Feline Ophthalmology: Cats are Not Small Dogs
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Transcript of Feline Ophthalmology: Cats are Not Small Dogs
KEITH MONTGOMERY DVM, DACVO
FELINE OPHTHALMOLOGY: CATS ARE NOT SMALL DOGS
WWW.UVSONLINE.COM
Adnexa
Conjunctiva
Cornea
Iris
Glaucoma
OUTLINE
11/14/2017CE FALL 2017 | FELINE OPHTHALMOLOGY: CATS ARE NOT SMALL DOGS
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K9: entropion (common)
Eyelid conformation (macroblepharon)
Usually bilateral
ENTROPION
11/14/2017CE FALL 2017 | FELINE OPHTHALMOLOGY: CATS ARE NOT SMALL DOGS
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K9: entropion (common)
Feline entropion
Less common
Young cats (prior surface disease)
Geriatric cats (orbital fat atrophy)
Typically unilateral
ENTROPION
11/14/2017CE FALL 2017 | FELINE OPHTHALMOLOGY: CATS ARE NOT SMALL DOGS
Surgical management and outcome of lower eyelid entropion in 124 catsJames S. White,* Rachael A. Grundon,† Chloe Hardman,† Anu O’Reilly† and Robin G. Stanley†
WWW.UVSONLINE.COM
K9: entropion (common)
Feline entropion
Less common
Young cats (prior surface disease)
Geriatric cats (orbital fat atrophy)
Typically unilateral
ENTROPION
11/14/2017CE FALL 2017 | FELINE OPHTHALMOLOGY: CATS ARE NOT SMALL DOGS
Surgical management and outcome of lower eyelid entropion in 124 catsJames S. White,* Rachael A. Grundon,† Chloe Hardman,† Anu O’Reilly† and Robin G. Stanley†
WWW.UVSONLINE.COM
K9: entropion (common)
Feline entropion
Less common
Young cats (prior surface disease)
Geriatric cats (orbital fat atrophy)
Typically unilateral
ENTROPION
11/14/2017CE FALL 2017 | FELINE OPHTHALMOLOGY: CATS ARE NOT SMALL DOGS
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Feline entropion
Aggressive Hotz-celsus
Combination surgery
Hotz-celsus / lateral wedge
Prophylactic entropion sx?
ENTROPION
11/14/2017CE FALL 2017 | FELINE OPHTHALMOLOGY: CATS ARE NOT SMALL DOGS
Entropion correction in dogs and cats using a combination Hotz–Celsus and lateral eyelid wedge resection: results in 311 eyesRobert A. Read and Hugh C. Broun
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K9: benign (88%)
Adenoma, epithelioma, papilloma
Surgical excision (rule of 1/3)
EYELID TUMORS
11/14/2017CE FALL 2017 | FELINE OPHTHALMOLOGY: CATS ARE NOT SMALL DOGS
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K9: benign (88%)
Feline eyelid tumors
Infrequent compared to dogs
SCC (36 – 65%), lymphoma, adenocarcinoma
MCT, HSA, hidrocystomas
EYELID TUMORS
11/14/2017CE FALL 2017 | FELINE OPHTHALMOLOGY: CATS ARE NOT SMALL DOGS
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Feline eyelid SCC
Ulcerative skin lesion
Locally invasive, mets late in disease
Difficult to identify margins
EYELID TUMORS
11/14/2017CE FALL 2017 | FELINE OPHTHALMOLOGY: CATS ARE NOT SMALL DOGS
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Feline eyelid SCC
Wide surgical excision – curative
Eyelid reconstruction / grafting
Orbital exenteration
Adjunctive therapy:
Cryosurgery, radiation, PDT
EYELID TUMORS
11/14/2017CE FALL 2017 | FELINE OPHTHALMOLOGY: CATS ARE NOT SMALL DOGS
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Feline eyelid MCT
Single or multiple, variable appearance
Usually benign
Surgical excision usually curative
Responds well to Sr-90 irradiation
EYELID TUMORS
11/14/2017CE FALL 2017 | FELINE OPHTHALMOLOGY: CATS ARE NOT SMALL DOGS
Periocular cutaneous mast cell tumors in cats: evaluation of surgical excision (33 cases)Keith W. Montgomery,* Alexandra van der Woerdt,† Susette M. Aquino,† John S. Sapienza‡and Eric C. Ledbetter*
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Feline eyelid MCT
Single or multiple, variable appearance
Usually benign
Surgical excision usually curative
Responds well to Sr-90 irradiation
EYELID TUMORS
11/14/2017CE FALL 2017 | FELINE OPHTHALMOLOGY: CATS ARE NOT SMALL DOGS
Periocular cutaneous mast cell tumors in cats: evaluation of surgical excision (33 cases)Keith W. Montgomery,* Alexandra van der Woerdt,† Susette M. Aquino,† John S. Sapienza‡and Eric C. Ledbetter*
WWW.UVSONLINE.COM
Feline eyelid MCT
Single or multiple, variable appearance
Usually benign
Surgical excision usually curative
Responds well to Sr-90 irradiation
EYELID TUMORS
11/14/2017CE FALL 2017 | FELINE OPHTHALMOLOGY: CATS ARE NOT SMALL DOGS
Periocular cutaneous mast cell tumors in cats: evaluation of surgical excision (33 cases)Keith W. Montgomery,* Alexandra van der Woerdt,† Susette M. Aquino,† John S. Sapienza‡and Eric C. Ledbetter*
WWW.UVSONLINE.COM
Feline eyelid apocrine hidrocystomas
Multiple, smooth (tense to fluctuant)
Pigmented, nodular structures
Rare! Persians predisposed
Tx: Benign neglect, surgical excision, sclerotherapy
EYELID TUMORS
11/14/2017CE FALL 2017 | FELINE OPHTHALMOLOGY: CATS ARE NOT SMALL DOGS
Multiple eyelid apocrine hidrocystomas in two Persian catsBrice Cantaloube,* Isabelle Raymond-Letron† and Alain Regnier*
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K9: Allergic (follicular)
Steroid deficiency
Viral component?
Others KCS, bacterial (rare)
CONJUNCTIVITIS
11/14/2017CE FALL 2017 | FELINE OPHTHALMOLOGY: CATS ARE NOT SMALL DOGS
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K9: Allergic (follicular)
Steroid deficiency
Viral component?
Others KCS, bacterial (rare)
CONJUNCTIVITIS
11/14/2017CE FALL 2017 | FELINE OPHTHALMOLOGY: CATS ARE NOT SMALL DOGS
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K9: Allergic (follicular)
Feline Infectious conjunctivitis
FHV-1 infection
Chlamydophila / Mycoplasma?
Terramycin, erythromycin, fluoroquinolone QID (plus 1 – 2wks)
Doxycycline 5 mg/kg BID x 3 – 4wks
CONJUNCTIVITIS
11/14/2017CE FALL 2017 | FELINE OPHTHALMOLOGY: CATS ARE NOT SMALL DOGS
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Feline conjunctivitis
Symblepharon: if concurrent corneal ulceration
Chronicity:
Reduce stress / avoid steroids
Test for concurrent disease (e.g. Bartonella, FELV/FIV, FIP, toxo)
TCVM
CONJUNCTIVITIS
11/14/2017CE FALL 2017 | FELINE OPHTHALMOLOGY: CATS ARE NOT SMALL DOGS
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Feline conjunctivitis (other causes)
Eosinophilic (cytology)
KCS uncommon in cats!
Multifactorial
CONJUNCTIVITIS
11/14/2017CE FALL 2017 | FELINE OPHTHALMOLOGY: CATS ARE NOT SMALL DOGS
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K9: Corneal pigment
Pigmentary keratitis
Foreign body
Iris prolapse!
CORNEAL PIGMENT
11/14/2017CE FALL 2017 | FELINE OPHTHALMOLOGY: CATS ARE NOT SMALL DOGS
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K9: Corneal pigment
Pigmentary keratitis
Foreign body
Iris prolapse!
CORNEAL PIGMENT
11/14/2017CE FALL 2017 | FELINE OPHTHALMOLOGY: CATS ARE NOT SMALL DOGS
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K9: Corneal pigment
Pigmentary keratitis
Foreign body
Iris prolapse!
CORNEAL PIGMENT
11/14/2017CE FALL 2017 | FELINE OPHTHALMOLOGY: CATS ARE NOT SMALL DOGS
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Feline corneal sequestrum
Pathogenesis (FHV-1, entropion)
Variable appearance
Focal to large; superficial to deep
Discrete to diffuse; avascular to granulation tissue
Comfortable to blepharospastic
Tx: Keratectomy vs medical
CORNEAL PIGMENT
11/14/2017CE FALL 2017 | FELINE OPHTHALMOLOGY: CATS ARE NOT SMALL DOGS
WWW.UVSONLINE.COM
Feline corneal sequestrum
Pathogenesis (FHV-1, entropion)
Variable appearance
Focal to large; superficial to deep
Discrete to diffuse; avascular to granulation tissue
Comfortable to blepharospastic
Tx: Keratectomy vs medical
CORNEAL PIGMENT
11/14/2017CE FALL 2017 | FELINE OPHTHALMOLOGY: CATS ARE NOT SMALL DOGS
WWW.UVSONLINE.COM
Feline corneal sequestrum
Pathogenesis (FHV-1, entropion)
Variable appearance
Focal to large; superficial to deep
Discrete to diffuse; avascular to granulation tissue
Comfortable to blepharospastic
Tx: Keratectomy vs medical
CORNEAL PIGMENT
11/14/2017CE FALL 2017 | FELINE OPHTHALMOLOGY: CATS ARE NOT SMALL DOGS
WWW.UVSONLINE.COM
Feline corneal sequestrum
Pathogenesis (FHV-1, entropion)
Variable appearance
Focal to large; superficial to deep
Discrete to diffuse; avascular to granulation tissue
Comfortable to blepharospastic
Tx: Keratectomy vs medical
CORNEAL PIGMENT
11/14/2017CE FALL 2017 | FELINE OPHTHALMOLOGY: CATS ARE NOT SMALL DOGS
Use of a porcine urinary bladder acellular matrix for corneal reconstruction in dogs and catsOlivier Balland,* Anne-Sophie Poinsard,* Frank Famose,† Frederic Goulle,‡ Pierre-Francois Isard,§Iona Mathieson¶ and Thomas Dulaurent§
WWW.UVSONLINE.COM
Feline corneal sequestrum
Pathogenesis (FHV-1, entropion)
Variable appearance
Focal to large; superficial to deep
Discrete to diffuse; avascular to granulation tissue
Comfortable to blepharospastic
Tx: Keratectomy vs medical
CORNEAL PIGMENT
11/14/2017CE FALL 2017 | FELINE OPHTHALMOLOGY: CATS ARE NOT SMALL DOGS
Use of a porcine urinary bladder acellular matrix for corneal reconstruction in dogs and catsOlivier Balland,* Anne-Sophie Poinsard,* Frank Famose,† Frederic Goulle,‡ Pierre-Francois Isard,§Iona Mathieson¶ and Thomas Dulaurent§
WWW.UVSONLINE.COM
Feline corneal sequestrum
Pathogenesis (FHV-1, entropion)
Variable appearance
Focal to large; superficial to deep
Discrete to diffuse; avascular to granulation tissue
Comfortable to blepharospastic
Tx: Keratectomy vs medical
CORNEAL PIGMENT
11/14/2017CE FALL 2017 | FELINE OPHTHALMOLOGY: CATS ARE NOT SMALL DOGS
Use of a porcine urinary bladder acellular matrix for corneal reconstruction in dogs and catsOlivier Balland,* Anne-Sophie Poinsard,* Frank Famose,† Frederic Goulle,‡ Pierre-Francois Isard,§Iona Mathieson¶ and Thomas Dulaurent§
WWW.UVSONLINE.COM
Feline corneal sequestrum
Pathogenesis (FHV-1, entropion)
Variable appearance
Focal to large; superficial to deep
Discrete to diffuse; avascular to granulation tissue
Comfortable to blepharospastic
Tx: Keratectomy vs medical
CORNEAL PIGMENT
11/14/2017CE FALL 2017 | FELINE OPHTHALMOLOGY: CATS ARE NOT SMALL DOGS
WWW.UVSONLINE.COM
Feline corneal sequestrum
Pathogenesis (FHV-1, entropion)
Variable appearance
Focal to large; superficial to deep
Discrete to diffuse; avascular to granulation tissue
Comfortable to blepharospastic
Tx: Keratectomy vs medical
CORNEAL PIGMENT
11/14/2017CE FALL 2017 | FELINE OPHTHALMOLOGY: CATS ARE NOT SMALL DOGS
WWW.UVSONLINE.COM
Feline corneal sequestrum
Pathogenesis (FHV-1, entropion)
Variable appearance
Focal to large; superficial to deep
Discrete to diffuse; avascular to granulation tissue
Comfortable to blepharospastic
Tx: Keratectomy vs medical
CORNEAL PIGMENT
11/14/2017CE FALL 2017 | FELINE OPHTHALMOLOGY: CATS ARE NOT SMALL DOGS
WWW.UVSONLINE.COM
K9: Chronic ulcers
Indolent ulcers
Non-healing ulcers
Entropion
Ectopic cilia
Conjunctival FB
Bacterial infection
CORNEAL ULCER (GEOGRAPHIC)
11/14/2017CE FALL 2017 | FELINE OPHTHALMOLOGY: CATS ARE NOT SMALL DOGS
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K9: Chronic ulcers
Indolent ulcers
Non-healing ulcers
Entropion
Ectopic cilia
Conjunctival FB
Bacterial infection
CORNEAL ULCER (GEOGRAPHIC)
11/14/2017CE FALL 2017 | FELINE OPHTHALMOLOGY: CATS ARE NOT SMALL DOGS
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Feline herpes virus infection
Topical antibiotics
Anti-viral (cidofovir, famciclovir)
Atropine / oral NSAID
No steroids or grid keratotomy!
CORNEAL ULCER (GEOGRAPHIC)
11/14/2017CE FALL 2017 | FELINE OPHTHALMOLOGY: CATS ARE NOT SMALL DOGS
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Feline herpes virus infection
Corneal debridement
Topical NSAID?
Lysine no longer recommended
Arginine antagonization
In vitro effect on FHV-1 replication
Clinical studies (increased disease)
CORNEAL ULCER (GEOGRAPHIC)
11/14/2017CE FALL 2017 | FELINE OPHTHALMOLOGY: CATS ARE NOT SMALL DOGS
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Feline herpes virus infection
Corneal debridement
Topical NSAID?
Lysine no longer recommended
Arginine antagonization
In vitro effect on FHV-1 replication
Clinical studies (increased disease)
CORNEAL ULCER (GEOGRAPHIC)
11/14/2017CE FALL 2017 | FELINE OPHTHALMOLOGY: CATS ARE NOT SMALL DOGS
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Feline herpes virus infection
Reduce stress
Evaluate for systemic disease
Bolster immune system
CORNEAL ULCER (GEOGRAPHIC)
11/14/2017CE FALL 2017 | FELINE OPHTHALMOLOGY: CATS ARE NOT SMALL DOGS
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K9: Iris nevi or melanocytoma
Monitoring
Transcorneal laser treatment
Usually benign / malignant melanomas rare
IRIS PIGMENTATION
11/14/2017CE FALL 2017 | FELINE OPHTHALMOLOGY: CATS ARE NOT SMALL DOGS
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Feline diffuse iris melanoma
Malignant
19 – 63% metastatic rate
Early metastasis (liver, spleen, lungs)
Age matters
IRIS PIGMENTATION
11/14/2017CE FALL 2017 | FELINE OPHTHALMOLOGY: CATS ARE NOT SMALL DOGS
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Feline diffuse iris melanoma
Slow progression following mets? (6 – 10 months)
Poor prognosis:
Extrascleral extension
Choroidal invasion
Mitotic index > 7
Secondary glaucoma
IRIS PIGMENTATION
11/14/2017CE FALL 2017 | FELINE OPHTHALMOLOGY: CATS ARE NOT SMALL DOGS
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Feline diffuse iris melanoma
Slow progression following mets? (6 – 10 months)
Poor prognosis:
Extrascleral extension
Choroidal invasion
Mitotic index > 7
Secondary glaucoma
IRIS PIGMENTATION
11/14/2017CE FALL 2017 | FELINE OPHTHALMOLOGY: CATS ARE NOT SMALL DOGS
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K9: Iris cysts
Feline iris cysts
Heavily pigmented
Rare
Misdiagnosed as uveal melanoma – ocular ULS!
IRIS PIGMENTATION
11/14/2017CE FALL 2017 | FELINE OPHTHALMOLOGY: CATS ARE NOT SMALL DOGS
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K9: Iris cysts
Feline iris cysts
Heavily pigmented
Rare
Misdiagnosed as uveal melanoma – ocular ULS!
IRIS PIGMENTATION
11/14/2017CE FALL 2017 | FELINE OPHTHALMOLOGY: CATS ARE NOT SMALL DOGS
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K9: Iris cysts
Feline iris cysts
Heavily pigmented
Rare
Misdiagnosed as uveal melanoma – ocular ULS!
IRIS PIGMENTATION
11/14/2017CE FALL 2017 | FELINE OPHTHALMOLOGY: CATS ARE NOT SMALL DOGS
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K9: Primary or secondary
Feline glaucoma
Clinical signs more subtle
Hyperemia often absent
Corneal edema less significant
Mydriasis / buphthalmos (visual?)
GLAUCOMA
11/14/2017CE FALL 2017 | FELINE OPHTHALMOLOGY: CATS ARE NOT SMALL DOGS
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Feline glaucoma
Secondary until proven otherwise (uveitis or neoplasia)
CAI (dorzolamide vs Azopt)
Prostaglandin analogues
Transient?
GLAUCOMA
11/14/2017CE FALL 2017 | FELINE OPHTHALMOLOGY: CATS ARE NOT SMALL DOGS
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Feline glaucoma
Unresponsive to medical therapy:
Enucleation
Feline enucleation (avoid tension on ON)
Avoid orbital prosthesis / CBA
GLAUCOMA
11/14/2017CE FALL 2017 | FELINE OPHTHALMOLOGY: CATS ARE NOT SMALL DOGS
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QUESTIONS?
11/14/2017CE FALL 2017 | FELINE OPHTHALMOLOGY: CATS ARE NOT SMALL DOGS