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SX, OPHTH, DENT > Ocular Neoplasia > Flashcards

Ocular Neoplasia Flashcards

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1
Q

Secondary neoplasia can occur in the eye due to metastasis. This is relatively rare except for what cancer type

A

Lymphoma

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2
Q

Where can ocular neoplasia develop

A

1) Orbital Neoplasia
2) Eyelid Neoplasia
3) Third eyelid and eyelid margin neoplasia
4) Corneal Neoplasia
5) AnteriorUveal Neoplasia
6) Choroidal Neoplasia

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3
Q

What do you need to differentiate orbial neoplasia from

A

orbital abscess

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4
Q

What are the clinical signs of orbital neoplasia

A

1) Exophthalmos (decreased retropulsion) - eye is bulging out
2) Third eyelid elevation
3) Generally non-painful
4) Generally chronic rather than acute
5) Generally older patients
+/- strabismus (eye misaligned to one side)
+/- lagophthalmos (eyelid cant close completely over cornea)

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5
Q

a condition where the eyeball protrudes abnormally from its socket.

globe is in front of the eyelids

A

Proptosis

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6
Q

where the eyelid cant close completely over the cornea

A

Lagophthalmos

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7
Q

Prognosis of orbital neoplasia depends on

A

neoplasia type and tissue involvement

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8
Q

What are your primary differentials for an animal with exophthalmos + third eyelid elevation

A

1) Cellulitis - painful, generally young, acute
2) Abscess - painful +/- fever, acute
3) Salivary gland sialocele
4) Neoplasia

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9
Q

Glaucoma makes your eye _____ while orbital neoplasia makes it ________

A

Glaucoma: Buphthalmic
Orbital Neoplasia: Exophthalmic

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10
Q

How can you differentiate orbital / retrobulbar tumors from abscesses

A

abscesses are really painful (especially when opening the mouth as ramus pushes on it)

neoplasia is generally not until the patient gets to a late stage (also older patients and slower progression)

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11
Q

How do you differentiate orbital neoplasia from

1) Cellulitis - painful, generally young, acute
2) Abscess - painful +/- fever, acute
3) Salivary gland sialocele

A

1) Ocular ultrasound
2) CT/MRI (best diagnostic- tells where and what it is)
3) +/- FNA
4) +/- Biopsy
5) +/- culture

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12
Q

What are the type of orbital neoplasias

A

1) Adenocarcinoma (various glandular sources)
2) Fibroma / Fibrosarcoma
3) Osteosarcoma
4) Meningioma
5) Lymphosarcoma
6) Nasal carcinoma (esp cats)

need a biopsy +/- FNA

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13
Q

How do you treat orbital neoplasia

A

Depends on the type of neoplasia and extent of involvement
-Exenteration indicated depending on size of mass
-Orbitotomy (eye sparing procedures) in some

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14
Q

eye removal as well as the tissue around the eye

A

Exenteration

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15
Q

removal of a mass in the orbital / retrobulbar area without removing the eye

A

Orbitotomy

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16
Q

What are common eyelid neoplasias in dogs

A

1) Meibomian gland adenoma (very common)
2) Fibropapilloma
3) Melanoma
4) Squamous Cell Carcinoma (rare in dogs)

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17
Q

T/F: it is rare for dogs to get a malignant eyelid tumor

A

True- even mast cell tumors on the eyelid can be removed with dirty margins and still be curative

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18
Q

Squamous cell carcinoma of the eyelid typically affects what species

A

Feline
Bovine
Equine

these are malignant

Rare in dogs

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19
Q

Most common primary eyelid tumor in dogs

A

Meibomian gland adenoma

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20
Q

What is the appearance of meubomian gland adenomas in dogs

A

papilloma like projection from / near meibomian glands
friable/ multilobulated

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21
Q

T/F: meibomian gland adenomas are almost always benign

A

True - can be locally invasive and will efface eyelid margin if left to grow

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22
Q

What might be a negative effect of meibomian gland adenoma

A

can be locally invasive and will efface eyelid margin if left to grow

could potentially cause corneal ulceration and be locally invasive

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23
Q

What diagnostics can you do for meibomian gland adenoma

A

Clinical signs
Excisional Biopsy
Histopathology

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24
Q

How do you treat meibomian gland adenoma

A

1) Debulking with cryoablation (80-90% success)
can often be done awake or with light sedation
higher risk for regrowth

2) Wedge resection surgery under general anesthesia
Can safely take 30% of lid without complex reconstruction

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25
Why might you send an eyelid mass into histopathology
if looks different, already comes back. might be best to send in
26
similar to meibomian gland adenoma papilloma-appearing projection often pedunculated generally not on eyelid margin less friable than meibomian gland adenoma
Fibro-papilloma
27
You can resect _____% of the eyelid without complex reconstruction
30%
28
How do you treat fibro-papilloma
same as meibomian gland adenoma local anesthesia +/- sedation for debulking -adjunctive cryoptherapy -wedge excision (general anesthesia) 1) Debulking with cryoablation (80-90% success) can often be done awake or with light sedation higher risk for regrowth 2) Wedge resection surgery under general anesthesia Can safely take 30% of lid without complex reconstruction
29
What are the clinical signs of benign eyelid melanoma in dogs
1) Darkly pigmented mass 2) Growing from the eyelid margin 3) Older animal 4) Vizsla, Weimaraner common
30
What dog breeds are benign eyelid melanoma common in
Vizsla, Weimaraner (liver-coated dogs)
31
How do you diagnose benign eyelid melanoma in dogs
Clinical signs Histopathology
32
How do you treat benign eyelid melanoma in dogs
Cryotherapy +/- debulk- these tend to be hard to curette Wedge excision to get clean margins
33
What kinds of animals does eyelid SCC typically effect
1) Lightly pigmented cats and horses 2) IV radiation exposure
34
What is the most common primary eyelid tumor in cats
SCC
35
What is a potential result of eyelid SCC in cats and horses
Metastasis, particularly late in disease
36
SCC is an ulcerative lesion that is most common in what eyelid
the lower lid
37
How do you diagnose eyelid SCC
Biopsy with histopathology
38
How do you treat eyelid SCC
1) Complete surgical excision (often requires blepharoplasty to reconstruct the lid) 2) Radiation therapy 3) Topical chemotherapy 4) Immune therapy (eg. interferon- not available anymore)
39
for eyelid neoplasia, when in doubt what should you do
biopsy for diagnosis then treat based on histopathology
40
SCC on the third eyelid is common in what species
Bovine managed similalrly to eyelid SCC
41
What are the clinical signs of hemangioma/ hemangiosarcoma of the third eye lid
1) Raised red mass on bulbar conjuctival or 3rd eyelid 2) Delicate and bleed easily 3) Generally small 4) Middle aged to older dogs
42
How do you treat hemangioma/ hemangiosarcoma of the third eye lid
Diagnose: clinical signs excisional biopsy Treatment: Excise `1mm marging with adjunctive cryotherpay or radiofrequency electrocautery these masses often send in so you can get an idea of if it will come back
43
Adenoma/Adenosarcoma of the gland of the third eye lid is often
well encapsulated diffuse enlargement of the third eye lid surgical excision of the third eyelid is often curative
44
Corneal squamous cell carcinoma is more common in what species
Brachycephalics Dogs and UV exposed horses
45
What cause corneal squamous cell carcinoma
1) KCS (dogs) 2) Immune mediated of similar chronic keratitis -Increased risk with long-term use of topical immunosuppressive medications (Tacrolimus and/or Cyclosprine) 3) UV exposure (horses) basically chronic inflammation to the cornea (entropion, FHV-1, etc)
46
How do you treat corneal SCC
Keratectomy (excise mass + superficial cornea) adjunctive cryotherapy, radiation therapy, or topical chemotherapy (because sometimes you cant get as deep) often curative
47
What are the clinical signs of limbal melanoma/melanocytoma
1) Dark mass along limbus 2) Raised, protruding out and into the cornea/ bulbar conjunctiva 3) Generally unilateral 4) Age variable 5) Breeds: GSH, Labs, goldens good prognosis for life and eye (often benign but needs to be treated
48
What breeds of dogs typically get limbal melanoma/melanocytoma
GSH, labs, goldens age variable
49
How do you diagnose limbal melanoma/melanocytoma
Clinical signs Differentiate limbal origin for uveal origin with ultrasound Biopsy
50
How do you treat limbal melanoma/melanocytoma
Excision with cryotherapy (or cryotherapy alone) +/- graft if scleral wall is compromised due to invasion
51
what is a fairly common mass that grows from anterior uvea (irus and/or cilary body) pink, lobulated, visible in pupillary margin
Cilary body adenoma / adenocarcinoma
52
What are the clinical signs of Cilary body adenoma / adenocarcinoma
1) Mass growing from anterior uvea (iris and/or ciliary body) 2) Pink, lobulated, issible in pupillary margin generally slow growing benign intraocular mass often not detected in early stages until it causes glaucoma or syncechiae locally problem (lead to enucleation) but never a systemic issue
53
How do you typically diagnose Cilary body adenoma / adenocarcinoma
Clinical Signs Intraocular mass Elevated IOP (glaucoma) Uveitis often diagnosed after enucleation because you cant get into the eye
54
How do you treat Cilary body adenoma / adenocarcinoma
1) Enucleate once uveitis or glaucoma develop 2) Intraocular mass removal if client motivated and its not too big
55
What are the clinical signs of uveal melanoma in dogs
1) Dark raised lesion on iris and/or ciliary body 2) Diffuse or local mass like 3) Melanin cells in anterior chamber 4) Secondary uveitis and/or glaucoma often slow growing unilateral middle to older age dogs
56
T/F: uveal melanoma in dogs is benign
True
57
uveal melanoma in dogs treatment
laser therapy if small once larger and causing glaucoma or uveitis = enucleation
58
T/F: uveal melanoma is benign in cats
false
59
What is the progression of uveal melanoma in cats
often starts as small nevi/freckle cant metastasize can grow fast
60
What are the clinical signs of uveal melanoma in cats
Dark brown / black diffuse pigment +/- uveitis +/- secondary glaucoma
61
How do you treat uveal melanoma in cats
Monitor and/or enucleate when progressive changes are seen Enucleate if: 1) Iris is very abnormal 2) Glaucoma and/or uveitis 3) Rapid progression rarely enucleate if little freckles age is really important in deciding what to do
62
are uveal melanoma in cats grows what can happen
dyscoria of the pupil
63
When the eye is involved, lymphoma is automatically what stage
Stage V
64
What are the clinical signs of anterior uveal lymphoma (secondary)
1) Mostly bilateral 2) Anterior uveitis 3) +/- thickened iris 4) Secondary glaucoma
65
How do you diagnose anterior uveal lymphoma (secondary)
1) Lymph node aspirate 2) Chest and abdomen imaging 3) Aqueocentesis
66
T/F: anterior uveal lymphoma (secondary) carries a poor prognosis
True
67
How do you treat anterior uveal lymphoma (secondary)
1) As for systemic lymphoma - steroids, chemo 2) Treat uveitis and glaucoma as needed -Topical nad oral steroids +/- anti glaucoma medication
68
What are the. clinical signs of choroidal melanoma
1) Dark raised lesion on fundic exam 2) Slowly progressive 3) Leads to retinal detachement 4) Associated with ocncurrent anterior uveal melanoma
69
choroidal melanoma leads to
1) retinal detachment 2) metastasis
70
choroidal melanoma is associated with
concurrent anterior uveal melanoma
71
How do you diagnose choroidal neoplasia
fundic examination
72
T/F: choroidal melanoma metastasis
True do a complete systemic workup for metastasis unlike anterior uveal melanoma this can metastasize
73
Does choroidal or anterior uveal melanoma metastasize
choroidal melanoma

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