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Management of eye disease

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Abstract

This chapter will focus on the management of some of the more common feline eye diseases encountered in first-opinion practice, notably conjunctivitis, corneal ulceration, uveitis, glaucoma and lens luxation. : Enucleation.

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Figures

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8.1 Bilateral serous ocular discharge, third eyelid protrusion with conjunctival hyperaemia and a corneal opacity in the left eye due to corneal ulceration in a kitten with FHV infection.
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8.2 Dendritic corneal ulceration, visible as branching fluorescein-positive green lines. This is pathognomonic for FHV infection of the eye but is not always present.
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8.3 Purulent ocular discharge, chemosis and conjunctival hyperaemia in a cat with infection. A deep corneal ulcer is also present, although corneal ulceration is not typically a feature of infection.
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8.4 Corneal ulcers. Very deep stromal ulcer. Medially there is corneal oedema, making the cornea appear white, while laterally there is stromal infiltration with blood vessels – a fibrovascular healing response. Large deep corneal ulcer with rupture. A large clot of aqueous humour is present ventrally (arrowed), plugging the defect. Deep central corneal ulcer, which had previously ruptured and then self-sealed, with corneal oedema and neovascularization visible around it.
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8.5 Appearance of the eye in Figure 8.4a six weeks later. The eye was treated with topical autologous serum and ofloxacin for 1 week, then topical fusidic acid for 2 weeks. This photograph is slightly overexposed but it is possible to see that the cornea has regained much of its clarity, apart from some faint grey fibrosis visible throughout, and there is no visible neovascularization.
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8.6 Appearance of the eye in Figure 8.4b six weeks after corneal pedicle graft placement from the lateral aspect. The conjunctival graft is well vascularized and incorporated nicely into the cornea; the epithelium of the cornea and conjunctiva are smooth and continuous.
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8.7 Corneal sequestrum. A central black corneal sequestrum is surrounded by a rim of fibrovascular tissue (pink) and oedema (white) and has evoked a neovascularization reaction from the dorsal limbus. In this situation, the sequestrum appears to have been caused by multiple distichia from the upper eyelid (arrowed). A corneal sequestrum has developed in the stroma at the centre of a chronic corneal indolent ulcer that failed to heal despite topical antibiotic treatment. At the edge of the ulcer the epithelium is non-adherent, allowing fluorescein stain to under-run it. There is corneal neovascularization from the dorsolateral aspect and corneal oedema (white area) below the ulcer. The centre of the ulcer is black because it has become necrotic.
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8.8 Eosinophilic keratoconjunctivitis. There is white mucoid ocular discharge, a white corneal stromal infiltrate and corneal neovascularization; corneal cytology confirmed eosinophilic keratoconjunctivitis. The other eye of the cat showed a whitish corneal infiltrate medially, which was probably an earlier stage of the disease process.
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8.9 The appearance of the eye featured in Figure 8.8a six weeks after treatment with topical prednisolone three times daily. The cornea has markedly improved, but faint neovascularization and white stromal infiltrate remains, so treatment needs to continue though it can be reduced to once daily.
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8.10 Anterior uveitis. Multiple cream to brown opacities on the corneal endothelium (keratic precipitates) and loss of iris detail are visible in this kitten with FIP. There are multiple keratic precipitates on the ventral aspect of the corneal endothelium, which appear white when silhouetted against the pupil and dark when silhouetted against the iris. A hair is present on the cornea. New blood vessel formation can be seen on the surface of the iris (rubreosis iridis). There are multifocal areas of increased pigmentation on the iris.
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8.11 Dilated pupil and small pigment opacities (arrowed) on the anterior lens capsule due to glaucoma secondary to uveitis. There is a posterior synechia at the 1 o’clock position, making the pupil margin irregular.
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8.12 This lens has increased opacity and is sitting in the ventral aspect of the anterior chamber due to anterior lens luxation secondary to uveitis. Note the smooth round edge of the lens – never visible in a normal eye.
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