feline ophthalmology: cats are not small dogs

KEITH MONTGOMERY DVM, DACVO

FELINE OPHTHALMOLOGY: CATS ARE NOT SMALL DOGS

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Adnexa

Conjunctiva

Cornea

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

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Feline entropion

Less common

Young cats (prior surface disease)

Geriatric cats (orbital fat atrophy)

Typically unilateral

ENTROPION

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†

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Feline entropion

Less common

ENTROPION

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†

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Feline entropion

Less common

ENTROPION

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Feline entropion

Aggressive Hotz-celsus

Combination surgery

Hotz-celsus / lateral wedge

Prophylactic entropion sx?

ENTROPION

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

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K9: benign (88%)

Feline eyelid tumors

Infrequent compared to dogs

SCC (36 – 65%), lymphoma, adenocarcinoma

MCT, HSA, hidrocystomas

EYELID TUMORS

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Feline eyelid SCC

Ulcerative skin lesion

Locally invasive, mets late in disease

Difficult to identify margins

EYELID TUMORS

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Feline eyelid SCC

Wide surgical excision – curative

Eyelid reconstruction / grafting

Orbital exenteration

Adjunctive therapy:

Cryosurgery, radiation, PDT

EYELID TUMORS

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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

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

Usually benign

EYELID TUMORS

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Feline eyelid MCT

Usually benign

EYELID TUMORS

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Feline eyelid apocrine hidrocystomas

Multiple, smooth (tense to fluctuant)

Pigmented, nodular structures

Rare! Persians predisposed

Tx: Benign neglect, surgical excision, sclerotherapy

EYELID TUMORS

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

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Steroid deficiency

Viral component?

Others KCS, bacterial (rare)

CONJUNCTIVITIS

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Feline Infectious conjunctivitis

FHV-1 infection

Chlamydophila / Mycoplasma?

Terramycin, erythromycin, fluoroquinolone QID (plus 1 – 2wks)

Doxycycline 5 mg/kg BID x 3 – 4wks

CONJUNCTIVITIS

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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)

CONJUNCTIVITIS

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Feline conjunctivitis (other causes)

Eosinophilic (cytology)

KCS uncommon in cats!

Multifactorial

CONJUNCTIVITIS

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K9: Corneal pigment

Pigmentary keratitis

Foreign body

Iris prolapse!

CORNEAL PIGMENT

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K9: Corneal pigment

Foreign body

Iris prolapse!

CORNEAL PIGMENT

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K9: Corneal pigment

Foreign body

Iris prolapse!

CORNEAL PIGMENT

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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

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Variable appearance

CORNEAL PIGMENT

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Variable appearance

CORNEAL PIGMENT

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Variable appearance

CORNEAL PIGMENT

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§

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Variable appearance

CORNEAL PIGMENT

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Variable appearance

CORNEAL PIGMENT

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Variable appearance

CORNEAL PIGMENT

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Variable appearance

CORNEAL PIGMENT

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Variable appearance

CORNEAL PIGMENT

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K9: Chronic ulcers

Indolent ulcers

Non-healing ulcers

Entropion

Ectopic cilia

Conjunctival FB

Bacterial infection

CORNEAL ULCER (GEOGRAPHIC)

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K9: Chronic ulcers

Indolent ulcers

Non-healing ulcers

Entropion

Ectopic cilia

Conjunctival FB

Bacterial infection

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Feline herpes virus infection

Topical antibiotics

Anti-viral (cidofovir, famciclovir)

Atropine / oral NSAID

No steroids or grid keratotomy!

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Corneal debridement

Topical NSAID?

Lysine no longer recommended

Arginine antagonization

In vitro effect on FHV-1 replication

Clinical studies (increased disease)

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Corneal debridement

Topical NSAID?

Lysine no longer recommended

Arginine antagonization

In vitro effect on FHV-1 replication

Clinical studies (increased disease)

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Reduce stress

Evaluate for systemic disease

Bolster immune system

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K9: Iris nevi or melanocytoma

Monitoring

Transcorneal laser treatment

Usually benign / malignant melanomas rare

IRIS PIGMENTATION

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Feline diffuse iris melanoma

Malignant

19 – 63% metastatic rate

Early metastasis (liver, spleen, lungs)

Age matters

IRIS PIGMENTATION

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Slow progression following mets? (6 – 10 months)

Poor prognosis:

Extrascleral extension

Choroidal invasion

Mitotic index > 7

Secondary glaucoma

IRIS PIGMENTATION

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Slow progression following mets? (6 – 10 months)

Poor prognosis:

Extrascleral extension

Choroidal invasion

Mitotic index > 7

Secondary glaucoma

IRIS PIGMENTATION

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K9: Iris cysts

Feline iris cysts

Heavily pigmented

Misdiagnosed as uveal melanoma – ocular ULS!

IRIS PIGMENTATION

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K9: Iris cysts

Feline iris cysts

Heavily pigmented

IRIS PIGMENTATION

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K9: Iris cysts

Feline iris cysts

Heavily pigmented

IRIS PIGMENTATION

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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

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Feline glaucoma

Secondary until proven otherwise (uveitis or neoplasia)

CAI (dorzolamide vs Azopt)

Prostaglandin analogues

Transient?

GLAUCOMA

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Feline glaucoma

Unresponsive to medical therapy:

Enucleation

Feline enucleation (avoid tension on ON)

Avoid orbital prosthesis / CBA

GLAUCOMA

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QUESTIONS?

feline ophthalmology: cats are not small dogs

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