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200 Conjunctivitis, Dogs

• C. felis Nutrition/Diet clinical improvements were seen, the presence
○ Topical treatment with oxytetracyline with Oral lysine may be beneficial in some cats with of C. felis DNA was still positive based on
VetBooks.ir past resolution of clinical signs is most (p. 464). • Ophthalmic antibiotics have rarely been
PCR.
chronic conjunctivitis secondary to FHV-1
or without polymyxin B q 6h for 2 weeks
associated with anaphylaxis in cats and
commonly used but may not eliminate
Possible Complications
shedding, which could be important in
should be used only when indicated.
multiple cat households. • Topical and oral corticosteroids can cause • Topical or systemic corticosteroids should
○ Doxycycline 10 mg/kg PO q 24h × 4 FHV-1 recrudescence. be avoided in cases of feline conjunctivitis
weeks or amoxicillin-clavulanic acid • Topical corticosteroids must be avoided when unless a specific diagnosis such as proliferative
13.75 mg/kg PO q 12h × 4 weeks is corneal ulceration is present. keratoconjunctivitis (eosinophilic) has been
recommended to eliminate shedding. • A shortened topical or systemic antibiotic made. Unlike dogs, most feline cases are
Continue for 2 weeks past clinical signs. course may allow recrudescence of C. felis. infectious.
Caution with tetracyclines in young cats; Topical treatment or shorter systemic course
follow doxycycline tablets with water to may lead to persistent shedding. The possible Prevention
minimize esophageal stricture formation. complications and difficulties with oral treat- • Environmental and behavioral modifications
○ If topical oxytetracycline is not available ment must be weighed against the possible to decrease stress may minimize FHV-1 flares.
and systemic treatment is not elected, complication of shedding. This is more of • Vaccination for C. felis may help in environ-
topical ophthalmic erythromycin is also a concern in multi-cat housing. ments with high prevalence.
effective in resolving clinical signs but • Fly prevention may prevent Thelazia spp.
must be used 2 weeks past resolution of Recommended Monitoring • Minimize UV exposure for light cats for
clinical signs. Phone or email communication with owners lipogranulomatous conjunctivitis.
• Thelazia spp: manual removal of worms can be useful for managing chronic FHV-1
with forceps after topical anesthetic alone cases to minimize stress from frequent exams. Technician Tips
or follow with single dose of any of the • Wear gloves and wash hands when restraining
following: ivermectin SQ at 0.2 mg/kg, PROGNOSIS & OUTCOME cats with conjunctivitis due to the possible
milbemycin oxime 2 mg/kg PO, topical but rare zoonotic potential of C. felis and
2.5% moxidectin Most acute cases completely resolve with to prevent spread to other cats.
• Cuterebra spp: manual removal of larvae proper treatment. Chronic conjunctivitis can • Owners disagree about whether ophthalmic
after topical anesthetic, topical antibiotic be a frustrating, lifelong, intermittent problem solutions or ointments are easiest to apply.
+/− antiinflammatory prn that may not resolve with treatment, especially Compliance may increase if given their
• Proliferative keratoconjunctivitis (eosino- if due to FHV-1. preferred formulation.
philic)
• Allergic conjunctivitis: topical corticosteroids PEARLS & CONSIDERATIONS Client Education
(Neopolydex, prednisolone acetate) and/or • Medicating cats can be difficult, especially
topical antihistamines (Ketotifen) q 6-24h Comments chronically or multiple times per day. A
prn based on severity; consider systemic • Most cases are infectious and suspected to technician demonstrating how to properly
management (p. 91) be due to recrudescent FHV-1. administer ophthalmic medications to the
• Lipogranulomatous conjunctivitis: surgical • C. felis typically starts unilaterally and cat during the appointment may be helpful.
resection of nodules if causing irritation becomes bilateral within 2 weeks. • Call or return if signs worsen to rule out
• Foreign bodies and chemical/environmental • Keratitis is common with FHV-1 and rare development of a corneal ulcer or topical
irritants: manual removal of foreign body or with C. felis. medication hypersensitivities.
elimination of irritant and topical lubricant, • The role of Mycoplasma is controversial
antibiotic, and/or antibiotic-corticosteroid q because it can be present on the conjunctiva SUGGESTED READING
6-24h prn of asymptomatic cats and experimental infec- Maggs DJ: Conjunctiva. In Maggs DJ, et al, editors:
• For secondary causes, treat the underlying tion requires immunosuppression. However, Slatter’s Fundamentals of veterinary ophthalmology,
ophthalmic disorder. treatment is the same as that for C. felis. ed 5, St. Louis, 2013, Saunders.
• C. felis and Mycoplasma inclusions are often
Chronic Treatment confused with medication blue bodies and RELATED CLIENT EDUCATION
• Antivirals may be useful for chronic con- melanin granules on cytology. SHEET
junctivitis caused by FHV-1, especially in • Enrofloxacin can be used to treat C. felis
cats that are immunosuppressed (p. 464). but is not recommended due to potential How to Administer Eye Medications
• Proliferative keratoconjunctivitis often drug-induced retinal degeneration.
requires chronic treatment with topical • Pradofloxacin 5 mg/kg, q 24h for 42 con- AUTHOR: Sony Kuhn, DVM, DACVO
corticosteroids or immunosuppressives. secutive days has been studied, and although EDITOR: Diane V. H. Hendrix, DVM, DACVO

Conjunctivitis, Dogs Client Education
Sheet

BASIC INFORMATION the conjunctival fornix as it reflects back at the ocular health through the conjunctiva-associated
level of the orbital rim onto the surface of the lymphoid tissue (CALT) and through goblet
Definition globe to become the bulbar conjunctiva. The cells, which provide the mucin layer of
Conjunctivitis refers to inflammation of the conjunctiva also lines the palpebral and bulbar the precorneal tear film. Conjunctivitis is
conjunctiva. The conjunctiva lines the inside surface of the nictitating membrane. The con- common in dogs as an isolated problem and
of the eyelids (palpebral conjunctiva) and forms junctiva plays an important role in maintaining in conjunction with a wide array of other

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