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704 Ocular Discharge

PHYSICAL EXAM FINDINGS DIAGNOSIS Acute General Treatment
Unilateral or bilateral, serous, mucoid, or Diagnostic Overview • Treat the underlying cause (see Etiology and
VetBooks.ir more of the following: Ocular discharge is apparent on physical • Blockage of nasolacrimal system: treat the
Pathophysiology above).
mucopurulent ocular secretions with one or
primary lesion causing the obstruction
exam. The underlying cause should be initially
• Blepharitis: inflammation of the eyelids
• Conjunctivitis (pp. 199 and 200)
physical exam, and complete ophthalmic
• Corneal ulceration (p. 209) investigated with a review of the history, (may be difficult to diagnose; if so, consult
a veterinary ophthalmologist).
• KCS (p. 568) exam. If the cause is not elucidated, specific
• Qualitative tear film abnormality (e.g., mucin ocular tests (some requiring referral) may be Chronic Treatment
and/or lipid deficiency) warranted. May be required with certain diseases (e.g.,
• Entropion and/or ectropion (p. 296) KCS)
• Distichiasis/ectopic cilia/trichiasis (p. 273) Differential Diagnosis
• Anterior uveitis (p. 1023) • Ocular discharge with red eye(s) is often Possible Complications
• Glaucoma (p. 387) associated with overproduction of tears (i.e., • Conjunctivitis due to FHV-1 may lead to
• Globe size abnormalities (p. 705) linked with causes of corneal mechanical symblepharon (i.e., adhesions of conjunctiva
• Orbital disease (p. 716) irritation, infection, or ocular pain). to surrounding tissues), KCS, ulcerative
• Congenital anomalies or infection of naso- • Ocular discharge with quiet eye(s) (i.e., no keratitis, and stromal keratitis (p. 464).
lacrimal system (e.g., dacryocystitis) evidence of ocular pain or eyelid conditions) • Chronic epiphora can lead to focal facial
is often associated with impaired drainage of dermatitis at the medial canthus.
Etiology and Pathophysiology tears (e.g., congenital or acquired blockage
Serous discharge: of nasolacrimal system). Recommended Monitoring
• Corneal mechanical irritation Varies, depending on the underlying cause
○ Distichiasis/ectopic cilia/trichiasis Initial Database
○ Entropion • Complete ophthalmic exam (p. 1137): PROGNOSIS & OUTCOME
○ Eyelid agenesis (partial absence of palpe- ○ Careful examination with magnification
bral margin): more common in cats of the eyelids Prognosis is guarded to excellent, depending
○ Eyelid neoplasia ○ Schirmer tear test (normal 15-25 mm/ on the underlying cause.
• Obstruction of nasolacrimal system, min; excessive lacrimation > 25 mm/min
congenital with corneal irritation) PEARLS & CONSIDERATIONS
○ Imperforate lacrimal punctum (commonly ○ Fluorescein dye application (corneal
ventral lacrimal punctum not open) dye retention with corneal ulceration; Comments
○ Micropunctum (small ventral lacrimal dye exiting nares helps confirm patent • Routine aerobic bacterial C&S tests should
punctum; common) nasolacrimal system) be done in cases of mucopurulent discharge,
○ Nasolacrimal aplasia (lack of opening into ○ Intraocular pressure (IOP) (pressures especially those nonresponsive to therapy, to
nasal cavity; rare) > 25 mm Hg with glaucoma; may be low identify the implicated bacteria or fungus.
○ Obstruction of nasolacrimal duct in at < 15 mm Hg with uveitis; both are • Fungal infections rarely cause ocular discharge
dogs by dacryops (cysts originating from painful conditions) in cats and dogs.
lacrimal tissue) or nasal cyst (rare) • Conjunctival and/or corneal (if infected • Serous ocular discharge in cats is common
• Blockage of nasolacrimal system, acquired corneal ulcer) swabs with FHV-1 infection.
○ Dacryocystitis (inflammation of the ○ Cytologic exam to determine cell type and • A thorough examination of the entire con-
nasolacrimal system) possible cause junctival sac, including dorsally throughout
○ Neoplasia: primary (rare); secondary (more ○ Culture and susceptibility (C&S): aerobic; the dorsal surface of the globe and ventrally
common) (e.g., nasal; maxillary sinus) anaerobic and fungal pathogens are rare on both sides of the third eyelid, may be
○ Foreign body necessary to identify any retained foreign
○ Trauma to medial canthus/eyelid, involv- Advanced or Confirmatory Testing material.
ing lacrimal punctum/puncta and/or • Varies depending on underlying cause
canaliculus/canaliculi • Polymerase chain reaction (PCR): FHV-I, Technician Tips
• Ocular pain Chlamydia spp, and Mycoplasma spp The type of ocular discharge can be important
○ Conjunctivitis • Blockage of nasolacrimal system can be in the diagnosis of the inciting cause. It is best
○ Simple or indolent/recurrent corneal investigated with nasolacrimal flush; if if all the discharge is not removed before the
ulceration no fluorescein dye exits nares, blockage is veterinarian evaluates the patient.
○ Qualitative tear film abnormality (e.g., suspected. If results are unclear, confirma-
mucin and/or lipid deficiency) tion is possible with nasal radiographs with Client Education
○ Anterior uveitis a contrast study of the nasolacrimal system. At the first sign of abnormal ocular discharge
○ Glaucoma Contrast CT is best to assess the integrity in their pets, owners should consult their
Mucoid to mucopurulent discharge: of the nasolacrimal system. veterinarian.
• Blepharitis
• Conjunctivitis TREATMENT SUGGESTED READING
• KCS Pena MT, et al: Canine conjunctivitis and blepharitis.
• Melting/infected corneal ulceration Treatment Overview Vet Clin North Am Small Anim Pract 38:233-249,
• Orbital abscess/cellulitis Treatment is directed at the underlying cause. 2008.
• Dacryocystitis If discharge persists or progresses, referral AUTHOR: Chantale L. Pinard, DVM, MSc, DACVO
• Nasolacrimal foreign body (e.g., grass awn, to a veterinary ophthalmologist should be EDITOR: Diane V. H. Hendrix, DVM, DACVO
parasite) considered.

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