The conjunctiva and third eyelid

image of The conjunctiva and third eyelid
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This chapter deals with the conjunctiva and third eyelid, investigation of disease, canine and feline conditions.

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11.1 Anatomy of the conjunctiva.
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11.2 Conjunctival (white arrow) and episcleral (black arrow) blood vessels. Conjunctival blood vessels are longer, have more branches and are located more superficially than episcleral blood vessels.
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11.3 Epibulbar dermoid in a 4-month-old German Shepherd Dog, involving the conjunctiva and the lateral lower eyelid.
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11.4 A 3-year-old St Bernard with chemosis of unknown cause.
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11.5 Follicular conjunctivitis in a 5-year-old Leonberger and a 10-year-old Jack Russell Terrier.
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11.6 Ligneous conjunctivitis in a 4-year-old Dobermann. Note the greyish veil of pseudomembrane over the leading edge of the third eyelid.
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11.7 A 10-year-old Labrador Retriever with radiation-induced conjunctivitis (following external beam radiation for sinus neoplasia).
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11.8 An 11-year-old Labrador Retriever with pyogranulomatous blepharoconjunctivitis diagnosed on conjunctival biopsy.
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11.9 An 11-year-old German Shepherd Dog with zygomatic gland adenocarcinoma causing increased conjunctival exposure and secondary conjunctival hyperaemia.
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11.11 Subconjunctival fat prolapse. (Courtesy of G McLellan)
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11.13 Conjunctival mast cell tumour in a 9-year-old Labrador Retriever.
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11.14 Conjunctival papilloma in an 8-year-old Lhasa Apso.
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11.15 Subconjunctival haemorrhage and hyphaema in a 12-month-old Whippet following head trauma.
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11.16 Bilateral subconjunctival haemorrhage in a 5-year-old Labrador Retriever with a coagulopathy.
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11.17 Conjunctival haemorrhage following a suspected chemical injury in a Labrador Retriever.
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11.18 Alkaline injury to the right eye of a 6-year-old Rottweiler that occurred 24 hours previously.
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11.19 An 18-month-old Whippet, 2 months following an alkaline injury (caustic soda) to the right eye. Note the conjunctival adhesion and fornix shortening.
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11.20 Conjunctival foreign body (plant material) in a 10-year-old Yorkshire Terrier.
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11.21 An 8-week-old Burmese kitten with an epibulbar dermoid (no eyelid involvement).
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11.22 Conjunctivalization of the limbus in a Siamese kitten with FHV-1 infection. Note also the third eyelid hyperaemia and clear ocular discharge.
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11.23 FHV-1 conjunctivitis in a Domestic Shorthaired kitten.
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11.25 Acute conjunctivitis in a Domestic Shorthaired kitten. Note the marked chemosis and lacrimation.
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11.26 Eosinophilic keratoconjunctivitis. An 18-month-old Maine Coon cat. Note the cream coloured cellular deposits on the cornea and bulbar conjunctiva. A 3-year-old Domestic Shorthaired cat with severe disease.
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11.27 Symblepharon in a young adult cat. Note the conjunctivalization of the dorsolateral cornea and third eyelid protrusion due to the adhesions.
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11.29 Eyelid squamous cell carcinoma in a 10-year-old Domestic Shorthaired cat. Note the involvement of the conjunctiva and third eyelid.
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11.30 Lymphoma infiltration of the conjunctiva in a 4-month-old cat with feline leukaemia virus. (Courtesy of D Gould)
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11.31 Anatomy of the third eyelid and nictitans gland.
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11.32 A 16-month-old Great Dane with scrolled cartilage of the left third eyelid.
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11.33 Third eyelid gland prolapse in a 9-month-old Bulldog.
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11.34 Mucosal pocket technique for prolapsed third eyelid gland replacement. Appearance of prolapsed third eyelid gland. A pocket is created inferior to the globe, through the conjunctiva, into which the gland is placed. Conjunctival incisions are made superior and inferior to the gland prolapse on the posterior surface of the third eyelid. A subconjunctival pocket is bluntly dissected inferiomedial to the globe via the inferior incision in the conjunctiva. The two incisions are then partially closed using buried absorbable sutures (6/0 (0.7 metric) polyglactin) with the gland ‘pocketed’. Care should be taken not to close the ends of the pocket to allow glandular secretion to escape and avoid the possible complication of cyst formation. It is important that the suture material is fully buried and does not contact the cornea, because this usually results in ulceration. The use of surgical loupes is strongly recommended for this technique. (Illustration by Roser Tetas Pont)
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11.35 Suturing of the third eyelid gland to the orbital rim as a treatment for prolapse of the gland. Forceps grasp the periphery of the free margin of the third eyelid and pull it across the eye (stay sutures may be used). An incision is made in the inferiomedial conjunctival fornix (at the base of the third eyelid) using scissors. Blunt dissection allows access to the periosteum of the medioventral orbital rim. A firm bite of periosteum along the orbital rim is taken using 3/0 (2 metric) polydioxanone or monofilament nylon: the suture material (with a swaged-on needle) is introduced through the previously made incision. It can be a little difficult to obtain a bite of periosteum and bring the needle out through the original incision, because access to the area is limited. After taking a bite of orbital periosteum, the needle is passed through the original incision dorsally to the prolapsed gland to emerge from the gland at its most prominent point of prolapse. With the third eyelid everted, the needle is passed back through the exit hole in the gland to take a horizontal bite through the most prominent part of the gland. Finally, the needle is passed back through the last exit hole to emerge through the original incision in the conjunctival fornix, thus encircling a large portion of the gland. The suture ends are then tied. This creates a loop of suture through the gland which anchors it to the periosteum of the orbital rim, preventing it from re-prolapsing. The conjunctival incision can now be repaired using 6/0 (0.7 metric) polyglactin or may be left unsutured. Topical antibiotic cover is provided postoperatively.
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11.36 Cyst originating from the third eyelid gland in a Golden Retriever following mucosal pocketing surgery. Excised cyst for gland prolapse.
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11.38 A 6-year-old Domestic Shorthaired cat with a retrobulbar abscess causing third eyelid protrusion and hyperaemia.
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11.39 A 10-year-old Collie cross with orbital neoplasia (myxosarcoma) causing third eyelid protrusion.
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11.40 A 6-year-old Golden Retriever with idiopathic Horner’s syndrome, showing third eyelid protrusion with miosis and ptosis affecting the left eye.
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11.41 Tetanus in a 4-year-old English Bull Terrier. Note the pricked ears and bilateral third eyelid protrusion.
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11.43 Extensive third eyelid squamous cell carcinoma in a 12-year-old Domestic Shorthaired cat.
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11.44 Conjunctival melanoma in an 8-year-old Great Dane cross.
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11.45 Third eyelid histiocytoma in a 13-month-old English Springer Spaniel.
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11.46 Multicentric lymphoma presenting as third eyelid thickening in a 5-year-old English Cocker Spaniel.
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11.47 Conjunctival and third eyelid lymphosarcoma as part of multicentric disease in a 12-year-old Domestic Shorthaired cat.
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11.48 Plasma cell infiltrates of the third eyelid in a 4-year-old German Shepherd Dog. Note the smooth pink–tan nodules along the third eyelid margin and on the anterior surface of the third eyelid.
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