Page 1052 - Cote clinical veterinary advisor dogs and cats 4th

522 Hypopyon

TREATMENT Possible Complications mucosal edema, may be seen after clinical
improvement of respiratory event.
Death from severe respiratory distress, bron- • Tracheal size may improve after bulldogs
VetBooks.ir Animals with tracheal hypoplasia usually present Recommended Monitoring reach adulthood. Of young dogs with
Treatment Overview
chopneumonia, or hyperthermia
with signs caused by other abnormalities (e.g.,
hypoplastic trachea, 60% are clinically
elongated soft palate, stenotic nares, pneumo-
pneumonia. Radiographic improvement can
nia). Direct treatment toward correction of the Repeat thoracic films for dogs with broncho- normal > 6 months after diagnosis.
abnormality that is the primary cause of clinical lag several days behind clinical improvement. Prevention
signs, and treat secondary infections when Affected animals should not be bred.
present. Delay surgery for stenotic nares and PROGNOSIS & OUTCOME
elongated soft palate in animals with pneumonia Technician Tips
until lungs have improved radiographically, • In the absence of concurrent respiratory • Normal bulldogs have a smaller tracheal
unless severe dyspnea is present. disease, hypoplastic trachea is well tolerated. diameter than other breeds and therefore
Mortality rate (death or euthanasia) of 50% need smaller endotracheal tubes when
Acute General Treatment reflects associated respiratory disease or other undergoing general anesthesia.
• Oxygen supplementation if needed (p. 1146) defects (e.g., megaesophagus, cardiac disease). • Trauma during intubation may cause mucosal
• Sedation if dyspnea/ hyperpnea associated • In bulldog puppies, TD/TI ratios can increase swelling and edema, further narrowing the
with stress with growth to mature body size and resolu- airway.
○ Acepromazine 0.03-0.05 mg/kg IV (e.g., tion of bronchopneumonia.
0.25-0.5 mg total dose for medium-sized Client Education
dog) with butorphanol 0.2-0.4 mg/kg IV PEARLS & CONSIDERATIONS • Consider thoracic radiographs of bulldogs
q 2-4h as needed and Boston terriers before breeding.
• For bronchopneumonia, broad-spectrum Comments • Affected dogs have lifelong risk of respiratory
antibiotic treatment based ideally on results • Dyspnea is not related to the degree of infections and dyspnea.
of culture and sensitivity (p. 795) tracheal lumen diameter narrowing but to
presence of other diseases. SUGGESTED READING
Chronic Treatment • Interobserver agreement on radiographic Coyne BE, et al: Hypoplasia of the trachea in dogs:
• Reduce weight if obese measuring techniques is poor, making them 103 cases (1974-1990). J Am Vet Med Assoc
• Limit exercise, avoid heat (prone to unreliable. 2017:68-772, 1992.
hyperthermia) • Hypoplastic trachea does not affect outcome
• Reduce stress. Consider trazodone for home of surgery for elongated soft palate or stenotic AUTHOR: Karen M. Tobias, DVM, MS, DACVS
EDITOR: Megan Grobman, DVM, MS, DACVIM
use (2-5 mg/kg PO; max dose 14 mg/kg). nares.
• Correct associated structural respiratory • Some generalized increase in tracheal
defects (p. 128). diameter, attributed to resolution of tracheal

Hypopyon Client Education
Sheet

BASIC INFORMATION ASSOCIATED DISORDERS • ± Corneal neovascularization (p. 212)
Hypopyon is always secondary to anterior • ± Keratitic precipitates
Definition uveitis. Other concurrent diseases relate to • Epiphora to mucopurulent discharge
Presence of settled white blood cells in the causes of anterior uveitis. • Intraocular pressure (IOP) may be low
anterior chamber acutely, but with chronicity, secondary
Clinical Presentation glaucoma may occur.
Synonyms HISTORY, CHIEF COMPLAINT • ± Corneal ulceration
Purulent debris (pus) in the anterior chamber Creamy white to light tan debris settled in the • ± Abnormal physical exam
ventral aspect of the anterior chamber is often
Epidemiology associated with a cloudy, red, painful eye. There Etiology and Pathophysiology
SPECIES, AGE, SEX may also be blepharospasm and an elevated • Hypopyon is produced by a strong leukocyte
Dogs and cats, no age or sex predisposition nictitating membrane. stimulus such as local or systemic bacterial
or fungal infections. Even in these cases,
RISK FACTORS PHYSICAL EXAM FINDINGS aqueous humor cultures are often negative,
• Keratomalacia (melting corneal ulcer) • Creamy white to light tan opacity settled and therefore aqueocentesis is rarely indicated.
(p. 209) in ventral anterior chamber. The cells may • Complicated corneal ulcers (infected or
• Any cause of anterior uveitis or end- be subtle and obscured by the nictitating malacic) often lead to uveitis and hypopyon.
ophthalmitis (bacterial, fungal, viral, parasitic membrane or may fill much of the ante- • Lymphoma and leukemia may increase ante-
or immune mediated) (p. 1023) rior chamber. Rarely is the entire anterior rior chamber cells to the point of producing
• Metastatic or primary ocular neoplasia chamber involved. hypopyon.
(p. 559) • Aqueous flare • The cells accumulate in ventral anterior
• Prior intraocular surgery (especially cataract • ± Corneal edema chamber due to gravity and egress the eye
surgery) • Conjunctival/episcleral hyperemia by the iridocorneal angle.

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