12.05.2015
Slideshare uses cookies to improve functionality and performance, and to provide you with relevant advertising. CNIII paralysis, ptosis would be severe, may be associated with eyeball plegia and mydriasis. Several techniques, create traction at the lateral canthus and reduce the palpebral fissure. Can also use brow suspension by tacking non-absorbale sutures to the frontal bone periosteum. Removal of skin at the eyelid edge including hair follicles to get the hair out of the way. When eyelashes grow from meibomian gland thru the palpebral conjunctiva, and touch the eye. Flush the NL duct, topical and systemic antbx with frequent flushing, put in a naso-lacrimal stent for 2-4 weeks.
Kittens, and they are systemically sick along with hypermeia, chemosis and ocular discharge. In long faced dogs, their medial canthus gets too deep and they get discharge and conjunctivitis. Superficial, because there are many more never fibers in the superficial stroma and epithelium.
Hypo-reflective spots (peripheral), vessels attenuated (peripheral), and are usually missed.
Choroidal hypoplasia (recognize at 6-8 weeks, called 'go-normals' because their fundus becomes pigmented and you can no longer recognize the deformity) coloboma, retinal detachment, hyphema. Break (tear or hole) in retina that allows vitreous humor to enter the potential space beneath the retina. Hypertensive choriodopathy or hypertensive retinopathy, retinal detachment, iridal hemorrhages. Intraocular pressure too high for optic nerve and retina to function normally, degenerative disease affecting the optic nerve and retinal ganglion cells.
What are some things that might make you think your horse has had recurrent bouts of uveitis? Loss of sympathetic input, from Horner's, cranial trauma, toxicities, spastic pupil syndrome.
Pectinate ligament dysplasia, so that the meshwork is not as it should be, or complete closure of the cleft. Cataracts are opacities within the lens that may affect a small portion of the lens or the entire lens. Heredity, metabolic diseases, senile changes, trauma, nutritional deficiencies, toxins, drugs, radiation therapy and inflammation will cause cataracts in dogs. Senile — these can be amenable to surgery but it is essential there is early referral for retinal assessment (Generalised Progressive Retinal Atrophy needs to be ruled out as well as any other coexisting retinal diseases). Trauma and inflammation — some of these cases are not amenable to surgical intervention because of intraocular changes such as adhesions and pigment deposition which detracts from an overall successful result.
It may be argued that an older sedentary dog with cataract and no vision has a good quality of life. The surgery aims to give a blind animal vision and allow it to live a relatively normal life. It will be found that the dog may have some trouble focusing on near objects at first, but will get better at this with time. The visual improvement in a 12-year-old diabetic dog is noticeable within hours of surgery! The longer a cataract remains in a dogs’ eye the more likely cataract associated pathology which can cause severe pain or permanent blindness will be seen. Dislocation or Luxation of the Lens — the longer a cataract remains in an eye the thicker and more contracted the anterior and posterior capsules become.
Posterior Capsular Opacities — these are more likely to form in mature cataracts and will cloud vision when the lens is removed (the posterior capsule is always left intact in cataract surgery to prevent vitreous prolapse).
Pigment Deposition — this may follow cataract surgery if there has been a prolonged bout of LIU prior to surgery and effectively cause the same problems as capsular opacities.
Glaucoma — prolonged LIU can cause adhesions which disturbs the flow of aqueous through the pupil or out the angle of filtration, thus producing a secondary glaucoma. Retinal Detachment — in the Bichon Frise there appears to be a high correlation between mature cataract and retinal detachment which results in permanent blindness. In the situation where it is evident that there is progression of the cataract(s) and the animals vision is becoming compromised, early referral is advised so that a full ophthalmic examination can be done with particular reference to the state of the retina. Currently the cost of cataract surgery in our clinic is in the region of $1700-1900 for one eye to $2700-2900 for both. In a situation where a retinal disease is either suspected or known, and cataract progression has been mainly responsible for the sudden progression of the visual difficulties the dog is having, surgery will allow the utilisation of what retinal function the dog has left. Retinal Detachment — certainly a factor in the Bichon if cataracts are left in too long.
General Anaesthesia — these days with Isofluorane anaesthesia, fluid support and close monitoring with pulse-oximeter, maintenance and recovery from anaesthesia poses few problems with all cases going home the day of surgery.
The owners major input is in transport, paying the bill for the surgery (and hoping for an improvement in relations with the dog if there was a problem prior to surgery-payback time!),instilling drops into the eye pre and post-operatively for up to 6-8 weeks and returning after the surgery for post-operative checks. General anaesthesia – The anaesthesia involves induction with an intravenous drug but maintenance for the duration of the surgery is oxygen and an anaesthetic gas (Isofluorane). Opening the cornea 180 degrees or if phacoemulsification is utilised, then a 3mm incision at 12 o’clock is used. During the surgery these lens contents are released into the eye will cause an intense inflammatory reaction.
1% Atropine – this keeps the pupil dilated to allow vision and reduce the possibility of adhesions of iris to residual lens capsule, reduces the pain from iris spasm in the eye and reduces the release of debris into the eye which can cause adhesions. Antibiotics – used immediately after surgery but will only be used as a course of treatment in diabetic animals because of their greater risk of infection. The stitches in the cornea will dissolve in 6-8 weeks and they may cause a mild reaction in the cornea so that a low dose of eye drops may be needed. The assessment of whether vision has been returned is best left for at least 2 weeks to allow debris within the eye to clear, although some vision may be attained within hours to several days.
These problems can be minimised by meticulous surgical technique, attendance to medicating the eye post operatively but even when everything seems right technically, restoration of vision may not eventuate.


My policy is not to charge for the first post operative visit as I would like to check on the progress of the eye for several months even years post operatively. After Craig graduated with Distinction from Massey University in 1970 he took up an internship at Melbourne University followed by a further two years in private practice in South Australia.
Since 1973 Craig has operated his companion animal practice in Palmerston North, Craig is a Registered Specialist in Veterinary Ophthalmology and he conducts Eye Referral Clinics throughout New Zealand. He currently serves on the Companion Animal Society Editorial Board and the New Zealand Kennel Club Hereditary Disorders Committee. This article is subject to copyright and cannot be replicated in any form without prior permission click here to contact us.
Think of it as an egg which has become hard-boiled-the only solution is to remove the lens which is very effective and restores good vision. KCS is treated with a lacrimomimetic topical drug, such as cyclosporine or tacrolimus, that helps improve tear production and reduce corneal scar tissue (Figure 2).1 These drugs are compounded in various concentrations in both liquid and ointment formulations.
Have you purchased a Tono-Pen only to have it sit in its case because you aren’t sure when or how to use it? Cover: Always store the unit with a cover on it and use a new cover after the unit has been calibrated and cleaned. Clean: Clean the unit by blowing a stream of canned air in the side ports of the metal end.
Control: Here is the crucial part of the procedure, be sure you have a minimal amount of patient restraint, both around the neck and eyelids. Examination of the fundus allows us to directly evaluate the patient’s blood vessels, nerves (optic nerve and retina), and clarity of the ocular medium (vitreous). Dilation is best achieved with tropicamide 1%, either alone or in combination with phenylephrine 2.5%. Often times a dog is referred for cataract evaluation when the real reason the patient is losing vision is due to inherited retinal atrophy. Practitioners are often confused about the term uveitis.3 Uveitis results when the iris and ciliary body blood vessels are inflamed and allow leakage of vessel contents, including cells, protein and, sometimes, fat (ie, diabetic uveitis). Aqueous flare is simply protein that has escaped from leaky vessels; if the vessel holes are large enough, cells or even whole blood can enter the anterior chamber.
Flare and cells can be found with a slit beam of light from a direct ophthalmoscope, PanOptic ophthalmoscope with a slit beam feature, inexpensive slit beam devices, or a hand-held slit lamp biomicroscope. If you don’t see anything obvious causing the pain and erosion, such as a foreign body or entropion, consider an ectopic cilium.
To find the hair, flip the upper lid and, with good magnification, locate the hair protruding from the conjunctiva. Treatment of ectopic cilium requires, under general anesthesia, removing the hair follicle en bloc and freezing the residual tissue. Stabilize the eyelid with a chalazion clamp so the abnormal area is easier to see and handle. With a 2-mm skin punch, do a partial thickness punch around the follicle and use a small blade to remove the tissue.
Proper treatment for a corneal ulcer is very dependent on whether the ulcer is superficial or deep. Magnification: Examine the cornea with magnification to determine how much tissue is missing.
Fluorescein stain: Fluorescein stain works by turning stromal tissue green, the epithelium has to be disrupted for the stain to infiltrate the stroma.
Determining Depth: If you have a piece of examination equipment with a slit-beam, the degree that the light beam bends helps facilitate determination of ulcer depth. A simple superficial or slowly healing indolent ulcer is treated by encouraging the epithelium to adhere to the underlying stroma. Deep ulcers are much more critical and can result in rapid perforation of the globe, requiring enucleation. Patients can present with extremely squinty lids for a number of reasons: one of those is entropion. While the patient is sitting still without being held, keep the treat in your closed hand by your chin and look at the patient straight on, comparing each eye’s lid margins.
Since the development of safer cataract surgery, it is best to have a patient referred for cataract evaluation sooner rather than later (eg, unilateral cataract patient or soon after a diabetic or pure-breed patient starts developing bilateral cataracts). Many clients choose early evaluation by an ophthalmologist to prevent or treat lens-induced uveitis and will consider unilateral cataract surgery. Cats with conjunctivitis and corneal disease present a diagnostic enigma to both general practitioners and ophthalmologists. A clinician may suspect a corneal ulcer since the lesion typically takes up fluorescein stain.
Despite some superficial stain uptake, EK requires use of topical steroids (prednisolone or dexamethasone).
I’ve saved the 10th tip for last because it is the most important point of the article.
Kenneth Abrams, DVM, Diplomate ACVO, is the president and founder of Veterinary Ophthalmology Services, Inc, in Warwick, Rhode Island. The type of fatty acids fed to a patient, as well as the total amount of fatty acids in the diet, have the additional potential to improve or impair health. The owner reported that Lucky vomited in the car a week earlier when coming home from the groomer. The NAVC does not, by publication of ads, express endorsement or verify the accuracy and effectiveness of the products and claims contained therein. Leave wound to heal by second intention, which will avoid regrowth of hair and scarring with retract eyelids. Forms adhesions (symblepharon), can also cause ophthalmia neonatorum if kitten is infected before their eyes open. These opacities vary from an incipient form (barely discernible ie retina easily seen), to a mature (retina not seen) to a hypermature or Morganian cataract (parts of retina seen as lens cortex or the “egg-white clears”). The pupil will appear more cloudy rather than dark and there will be subtle changes in the animals ability to see eg walking into objects, inability or clumsiness when fetching. In most cases these cataract-related disorders could be avoided by early surgical cataract removal. We are suspicious this is happening when one is presented with an eye with a mature cataract and a ‘red eye’.


The equipment used for this procedure expensive with phacoemulsification units currently costing $50-$80000 and the consumables such as sutures and instruments are costly. It is important to warn the owner that the surgery will not halt the progression of the retinal disease. The overriding feeling amongst most of the owners I see who present their animals for assessment, is the emotional upset of seeing their companion trying to cope with blindness. The administration of drops is most frequent in the first week after surgery then tapers off considerably. The frequent drug therapy before and after surgery is designed to suppress this reaction but treatment may be necessary for several months afterward. The success rate in my hands is high as we have the equipment and the experience to do this type of surgery. I am very happy for you to ring if you have any problems or are unsure of what may be happening and cannot contact me at the clinic -a lot of time, effort and expense has gone into this surgery so I want to ensure its success. The assistant should keep the patient relaxed as you gently open the eyelids without putting pressure on the globe.
Avoid use of atropine due to the fact that its effect lasts several days to a couple of weeks.
In these patients, the cataracts are secondary and, therefore, cataract removal will not improve vision as the retina will degenerate, eventually causing blindness. These findings indicate that the patient’s blood pressure should be evaluated for possible systemic hypertension.
The light beam within the anterior chamber will look cloudy if there is protein, cells, or both. To clarify, this is not distichia, extra eyelashes along the lid margin.4 While many of these patients will have distichiasis, an ectopic cilium is a single hair protruding from the underside of the eyelid through the conjunctiva. Techniques, such as epithelial debridement, bandage contact lenses, grid keratotomy, and some newer trial medications (ie, Adequan) are used to speed healing. Depending on lesion depth, particular skills of the clinician, and a host of other factors, treatment ranges from medical support with anticollagenase drugs, such as acetylcysteine or serum, to conjunctival grafts. Suspicions are high when the patient is a shar-pei or chow chow, but what about other breeds that can have entropion, such as rottweilers, retrievers, and various giant breeds?
If true anatomical entropion is present, the lid (usually the lower) is rolled in on the eye (Figure 8).
This reduces the risk that a patient will develop lens-induced uveitis if the cataract remains in the eye.
There are a number of factors that affect the best timing for surgery; early referral allows the owner to become fully educated before severe complications occur. However, when you see a granulation-type, gritty, and vascular reaction on the cornea (Figure 10), it is often EK. In most cases, cats with EK will respond immediately and dramatically to steroids and the drug is gradually withdrawn over several weeks to a few months as the cornea essentially returns to normal with minimal scarring. The publisher, NAVC, disclaims any liability for any damages resulting from the use of any product advertised herein and suggests that readers fully investigate the products and claims prior to purchasing.
Many cases get referred because a veterinarian may notice a change during routine health examination. This cost structure will also include several post-operative checks in Palmerston North or in any of the other clinics I visit in New Zealand. I have seen cases where there has been noticeable benefits for the animal in this situation.
For peace of mind there may be a requirement for an earlier post-operative check than previously planned. Purchase test strips that have the numbered template right on the strip and are impregnated with a blue dye that travels up the strip as the tears moisten it (Figure 1). It’s extremely easy to make the reading too high by forcefully restraining the patient.
Signs of retinal atrophy include tapetal hyperreflectivity and vascular attenuation or absence. You examine the eye and think you see a superficial erosion toward the superocentral aspect of the cornea.
If severe adhesions develop between the iris and lens (Figure 9) or secondary glaucoma or retinal detachment occur, it is too late to save the eye. While articles have been peer-reviewed and strive to present the most accurate information available, there is no implication that material published herein represents the best or only procedure for a particular condition and, further, the views of the authors are not necessarily those of the NAVC. Many breeds have a greater propensity to develop cataracts so there is a greater awareness by breeders and owners of these breeds.
If you are suspicious that there was excessive eyelid pressure or patient restraint, retest the patient.
One easy way is to simply call your local veterinary ophthalmologist and see if you can watch a day of appointments. It is the responsibility of the reader to verify the accuracy and applicability of any information presented and to adapt as new data becomes publicly available. There are some special considerations both surgically and post operatively with regard to anti-inflammatory treatment one must consider in these cases, but overall the results are extremely gratifying. One hint to help a patient relax for a more thorough examination is to apply a couple of spaced drops of proparacaine. Abrams received his DVM from Oklahoma State University and completed an internship in small animal medicine and surgery at Angell Memorial Animal Hospital in Boston, Massachusetts, and a residency in comparative ophthalmology at University of Tennessee College of Veterinary Medicine. I am no longer surprised at the commitment many owners have for their animals and take great delight in restoring very useful vision to most of the cases I see.
Remember, a thorough, systematic examination backed by clinical experience will help determine the diagnosis and treatment in many patients.
Prior to founding his current practice, he was a staff ophthalmologist at Tufts University Cummings School of Veterinary Medicine and Angell Memorial Animal Hospital.



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