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tvpjournal.com | July/August 2015 | TodAy's VeTerinAry PrAcTice obserVATions in oPhThAlmology Peer reviewed 75 or subsequent to meibomianitis. rupture of the meibomian gland leads to release of sebaceous material into the palpebral tissue that causes an infammatory response. Pyogranulomatous blepharitis may be bilateral or unilateral, and clinical signs include exudative and ulcerative eyelid lesions, focal or diffuse eyelid swellings, conjunctival hyperemia, edema of the eyelid margins, and mucopurulent ocular discharge. 3,5,7,9 There is no well-defned breed predilection, but clinical reports indicate that dalmatians and miniature schnauzers may be overrepresented. 9 Diagnosis. diagnosis includes: • biopsy with histopathologic examination that demonstrates granulomas with macrophages and neutrophils, folliculitis, and meibomianitis; 6 cocci may also be observed • impression smears of skin lesions that demonstrate marked numbers of neutrophils and macrophages, with or without cocci. Treatment. Therapy includes: • initial management with doxycycline, oral corticosteroids, topical steroids, and topical cyclosporine 9 • long-term management with azathioprine for additional immune suppression. Immune-Mediated Blepharitis Pemphigus Complex Description. The pemphigus complex is a group of uncommon immune-mediated diseases with 5 described variants: vulgaris, foliaceous, erythematosus, vegetans, and bullous. Vulgaris, foliaceous, and erythematosus are the most well-documented variants, with foliaceous most commonly seen in small animal patients. in all types of pemphigus, autoantibodies against the intercellular matrix of the epidermis lead to a type ii hypersensitivity reaction, resulting in skin lesions. 6,7,10 The pemphigus group can involve the mucocutaneous junctions, with infammation and ulceration of the eyelids commonly seen. 7 Facial lesions involving the eyelids (pemphigus foliaceous and pemphigus erythematosus) are characterized by pustules or vesicles that eventually rupture, leaving erosions, ulcers, crusting, scaling, and hypopigmentation. 5 Pemphigus vulgaris (Figure 8) is the most severe type of pemphigus, in which the oral cavity, nail beds, skin, eyelids, lips, and nares are affected. 6 Pemphigus foliaceous and pemphigus vulgaris can be fatal, while pemphigus erythematosus is a more benign condition that rarely produces systemic signs and responds well to treatment. 3 Diagnosis. biopsy with histopathologic examination is important for differentiation between variants: • Pemphigus foliaceous: neutrophils or eosinophils present within vesicle or pustule, intragranular and subcorneal acantholysis with cleft and vesicle formation, and acantholytic epidermal cells found at surface of erosions • Pemphigus erythematosus: lichenoid infiltrate of plasma cells, mononuclear cells, and eosinophils FIGURE 8. Seven-year-old castrated male mixed breed dog with immune-mediated blepharitis (pemphigus vulgaris). Note the diffuse crusting, ulceration, discharge, and scales affecting both eyes and all 4 eyelids, and extending to the nasal planum and mucocutaneous junctions ( a). Biopsy of an affected area on the nasal planum revealed vesicle formation, with basal epidermal cells arranged in a row of "tombstones." The infammatory reaction was interstitial. Topical and systemic corticosteroids were used initially to control the disease, and long-term therapy may consist of immunosuppressive drugs, such as cyclophosphamide or azathioprine, and a consultation with a veterinary dermatologist. Close-up view of the left eye (B); note the diffuse crusting, ulceration, discharge, and scaling affecting the eye circumferentially. Courtesy Dr. David Wilkie A B