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| TOP TEN Many clients choose early evaluation by an ophthalmologist to prevent or treat lens- induced uveitis and will consider unilat- eral cataract surgery. There are a number of factors that affect the best timing for surgery; early referral allows the owner to become fully educated before severe complications occur. 9 It is crucial to perform clinical examinations in an orderly manner so as not to skip any steps that would help determine a diagnosis. if you can watch a day of appointments. I commonly have veterinarians visit my practice and see appointments side- by-side with me. Remember, a thor- ough, systematic examination backed by clinical experience will help determine the diagnosis and treatment in many patients. ■ Cat Corneas Can be Confusing Cats with conjunctivitis and corneal disease present a diagnostic enigma to both general practitioners and ophthalmologists. However, there is one disease that is easily recognized—eosinophilic keratitis (EK). EK is an immune-mediated disease often seen in young to middle-aged cats of all breeds. It may be triggered by herpesvirus, but treat- ment requires anti-inflam- matory medications (ie, topical steroids).5 A clinician may suspect a corneal ulcer since the lesion typically takes up f luorescein stain. However, when you see a granulation-type, gritty, and vascular reaction on the cornea (Figure 10), it is often EK. Figure 10. EK with typi- cal appearance of gritty, granular, and vascular- ized inflammation Treating…Eosinophilic Keratitis %FTQJUF TPNF TVQFSGJDJBM TUBJO VQUBLF EK requires use of topical steroids (prednisolone or dexamethasone). In most cases, cats with EK will respond immediately and dramatically to steroids and the drug is gradually withdrawn over TFWFSBM XFFLT UP B GFX NPOUIT BT UIF cornea essentially returns to normal with minimal scarring. EK may recur a year or more after treatment. 10 66 “Look Ma…No Fancy Tests” I’ve saved the 10th tip for last because it is the most important point of the article. As I mentioned in the introduction, ophthalmology is a discipline of clinical recognition. How do you gain clinical experience? One easy way is to simply call your local veterinary ophthalmologist and see Today’s Veterinary Practice July/August 2011 &, FPTJOPQIJMJD LFSBUJUJT ,$4 LFSBUPDPOKVODUJWJUJT TJDDB References 1. Salisbury MA, Kaswan RL, Ward DA, et al. Topical application of cyclosporine in the management of keratoconjunctivitis sicca. JAAHA 1990; 26:269-274. 2. Gelatt KN, MacKay EO. Distribution of intraocular pressure in dogs. Vet Ophthalmol 1998; 1(2-3):109-114. 3. Gwin, RM. Anterior uveitis: Diagnosis and treatment. Seminars Vet Med Surg 1988; 3(1):33-39. 4. Goodwin C. Canine cilia disorders. Vet Tech 1998; 19(2):115-125. 5. Paulsen ME, Lavach JD, Severin GA, Eichenbaum JD. Feline eosinophilic keratitis: A review of 15 clinical cases. JAAHA 1987; 23:63-69. Kenneth Abrams, DVM, Diplomate ACVO, is the president and founder of Veterinary Ophthalmology Services, Inc, in Warwick, Rhode Island. He is also the past president of the American College of Veterinary Ophthalmologists. His special interests include intraocular surgery, retinal diseases, and glaucoma. Dr. Abrams received his DVM from Oklahoma State University and completed an internship in small animal medicine and surgery at Angell Memorial Animal Hospital in Boston, Massachusetts, and a residency in comparative ophthalmology at University of Tennessee College of Veterinary Medicine. Prior to founding his current practice, he was a staff ophthalmologist at Tufts University Cummings School of Veterinary Medicine and Angell Memorial Animal Hospital.