Page 1228 - Problem-Based Feline Medicine

1220 PART 15 CAT WITH EYE PROBLEMS

TRAUMA OF CONJUNCTIVITIS AND Differential diagnosis
PERIADNEXIAL TISSUE** Chronic cases may show healing by granulation, and
have a mucopurulent discharge similar in appearance
Classical signs to eosinophilic keratoconjunctivitis. Differentiate
using a conjunctival smear, which should have
● Small to large conjunctival tears.
eosinophils present in eosinophilic conjunctivitis, and
● Seromucoid or mucopurulent discharge.
in a healing wound, will show predominantly neu-
● Chemosis with hemorrhage in acute cases.
trophils. Eosinophilic conjunctivitis usually has a his-
● Blepharospasm, photophobia and ocular
tory of a chronic condition that has not responded to
guarding reflecting ocular pain.
antibiotic treatment.
Cats with orbital cellulitis will often have an inflamed
conjunctiva, chemosis and a mucopurulent discharge.
Clinical signs This condition may occur secondary to a conjunctival
wound deep in the fornix, which has become infected
Conjunctival wounds may present as small to large
with bacteria. Ocular ultrasound may be very helpful to
tears. Common causes are cat claw wounds, plant
diagnose orbital disease, where conjunctival injuries
injuries from thorns, or associated with other blunt ocu-
have been complicated with secondary orbital infections.
lar trauma, commonly from motor vehicle accidents.
Malar abscesses caused by periodontal disease may
In acute cases, there is chemosis (edema) of affected
cause chronic discharging sinuses in the lower con-
conjunctiva with hemorrhage.
junctival fornix. Check the mouth when chronic
Ocular discharge may be serous when there are small mucopurulent discharges are seen, and there is no his-
scratches, to mucoid or purulent when large infected tory of ocular trauma. Dental radiology will be helpful
wounds are present in the conjunctive or peri-adnexial to diagnose this condition.
tissue.
There may be hemorrhage and evidence of trauma in
Treatment
surrounding tissue.
It may be necessary to use a local anesthetic and heavy
Ocular pain is frequently present, manifested by ble-
sedation to clean the eye. Use normal saline (0.9%) or
pharospasm, photophobia and ocular guarding.
ocular irrigating solutions to gently remove discharges.
Discharges are very uncomfortable for the cat, and har-
bor unwanted bacteria.
Diagnosis If the wound in the conjunctiva is very large, suture it
with fine absorbable sutures, preferably buried
If the eye is very painful, apply a little topical anes-
underneath the conjunctiva. Sutures should be made
thesia. Proxymetacaine products are less irritating
from polygacton or polyglycolic acid using 6/0 to 8/0
to the tissues). The cat may then open the eye making
sizes.
it easier to visualize the conjunctival surfaces and
cornea. If the wound is infected, treat with broad-spectrum
topical antibiotic drops or ointment. Common antibac-
Close examination should reveal any conjunctival
terials include triple sulfonamides, neomycin/baci-
wounds, but may be difficult in cases with chemosis.
tracin, fucidic acid, chloramphenicol, gentamycin and
Check for foreign bodies such as grass seeds, which framycetin. It may be prudent to take a clean swab for
may be lodged under the third eyelid, or in the upper or bacterial isolation and sensitivity, prior to starting
lower conjunctival fornix. antibiotic therapy.