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296 Entropion/Ectropion

CHF or severe neurologic complications are and a new murmur, particularly a diastolic cefazolin 22 mg/kg IV) before the start of the
not present initially. murmur. Diastolic murmurs are typically • Year-round use of ectoparastie prevention
procedure.
• Recurrence or treatment failure is likely with
soft, blowing, decrescendo, and best heard
VetBooks.ir inadequate duration of therapy, inappropriate • Identification of an independently oscillating Technician Tips
at the left heart base.
should reduce the risk of bartonellosis.
antibiotic selection, or owner nonadherence
to prescribed treatment.
• Despite optimal therapy and monitoring, mass (vegetation), along with suggestive • Animals with IE are usually very ill, and
clinical signs, is consistent with IE.
cure rates for IE do not appear promising • Culture-negative IE is common in veteri- symptoms of sepsis are common.
for dogs, and CHF or other serious or fatal nary medicine, often warranting empirical • IE is an important cause of diastolic heart
complications are common. antibiotic therapy. murmur.
PEARLS & CONSIDERATIONS Prevention SUGGESTED READING
• Animals with SAS, implanted cardiac devices MacDonald K: Infective endocarditis in dogs: diag-
Comments (e.g., transvenous pacemakers), and other nosis and therapy. Vet Clin North Am 40:665-684,
• Although IE and myxomatous/degenerative conditions potentially causing endothelial 2010.
valve endocardiosis can cause valve thicken- damage should receive routine antibiotic AUTHORS: Sandra P. Tou, DVM, DACVIM; Bruce W.
ing and heart murmurs, the two conditions prophylaxis for all procedures that are Keene, DVM, MSc, DACVIM
typically differ dramatically in patient signal- likely to induce transient bacteremia. By EDITOR: Meg M. Sleeper VMD, DACVIM
ment, history, murmur duration, location, extrapolation from the current American
quality, timing, and clinical presentation. Heart Association Guidelines, recom-
• A high index of suspicion is justified for mended antibiotic prophylaxis consists of
any animal with fever (or history of fever) a single oral or IV antibiotic dose (e.g.,

Entropion/Ectropion Client Education Bonus Material
Online
Sheet

BASIC INFORMATION brachycephalic breeds, including Peking- Clinical Presentation
ese, pug and shih tzu; brachycephalic cats
Definition ○ Genetics not fully understood; most likely DISEASE FORMS/SUBTYPES
• Entropion is inversion of part of or the entire polygenic but could be inherited as a • Developmental: secondary to abnor-
eyelid margin toward the globe; it can be dominant trait with incomplete penetrance mal or poor conformation, may be
developmental or acquired. or a recessive trait congenital, juvenile, or senile (entropion
• Ectropion is eversion of part of or the entire • Developmental ectropion: bloodhound, and ectropion)
eyelid margin away from the globe; it can Saint Bernard, Great Dane, bullmastiff, • Spastic (entropion)
be developmental or acquired. Newfoundland, and some spaniel breeds • Cicatricial (entropion and ectropion)
• Combination entropion-ectropion affecting
Synonyms the same lid: bloodhound, Saint Bernard, HISTORY, CHIEF COMPLAINT
Inrolled eyelid (entropion); everted eyelid and English bulldog Entropion:
(ectropion) • Ocular discharge
RISK FACTORS • Blepharospasm
Epidemiology • Developmental entropion and ectropion: • Red eye
SPECIES, AGE, SEX breed predispositions • Visible inrolling of eyelid
Entropion: • Acquired entropion • ± Vision impairment in severe cases
• Common in dogs; rare in cats ○ Conditions that stimulate blepharospasm Ectropion:
• Can occur at any age; developmental (e.g., corneal ulceration) • Ocular discharge
entropion usually occurs in dogs < 1 year ○ Eyelid trauma • Red eye
of age ○ Blepharitis • Droopy/long lower eyelid
• Can occur at any age in cats but usually ○ Older age and associated loss of orbital
older cats fat (especially cats) PHYSICAL EXAM FINDINGS
Ectropion: ○ Phthisis bulbi (p. 705) Entropion:
• Dogs (variable ages depending on the ○ Enophthalmos • Inversion of the eyelid and any of the
cause) • Acquired ectropion following:
○ Eyelid trauma ○ Conjunctivitis (pp. 199 and 200)
GENETICS, BREED PREDISPOSITION ○ Blepharitis ○ Epiphora, mucoid or mucopurulent ocular
• Developmental (conformational) entropion: ○ Old age and associated loss of orbicularis discharge
○ Lateral entropion: English bulldog, chow oculi muscle tone ○ Blepharospasm
chow, Shar-pei, Saint Bernard, boxer, ○ Facial nerve paralysis ○ Protrusion of the third eyelid
rottweiler, pointers, spaniels, and all ○ Nonulcerative keratitis (pp. 206 and 212)
retrievers ASSOCIATED DISORDERS ○ Ulcerative keratitis (p. 209)
○ Medial canthal entropion: miniature and • Conjunctivitis ○ Corneal sequestration in cats (p. 208)
toy poodles, English bulldog, Cavalier • Keratitis (ulcerative and nonulcerative) ○ Enophthalmos secondary to atrophy of
King Charles spaniel, Maltese, and • See Risk Factors above retrobulbar fat in cats

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