Ocular tumours

image of Ocular tumours
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In all cases of ocular and periocular tumours, it is important to carry out a thorough general physical examination in addition to a detailed ophthalmic examination. The chapter covers tumours of the orbit; tumours of the eyelid; tumours of the conjunctiva, third eyelid and external globe; intraocular tumours; ocular paraneoplastic signs;

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22.2 Left exophthalmos due to orbital meningioma in a 9-year-old cat. The exophthalmos was most readily evident when viewed from above: note the prominent left cornea shown in comparison with the right eye. An MRI scan showed that the tumour invaded the orbit from the brain.
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22.3 Right exophthalmos due to nasal adenocarcinoma invading the orbit. Note the ipsilateral nasal discharge.
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22.4 Papilloedema due to compression of the optic nerve by an orbital tumour in a dog. The optic nerve head protrudes into the vitreous, and the retinal blood vessels can be seen to change direction as they follow its course. The retina appears out of focus due to the narrow depth of field of the fundus camera.
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22.6 Canine sebaceous adenoma affecting the left eye of an 8-year-old West Highland White Terrier. This type of tumour arises from the meibomian gland opening on the eyelid margin. Eversion of the eyelid revealed swelling of the meibomian gland beneath the palpebral conjunctiva. (Courtesy of SM Crispin)
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22.7 Erosive basal cell carcinoma of the right upper eyelid in a 6-year-old cat.
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22.8 Mast cell tumour of the left upper eyelid in a 3-year-old cat.
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22.9 Multiple bilateral apocrine hidrocystomas affecting the lower eyelid in a 10-year-old Persian cat.
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22.11 Two examples of a group of immune-mediated conditions of the canine globe that may mimic tumours: nodular granulomatous episclerokeratitis in a 4-year-old English Springer Spaniel; necrotizing sclerokeratitis in a 2-year-old Golden Retriever. Definitive diagnosis is by biopsy.
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22.12 Staphyloma affecting the right eye of a 7-year-old crossbreed dog. This condition represents a focal area of scleral thinning with exposure of underlying choroidal pigment. The lesion can mimic ocular melanoma.
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22.13 Lymphoma infiltrating the right dorsal palpebral conjunctiva in a 4-month-old FeLV-positive DSH cat. This condition can mimic chronic conjunctivitis. Conjunctival biopsy is usually diagnostic.
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22.14 Canine epibulbar melanoma in a 6-year-old Golden Retriever. Epibulbar and limbal melanomas involve the episclera, not the overlying conjunctiva; note how the conjunctival blood vessels pass over the tumour and not into it.
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22.15 Canine anterior uveal melanoma in an 8-year-old Boxer dog, showing extraocular extension through the limbus. It is important to differentiate this from limbal melanoma.
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22.17 Benign anterior uveal melanoma affecting the iris in a 7-year-old crossbreed dog.
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22.18 Anterior uveal cyst in a 4-year-old crossbreed dog. Transillumination using focal illumination demonstrates its cystic nature.
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22.19 Anterior uveal melanoma in a 14-year-old cat. Note the pupil distortion and pigment deposition on the anterior lens capsule, both of which imply potential malignancy. Thickening of the iris was also evident on slit-lamp examination, and the intraocular pressure was elevated relative to the contralateral eye. In addition, gonioscopy revealed progression of the pigmented tumour towards the iridocorneal drainage angle (see Figure 22.26 ).
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22.20 Benign ocular melanosis in a 4-year-old cat.
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22.21 Ciliary body adenoma in a 10-year-old West Highland White Terrier. The mass protrudes through and distorts the pupil medially. In this case, FNA of the mass allowed cytological diagnosis.
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22.22 Rarely, pigmented iridociliary tumours are seen that may mimic anterior uveal melanoma. In this 11-year-old Staffordshire Bull Terrier, ophthalmic examination suggested an iris melanoma. However, histopathological examination following enucleation revealed a pigmented iridociliary tumour. (below, courtesy of J Mould)
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22.23 Multicentric lymphoma causing anterior uveitis in a 5-year-old Labrador Retriever. In this case chronic uveitis has caused extensive adhesions between the iris and lens capsule, leading to iris bombé and secondary glaucoma. Note the dense white circumcorneal band.
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22.24 Tonometry using an applanation tonometer. Care must be taken to avoid pressure on the neck, as this can artificially elevate intraocular pressure readings.
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22.25 Barkan-Lovac, Koeppe and Sussman goniolenses.
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22.26 Gonioscopy of the eye shown in Figure 22.19 using a Koeppe goniolens revealed pigmented tissue extending towards the pectinate fibres of the iridocorneal drainage angle.
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22.27 Aqueocentesis technique. This can aid diagnosis of ocular lymphoma when suggestive anterior segment signs such as anterior uveitis are present. It is rarely useful for diagnosis of other tumour types, since there is minimal cell shedding from most types of anterior segment tumours.
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22.28 Papilloedema in association with an intracranial mass in a 12-year-old West Highland White Terrier.
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