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Ocular problems

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Abstract

Ocular problems are commonly encountered in general practice and can range from conjunctivitis to sight-threatening emergencies. This chapter describes how to conduct a thorough ophthalmic examination, as well as how to recognize and manage common ocular problems. This chapter looks at the ophthalmic examination, conditions of the eyelids, conditions of the nictitating membrane (third eyelid), conditions of the conjunctival sac, conditions of the nasolacrimal system, conditions of the cornea, conditions of the iris, glaucoma, conditions of the lens, conditions of the retina and conditions of the globe and orbit.

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Figures

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21.1 Restraining a patient for an ophthalmic examination.
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21.2 Distant direct ophthalmoscopy.
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21.3 Binocular indirect ophthalmoscopy.
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21.4 Monocular indirect ophthalmoscopy.
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21.5 Eliciting a menace response by advancing a hand in front of the eye.
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21.8 Corneal lesions. Superficial corneal vascularization in a 5-year-old Bulldog bitch, secondary to upper lid distichiasis. The keratitis responded to removal of the extra lashes and symptomatic topical dexamethasone and ciclosporin. Deep vascularization, evident as a purple brush border, in a 14-year-old Cocker Spaniel with uveitis. (Courtesy of Chris Dixon) Corneal oedema is evident as a diffuse blue-white opacification of the cornea in this 7-year-old male Boston Terrier with primary endothelial degeneration. (Courtesy of Chris Dixon) Corneal lipidosis in a 5-year-old male Boxer; the lesion was non-progressive and clinically insignificant. Corneal calcification in a 12-year-old Yorkshire Terrier bitch. The associated ulceration resulted in corneal perforation and necessitated enucleation. Corneal scarring in a 6-year-old Springer Spaniel bitch, as a result of an alkali burn. The ulceration healed with conservative management and the scarring, although dense, did not cause a significant visual impairment. Superficial corneal pigmentation in a 4-year-old male Pug due to chronic exposure keratitis caused by the large palpebral aperture and the exophthalmic conformation.
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21.9 Normal canine fundus. Note the branching retinal vascularization, coloration of the tapetal fundus and irregular myelinated margin of the optic disc.
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21.10 Lower lid entropion in a 7-month-old male Bulldog.
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21.11 Lower lid entropion is most readily corrected by excising a crescent from the affected lower eyelid (Hotz–Celsus resection). Keeping the incision close to the lid margin (ideally within 2 mm) turns the eyelid out instead of pulling it down, and reduces the risk of iatrogenic ectropion. Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission.
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21.12 A temporary tarsorrhaphy suture to correct lateral lower lid entropion in a 14-week-old Labrador Retriever bitch.
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21.13 Diamond eye conformation in a 6-year-old Clumber Spaniel bitch.
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21.14 Small eyelid defects can be closed with simple interrupted sutures, entrapping the ends of the suture material at the eyelid margin within the adjacent suture to prevent corneal abrasion. Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission.
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21.15 A more secure closure, suitable for larger defects, is achieved with a 2-layer continuous suture starting from the eyelid margin and progressing within the subconjunctival stroma up to the margin, and returning to close the cutaneous layer. Exiting and entering the eyelid margin through the meibomian gland openings helps to ensure accurate closure of the eyelid margin. Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission.
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21.16 Distichiasis. The extra lashes arising from the meibomian glands are readily identified when silhouetted against the sclera.
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21.17 Upper eyelid ectopic cilia (arrowed), emerging through the palpebral conjunctiva adjacent to a small pigmented focus.
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21.18 Third eyelid gland prolapse in a 4-month-old male Bulldog.
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21.19 Keratoconjunctivitis sicca showing the characteristic tenacious ocular discharge.
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21.20 Epithelial dystrophy in an 8-year-old Boxer bitch.
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21.21 Descemetocele in a 6-year-old Cavalier King Charles Spaniel bitch with concurrent keratoconjunctivitis sicca. The cornea was repaired successfully with a conjunctival pedicle graft.
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21.22 Melting ulcer.
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21.23 Pannus in a 6-year-old German Shepherd Dog bitch.
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21.24 Iris cyst in a 7-year-old male Labrador Retriever.
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21.25 Glaucoma with episcleral vascular congestion and corneal oedema.
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21.26 Posterior polar subcapsular cortical cataract in a 4-year-old male Labrador Retriever, characteristic of inherited cataracts in this breed.
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21.27 Anterior lens luxation in a 4-year-old Lancashire Heeler. The lens equator can be seen refracting the light, and focal corneal oedema is present due to the endothelial decompensation where the lens is contacting the corneal endothelium.
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21.28 Advanced retinal degeneration characterized by retinal vascular attenuation, tapetal hyper-reflectivity and optic disc demyelination.

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