‘Hayfever in the jungle’ Emma Scurrell BVSc DipACVP MRCVS CytoPath Ltd., UK

Clinical history

•  16-year-old female gorilla •  15 month history of intermittent, bilateral

ocular discharge •  Family group and 4-year-old son • No other gorillas affected

Courtesy Dr Jane Hopper

Courtesy Dr Jane Hopper

Courtesy Dr Heidi Featherstone

Courtesy Dr Heidi Featherstone

Courtesy Dr Heidi Featherstone

Courtesy Dr Heidi Featherstone

Diagnostic tests

•  Cytology •  Histopathology •  Conjunctival bacteriology (aerobic/anaerobic) •  PCR for infectious agents (Chlamydia sp

[trachoma]), herpes, Treponema sp [syphilis]) •  Haematology/biochemistry •  Serology (SIV, STLV, herpes simplex virus,

Hepatitis A, Hepatitis B).

Histopathology

Cytology

Diagnosis

• Chronic proliferative eosinophilic conjunctivitis • Features reminiscent of vernal conjunctivitis

‘spring catarrh’

Comparative pathology: vernal conjunctivitis

•  Bilateral, recurrent allergic conjunctivitis •  Th2/IgE driven •  Predominantly males aged 5 – 20 •  Atopy (e.g. asthma, rhinitis, eczema) •  Symptoms commonly exacerbated in the spring/

summer, but in tropical climates the disease may persist year-long

•  Itching, photophobia, blurred vision, thick "ropy" discharge and blepharospasm

Comparative pathology: vernal conjunctivitis

• Three main forms: • palpebral form • limbal form • corneal form

Palpebral form ‘cobblestone papillae’

James Homme, M.D., and Jeff Wiswell, M.D. N Engl J Med 2012; 366:647February 16, 2012DOI: 10.1056/NEJMicm1014624

Limbal form ‘Horner-Trantas dots’

Comm Eye Health Vol. 18 No. 53 2005 pp 76 – 78.

Corneal form

Treatment

• Antihistamines • Mast cell stabilisers •  Topical steroids •  Topical cyclosporine

• Gorilla in this case: subconjunctival depomedrone

Thank you….