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Feline Ophthalmology

David A. Wilkie DVM, MS, DiplomateACVO

Professor EmeritusThe Ohio State University

Wilkie.1@osu.edu

Agenesisn lack of development

of the upper eyelidn superior-temporal

50% of the eyelidn usually bilateral

Dziezyc/Millichamp modification

What is wrong with this image?

What the books tell you to do

Dziezyc/Millichamp modification

What is wrong with this image?

What the books tell you to do

Hair grows towards the cornea!!

Lip to Lid

From: Popesko P: Atlas of topographical anatomy of the domestic animals

Parotid duct

Facial v.Facial n. dorsal and ventral buccal branch

Orbicularis oris

Bucinnator

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Lip to Lid

Whittaker CJG, Wilkie DA, et al: Lip commissure to eyelidtransposition for repair of feline eyelid agenesis. Vet Ophth 13:173-178, 2010

Parotid Duct

Oral Mucosa

Bridge incision

Bridge incision

Conjunctiva to oral mucosa8-0 vicryl simple continuous

Immediately Post-op

Immediately Post-op

2 months Post-op Symblepharon

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AnkyloblepharonSymblepharon

Preop-9 months old-has not seen since birth

Ankyloblepharon/Symblepharon

Preop

Postop

EntropionOften acquired, secondary to corneal disease

Permanent Lateral Tarrsoraphy

Modified Hotz-Celsus

A combined HC and lateral canthal closure had a 99.21% success rate of resolving lower lid entropion

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Eyelid Neoplasia

COPLOW - Comparative Ocular Pathology Laboratory of Wisconsin

Feline Eyelid Neoplasia

SCC SCC

Mast Cell Fibrosarcoma

Mast CellTumor Peripheral Nerve Sheath Tumor

Coplow

Mast Cell Tumor

ResultsAll periocular CMCTs were restricted to the eyelids. In addition to surgical excision, three cats were treated with adjunctive therapy (strontium-90 irradiation or cryotherapy) intraoperatively. Local tumor control was achieved in 22/23 cats with a minimum follow-up of 30 days (median follow-up time of 711 days); one cat developed disseminated CMCTs but no local recurrence. Cats with periocular CMCTs had a median survival time of 945 days. Metastatic disease involving peripheral lymph nodes or abdominal viscera was not detected in any cat at any time during the study. All periocularCMCTs were classified as low-grade based on histopathology, and complete excision was achieved in approximately 50% of cases.

Conclusions Surgical excision of periocular CMCTs in cats is an effective treatment option with rare local recurrence and metastases, even following incomplete surgical

excision.

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Feline conjunctival melanoma Feline conjunctival melanomaConjunctival Melanoma- 55% mortality

Eyelid Neoplasian Treatment:

n Dog vs. Catn Benign neglectn Surgery

n Excisional biopsyn Cryosurgeryn CO2 laser

n Chemotherapyn Radiation

1/3<1/3 <1/3

How much can I remove?

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n Reconstruction of larger eyelid mass excisionsn H-plasty/Z-plastyn Semicircular flapn Split eyelid flapn Cross eyelid flapn Rhomboid graft flapn Lip to Lidn Axial pattern flap

n H-Plastyn Repair of larger

excisionsn Preserve as much

conjunctiva as possible

n Diverging incisions

From: Projects by Dittmann J: http://www.delta-3.de/

ab

b = 120% a

Z-Plasty-for lateral canthus

From: Projects by Dittmann J: http://www.delta-3.de/

Feline Mast Cell Tumor

Z-Plasty Z-Plasty

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Post-op

Suture Removal

Feline SCC Axial Pattern Flap

5 days post cryo for conjunctival/eyelid hemangiosarcoma

Infectious Feline Conjunctivitis

n Clinical Signsn epiphora - usually

serousn blepharospasmn chemosisn conjunctival

hyperemia

Infectious Feline Conjunctivitis

n Clinical Signsn epiphora - usually

serousn blepharospasmn chemosisn conjunctival

hyperemian +/- Corneal

ulceration

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Infectious Feline Conjunctivitis

n Etiologyn Herpes felisn Chlamydophila felisn Calicivirus

Chlamydophila felisconjunctivitis

n Diagnosisn clinical signsn presence of

elementary bodies in the conjunctival epithelial cells

Chlamydophila felisconjunctivitis

n Potential zoonosis

Chlamydophila felisconjunctivitis

n Treatmentn Antibiotics

n Tetracyclinen 4x/day OU

n Erythromycin/Macrolides

n wash hands

Herpes felisn 3 syndromes in the cat based on the

age of the patient:n Ophthalmia neonatorum - <4 weeks

oldn Adolescent catn Adult cat

Ophthalmia neonatorum n purulent discharge, usually bilateraln corneal ulceration - severen upper respiratory infection oftenn Secondary bacterial opportunistsn �Barn cat Syndrome�

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Symblepharon

Adolescent cat -herpes n ulcerative keratitis, conjunctivitisn upper respiratory infectionn uni- or bilateral

Adult cat - herpesn classic dendritic

ulcern no URT signs

Herpesn Diagnosis

n dendritic or punctate superficial corneal ulcersn pathognomonic

for herpes keratitis

Herpes felisn 70% of cats infected with herpes virus

will become carriersn recurrent conjunctivitis/keratitisn stress and immunosuppression will

predispose to recurrencen FeLVn FIVn Other

Herpes felisn Diagnosis:

n History - previous stress?

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Herpes felisn Treatment:

n Antiviral agents topicallynIdoxuridine - Stoxil, HerplexnTrifluorothymidine - Viropticnq2-4 hr

n Cidofovir 0.5%nQ12 hr

Herpes felisn Treatment

n Antivirals - Systemicn Famciclovir

n Variable doses listedn 65 mg/cat divided dailyn New data suggests 40 mg/kg POn 90 mg/kg PO TID

Herpes felisn Treatment:

n L-lysine, 250-500 mg/day PO

Acute Eruptive Keratopathy

Possible association with systemicImmunosuppression

PrednisoneCyclosporin

Acute Eruptive Bullous Keratopathy

Descemet’s membrane rupture

Acute Eruptive Bullous Keratopathy4 hr preop

1 hr preop

4 wk Post-op

4 wk Post-op

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Acute Eruptive Keratopathy

Treatment with conjunctivalgraft or 3rd eyelid flap

Eosinophilic Keratitis

Eosinophilic keratitis n Diagnosis:

n Cytologyn Mast cellsn Eosinophils

Eosinophilic keratitis

Eosinophilic keratitis n Treatment:

n Topical cyclosporine

Eosinophilic keratitis n Treatment:

n Topical corticosteroidsn4-6x/day for 7 days nThen taper to control

n Note the risk for Herpes

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Pre treatment

7 days Post treatment with 0.1% dexamethasone

Eosinophilic Keratitis n Treatment

n Ovaban® n 5mg/cat SID for 4-7 daysn taper the dose to a maintenance level of 1.25 -

2.5mg/cat/weekn side effects:

n weight gainn mammary gland hyperplasia and neoplasian diabetes mellitusn behavior changes

n Topicaln 0.5% compounded

n BID-TID

n Stiles: ACVO 2015

Corneal Sequestrationn Clinical signs

n Brown-black corneal lesion

n Painful, often vascularized, fluorescein negative

n Associated with Herpes keratitis

n Can cause with:n Topical steroidsn Grid keratotomy

Corneal Sequestrationn Risk factors

n Brachycephalic catn Chronic irritationn Herpes

SequestrumMay spontaneously slough

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Corneal Sequestration n Treatment

n Superficial keratectomy

Sequestrum

Preop

Postop

Corneal Sequestration n Treatment

n Superficial keratectomy

n Conjunctival graftn Amnionn Corneal graft

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Corneal Ulcer

n Do cats get indolent ulcers?n Yes

Corneal Ulcern Do cats get indolent ulcers?

n Yesn Can I do a debridement and a grid

keratotomy?n NO!

Diamond Burr Debridement

Courtesy Dr Enry Garcia, University of Colorado

Jury still out on cats

Feline UveitisAnterior Uveitis

n Etiologiesn The etiologies of anterior uveitis can

be either ocular or systemic.

OcularSystemic

Uveitis

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Anterior Uveitisn Ocular Etiologies

n There are only 4 main ocular causes, rule them out first

Anterior Uveitisn Ocular:

n Corneal ulceration

n Lens-inducedn Ocular trauman Neoplasia

n primary

Anterior Uveitisn Systemic Etiologies:

n Bacteremia, viremia, or septicemian Autoimmunen Metastatic neoplasian A complete physical examination is

therefore essential.

Feline Uveitisn Davidson MG, Nasisse MP, et al. Feline Anterior

Uveitis: A study of 53 cases. J Am An Hosp Assoc1991;27:77-83

n Lappin MR, Marks A, et al. Serologic prevalence of selected infectious diseases in cats with uveitis. JAVMA 1992;201:1005-1016

n Peiffer RL, Wilcock BP, et al. Histopathologic study of uveitis in cats: 139 cases (1978-1988). JAVMA 1991;198:135-138

Feline Uveitisn Mean Age - 8.6 yrsn 2.6 : 1 male to femalen Most breeds w/ DSH or DLH

predominate

Feline Uveitisn Idiopathic / Immune-mediated

n (58% MGD; 33%RLP)n Neoplasia

n (13% MGD; 23% RLP)n Systemic infectious disease

n (26% MGD; 24.5% RLP; 83.1% MRL)

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Feline Infectious Disease• FELV (12%)• FIP (5-19%)• Toxo (5-75%)• FIV (13-21%)• Crypto (2%)• Bartonella

Cat may have more than one of these

Crypto

Crypto Crypto

Dr. Mike Davidson

FeLV FIV - Retinal dysplasia

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Toxo FIP

Dr. Mike Davidson

FIP FIP

FIP Histoplasmosis

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What is this? What would you do? Blastomycosis6 days later

Incidence of Bartonella Infection in US Cats

20% OVERALL

Regions: 1.2.3.4.

17%9%

28%22%

States with the highest incidence of infectionStates with moderately high incidence of infectionStates with moderate incidence of infectionStates with low incidence of infection

Incidence of Bartonella infection in cats increases in hot and humid climates because fleas flourish in these conditions.

Jameson, et al. J Inf Dis 172: 1145-9, 1995. CDC

20% OVERALL

Pre-treatment

Post-treatment

Bartonella +

Bartonella -Anterior Uveitis OU

n DSH, 7 months oldn Negative for: FIV, FeLV, toxoplasmosis, and FIP

Anterior Uveitisn Diagnostic Tests

n History - Duration, progression of diseasen Physical examination n Complete blood countn WBC count, Differentialn Platlet count

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Anterior Uveitisn Diagnostic Tests

n Biochemical profilen Serology

n FeLV, FIV, Toxo, Bartonella, Fungal

n Radiologyn Ultrasoundn Cytology/Histopathology

Ocular Oncology

Primary - intraocular Secondary - intraocular

Melanoma LymphosarcomaAdenoma/Adenocarcinoma CarcinomaSpindle cell sarcoma - cat Sarcoma

Primary or Secondary? Feline Neoplastic Uveitisn Lymphosarcoma #1

Feline Neoplastic Uveitisn Uveal melanoma

Enucleate

MonitorMonitor

Neoplasian Primary

n Melanoman anterior uvea (iris & ciliary body).n Incidence of metastasis may be as high as 60%n mitotic index for the tumor

n exceeds 10/HPF - malignant

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Progression over 4 years

- significance?-what would you

recommend?

Feline Iris Melanoma -suspected

Differential diagnosisuveal cysts

Neoplasian Primary

n Feline Spindle Cell Sarcoma (post-traumatic sarcoma)

Traumatic laceration- 4yr previously

Neoplasian Primary

n Feline Spindle Cell Sarcoma (post-traumatic sarcoma)n Arise from lens epithelial cells?? n Raren Induced by intraocular gentocin?n Highly malignant

n Metastasize n invade along the optic nerve to the

CNSn All blind feline eyes with evidence of

prior trauma or inflammation should be considered for enucleation

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Feline post-traumatic sarcoma Glaucoman Glaucoma in the cat is

rare compared to the dog

n Most cases of feline glaucoma are secondary in nature (87%)-uveitis-neoplasia

Glaucoman Clinical signs

n Subtle compared with canine

n The cat, generally does not exhibit pain, redness, or diffuse corneal edema

Primary Glaucoma n Although rare, I do believe that primary

open-angle glaucoma occurs in the Siamese catn European shorthairn Burmese

Glaucoman Be cautious with topical alpha-2

agonistsn Likely should avoid!n Sedation, cardiovascularn Death?

Secondary Glaucoman Etiologies

n Synechian Uveitis

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Uveal Cysts and Glaucoma

Uveal Cysts and Glaucoma

Diode laser ablation

Optic Nerven Excessive

myelinationn Aged cat

Enrofloxacinn Acute Blindness in Catsn Occurs at therapeutic dosen Irreversible

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Enrofloxacin 50mg/kgRetinal Detachment

n Etiologiesn Inflammationn Trauman Hypertensionn Infectious

Hypertension

Feline Hypertensive Retinopathy Feline Hypertensive Retinopathy

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Feline Hypertensive Retinopathy

Hypertensionn Treatment

nAmlodipinen Cat ¼ to ½ of a 2.5 mg tablet (0.625 to 1.25 mg)

given once or twice dailyn Dog 0.1 to 0.4 mg/kg PO, given once or twice daily

nEnalapriln Cat 0.25 to 0.5 mg/kg PO once or daily n Dog 0.5 to 1 mg/kg PO q12h