

Answer 36

remember:ice cream really satisfies life's temptations Idiopathic/autoimmune Congenital Removal of gland of 3rd eyelid Sulfa antibioics Loss of parasympathetic input Trigeminal nerve paralysis most commonly it is idiopathic autoimmune lacrimal adenitis, which means the immune system attacks the lacrimal glands that produce the tears it can also be congenital in small breed dogs, often associated with micro-ophthalmia it can also be caused by removing the gland of the nictitans membrane infectious cause: distemper toxic drugs like sulfa antimicrobials neurologic: lack of parasympathetic input trigeminal nerve paralysis, lack of corneal sensation

Question 37

true or false: KCS in cats is usually an autoimmune disorder

Answer 37

false, it is due to chronic blepharoconjunctivitis (like from FHV-1), and if you treat the underlying disease the tear production will return to normal autoimmune is NOT a thing in cats

Question 38

how do you treat KCS?

Answer 38

cyclosporin A: suppresses immune system( optimmune ointment) use these 2x daily Artificial tears-->help replace tears until cyclosporin starts to work topical antibiotic if nasty discharge topical steroids (but dont use if an ulcer present)

Question 39

how do you know if KCS treatment is working?

Answer 39

75% of dogs will respond to cyclosporin with an increased STT, and some that do not have an increased STT will still improve clinically

Question 40

if a dog isn't responding to cyclosporin for KCS, what other drug can you try?

Answer 40

Tacrolimus, more potent than cyclosporin, must be compounded

Question 41

when would you use pilocarpine?

Answer 41

for KCS if there is xeromycteria cases (dry nose), this drug is a parasympthomimetic, can use oral and topical together

Question 42

parotid duct transportation is a treatment option for...

Answer 42

KCS, this is a last resort treatment and can have long term complications