Today's Veterinary Practice

MAY-JUN 2013

Today's Veterinary Practice provides comprehensive information to keep every small animal practitioner up to date on companion animal medicine and surgery as well as practice building and management.

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| CLINICAL APPROACH TO THE CANINE RED EYE (continued from page 18) • Cataracts (lens-induced uveitis) • Corneal ulceration • Intraocular neoplasia • Other external evidence of trauma. As for any other inflammatory conditions, underlying etiology must be determined in order to institute proper therapy. However, this determination is often impossible even with thorough diagnostic investigation. Treatment Treatment should be directed at addressing the primary cause and decreasing pain and inflammation. • Atropine 1% Q 6–8 H may be used to relieve miosis and pain; it should not be used in patients with normal or elevated IOP in the face of uveitis as it will exacerbate glaucoma. • Prednisolone acetate 1% ophthalmic suspension (Q 4–6 H38) and/or topical NSAIDs, such as diclofenac sodium 0.1% or flurbiprofen sodium 0.03%, can be used alone or in combination to reduce intraocular inflammation. • Systemic NSAIDs, such as IV meloxicam (0.2 mg/kg)39 and oral firocoxib (5 mg/kg),40 may be beneficial in controlling inflammation associated with uveitis; however, concurrent disease and hepatic and renal function should be considered before using systemic NSAIDs. • Systemic glucocorticoids should only be used to treat uveitis after infectious causes and neoplasms requiring chemotherapy, such as lymphoma, have been ruled out. Clinical Note: Referral to an ophthalmic specialist is appropriate for management of severe or resistant cases of uveitis. OTHER CAUSES OF RED EYE This article has focused on causes of red eye that are most likely to threaten vision. However, it is important to remember that there are other causes for the apparently "acute" red eye, including more insidious disorders that are perceived as acute by the owner. These include: • Blepharitis associated with lid lacerations, pyogranulomatous blepharitis, and infectious blepharitis, which often present as a cause of acute ocular redness • Conjunctivitis (KCS, allergic conjunctivitis) and prolapsed gland of the third eyelid ("cherry eye") • Nonulcerative keratitis, such as chronic superficial keratitis (pannus), qualitative tear film abnormalities, and other keratopathies without ulceration • Orbital diseases (cellulitis, abscess, neoplasia), which routinely present with conjunctival hyperemia and chemosis. IN SUMMARY Correct diagnosis and treatment of the red eye are important to prevent loss of vision, the globe, or, in some cases, loss of life. Corneal ulcers, uveitis, and glaucoma must all be considered and can be diagnosed by performing a thorough ophthalmic examination, STT, fluorescein staining, and tonometry. Each of these diagnoses requires prompt and specific treatment in order to ensure a positive outcome. n 40 Today's Veterinary Practice May/June 2013 CAI = carbonic anhydrase inhibitor; DBD = diamond burr debridement; IOP = intraocular pressure; KCS = keratoconjunctivitis sicca; NSAID = nonsteroidal anti-inflammatory drug; SCCED = spontaneous chronic corneal epithelial defects; SD = standard deviation; STT = schirmer tear test; WBC = white blood cell Figures courtesy of University of Georgia teaching collection Dr. Laminack wishes to thank Dr. Denise Weaver, Dr. Troy Pickerel, the practice team of Companion Animal Hospital, and the University of Georgia Veterinary Teaching Hospital Ophthalmology Service for their support. She also extends gratitude to her mentors and coauthors, Dr. Anthony Moore and Dr. Kate Myrna. For article references, go to todaysveterinarypractice.com. Elizabeth Barfield Laminack, DVM, is a veterinarian at Companion Animal Hospital in Athens, Georgia. When not in the clinic, she studies small animal ophthalmology at the University of Georgia Veterinary Teaching Hospital. In 2012, she completed research abstracts for the Association for Research in Vision and Ophthalmology on canine primary glaucoma and for the American College of Veterinary Ophthalmology regarding canine secondary glaucoma. She received her DVM from University of Georgia. Phillip Anthony Moore, DVM, Diplomate ACVO, is an associate professor in the Department of Small Animal Medicine and Surgery at University of Georgia College of Veterinary Medicine. His primary research interest is the anterior segment of the eye. Dr. Moore received his DVM from Auburn University; he completed both an internship and residency at University of Georgia. Kathern Myrna, DVM, MS, is an assistant professor of ophthalmology at the University of Georgia. Her interests are in comparative ophthalmology, corneal wound healing, and ocular analgesia. She completed a specialty internship in small animal ophthalmology at Angell Animal Medical Center in New England. She completed a residency in comparative ophthalmology and MS in comparative biomedical sciences at University of Wisconsin-Madison. She received her DVM from Virginia-Maryland Regional College of Veterinary Medicine.

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