Clinical techniques in small animal practice最新文献

Systemic feline diseases (parasitic, bacterial, fungal, viral, neoplastic, metabolic, vascular, and immune-mediated) are often associated with ocular symptoms. An ocular examination is an important diagnostic tool and should be part of any physical examination. Conversely, cats afflicted with systemic disease require periodic ocular examinations for prognostic information and to prevent vision threatening complications. Typical feline systemic diseases encountered by the practicing clinician are presented with their commonly associated ocular signs.

Feline herpesvirus type 1 (FHV-1) infection, but not necessarily chronic or recurrent disease, is common throughout domestic cat populations worldwide. Knowledge of a few essential virological facts permits practitioners to provide appropriate advice to owners of individual pet cats infected with this virus and to assist in the management of shelters and other multicat households in which the virus is enzootic. This article discusses pathogenesis, diagnostic techniques, and clinical signs considered characteristic of infection with FHV-1. Treatment options are considered under the broad categories of supportive care, antiviral agents, and adjunctive therapies.

Chlamydiae are an important cause of acute and chronic conjunctivitis in cats. Until recently, only one organism was thought to infect cats, Chlamydophila felis (previously Chlamydia psittaci var. felis). Recently, other Chlamydia-like organisms belonging to the family Parachlamydiaceae, which comprises organisms that reside and proliferate within free-living amoeba, have been identified in cats with neutrophilic and eosinophilic conjunctivitis. The relative importance of these organisms and their amoebic hosts requires investigation. There is also weak evidence that chlamydiae may also be capable of causing reproductive tract disease and lameness in cats. Diagnosis of chlamydial conjunctivitis requires use of specialized culture techniques or the polymerase chain reaction. The antibiotic of choice to treat these infections is doxycycline; azithromycin is less effective. All cats in the household should be treated simultaneously. The zoonotic potential of these organisms appears low, but some precaution is warranted when handling affected cats.

The cornea is naturally transparent. Anything that interferes with the cornea’s stromal architecture, contributes to blood vessel migration, increases corneal pigmentation, or predisposes to corneal edema, disrupts the corneas transparency and indicates corneal disease. The color, location, and shape and pattern of a corneal lesion can help in determining the underlying cause for the disease. Corneal disease is typically divided into congenital or acquired disorders. Congenital disorders, such as corneal dermoids are rare in cats, whereas acquired corneal disease associated with nonulcerative or ulcerative keratitis is common. Primary ocular disease, such as tear film instability, adenexal disease (medial canthal entropion, lagophthalmus, eyelid agenesis), and herpes keratitis are associated with the majority of acquired corneal disease in cats. Proliferative/eosinophilic keratitis, acute bullous keratopathy, and Florida keratopathy are common feline nonulcerative disorders. Nonprogressive ulcerative disease in cats, such as chronic corneal epithelial defects and corneal sequestration are more common than progressive corneal ulcerations.

Uveitis is the inflammation of any or all parts of the vascular tunic of the eye; the vascular tunic includes the iris, the ciliary body, and choroid. A good knowledge base, up-to-date reference materials, and good instruments will improve the diagnosis of uveitis. Feline uveitis can be caused by numerous infectious agents in addition to neoplasia and less likely trauma. The infectious causes most commonly associated with feline uveitis include feline leukemia virus, feline immunodeficiency virus, feline infectious peritonitis, systemic fungal infections, toxoplasmosis, and bartonellosis. Neoplastic causes of uveitis can be primary or secondary. Iris melanoma is the most common primary uveal neoplasia and trauma-associated sarcoma is the second most common primary uveal neoplasia. Treatment for the clinical signs of anterior uveitis include topical steroidal or non-steroidal anti-inflammatory agents, parasympatholytic agents for ciliary spasm, to keep the pupil dilated, and to prevent posterior synechia. Posterior uveitis should be treated with systemic medications that will address the underlying cause. Enucleation of blind, painful eyes not responsive to medications is a means to alleviate the animal’s discomfort and to further diagnose the underlying cause.

Congenital and inherited ocular diseases are reported less frequently in the cat than the dog. The 2 species also differ in their array of disorders, with familiar canine abnormalities like cataracts overshadowed by unique feline diseases such as eyelid agenesis and corneal sequestration. Organized according to the primary ocular structure affected and commingling congenital and inherited disorders in each section, the review begins with multiple ocular anomalies and their impact on globe-orbit relationship. Adnexal disorders include eyelid agenesis, entropion, dermoid, and nictitans gland protrusion. Corneal abnormalities range from the routine sequestrum and PPM-related opacity to those rare infiltrates accompanying inborn errors of metabolism. Brief descriptions of uveal anomalies, primary glaucoma, cataracts, and lens luxations follow. Retinal dysplasia and progressive retinal atrophy complete the summary. Suspicions of heritability are often based on small numbers of animals in sporadic reports of ocular disease, but the Persian, Burmese, and Siamese are among the breeds repeatedly linked with one or more of these disorders.

Feline ocular emergencies include any ophthalmic condition that has rapidly developed or is the result of trauma to the eye or periocular structures. Common feline emergencies include proptosis, lid lacerations, corneal ulcers, and foreign bodies. Complete ophthalmic examination including procurement of the minimal ophthalmic database (Schirmer tear test, fluorescein stain, and intraocular pressure measurement) should be obtained whenever possible to ensure that the complete and correct diagnosis is made. Concern for the patient’s vision and ocular comfort should guide the practioner’s diagnostic and therapeutic plan. This article reviews some of the more common feline ocular emergencies, including conditions affecting the orbit and globe, adnexa, conjunctiva, and cornea. Feline uveitis, glaucoma, and lenticular diseases are covered more thoroughly elsewhere in this issue.

The lens is the second most powerful structure for refraction in the eye, and is important in the fine-focusing ability in individual species. Specific disorders of the feline lens are frequent in clinical practice and include: congenital anomalies, nuclear sclerosis, cataracts, lens subluxations and luxations, intraocular sarcomas, and anterior lens displacement associated with aqueous misdirection glaucoma. Clinical signs and current therapeutic options are discussed for the general practitioner. A close working relationship with the regional veterinary ophthalmologist is advised.