Today's Veterinary Practice

JUL-AUG 2015

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TodAy's VeTerinAry PrAcTice | July/August 2015 | tvpjournal.com obserVATions in oPhThAlmology Peer reviewed 74 severe, a short tapering course of corticosteroids can be initiated. since staphylococcal toxins may have a necrotizing effect, topical corticosteroids may be benefcial. With therapy, improvement is usually observed within 7 to 10 days. Parasitic Blepharitis ( Demodex, Sarcoptes, & Cuterebra Species) Description. Parasitic blepharitis is most often caused by infestation with Demodex and Sarcoptes species, 5 with D canis (Figure 6) most commonly isolated. localized demodicosis occurs in animals younger than 10 months of age, with lesions characterized by circumscribed alopecia, mild erythema, and scaling, which may be unilateral. 5 lesions can often be complicated by secondary bacterial infections that lead to marked periocular swelling and moist erythematous lesions. 5 in older animals, demodicosis tends to be more generalized. Sarcoptes scabei infection affecting the eyelids is characterized by adherent crusts, thickening, and partial alopecia, but it more commonly affects the elbows, ears, and hocks, with erythematous papules, crusts, intense pruritus, and alopecia. 5,7 eyelid disease is unlikely to be seen alone with Sarcoptes infection. 5 infestation with Cuterebra species has been reported in the conjunctiva of a puppy. 7,8 The larva enters the conjunctiva or eyelid surface and leaves a thick- walled identifying entry hole. 7,8 Cuterebra larvae cause a focal parasitic blepharitis, with presence of a draining tract. Diagnosis. diagnostic approach is determined by suspected parasite species: • Demodex species: Trichography with or without skin scraping and microscopic observation of mites • Sarcoptes species: clinical signs, skin scraping, or biopsy with microscopic observation of mites, or response to therapy • Cuterebra species: clinical signs and presence of a draining tract. Treatment. similar to diagnosis, therapeutic approach is specifc to parasite species identifed: • Demodex species: spontaneous regression of localized disease occurs, with treatment seldom required; systemic antibiotic therapy indicated if a secondary bacterial infection is present. Amitraz can be used if systemic disease is present. ivermectin and moxidectin can also be used for treatment of systemic disease. • Sarcoptes species: sulfur dips or amitraz can be used with systemic disease without eyelid involvement. With eyelid involvement, consider using moxidectin or selamectin as approved therapies. • Cuterebra species: larva removal, topical antibiotic therapy for visible draining tract, and systemic antibiotic therapy. Pyogranulomatous Blepharitis Description. Pyogranulomatous lesions (Figure 7 ) are well circumscribed and contain predominantly macrophages and neutrophils. 9 The disease can occur as part of a dermatologic condition, particularly in response to rupture of a hair follicle FIGURE 7. Six-year-old spayed female Irish setter with pyogranulomatous blepharitis. Note the well-circumscribed pyogranulomas, diffuse eyelid swelling, erythema, and edema of eyelid margins. Biopsy of one of the well-circumscribed lesions revealed granulomas with macrophages, neutrophils, and evidence of folliculitis. A combination of oral doxycycline, oral and topical steroids, and topical cyclosporine was used for initial management. Long-term management included azathioprine for additional immune suppression. Courtesy Dr. Ellen B. Belknap FIGURE 6. Three-year-old spayed female mixed breed dog with parasitic blepharitis ( Demodex species). Note the circumferential alopecia, crusting, discharge, and erythema. A secondary bacterial colonization of the eyelids is present. Skin scraping and trichogram yielded numerous Demodex mites. Oral antimicrobial therapy combined with oral and injectable ivermectin was curative. Courtesy Dr. Kevin Shanley

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