Page 1231 - Problem-Based Feline Medicine

59 – THE CAT WITH OCULAR DISCHARGE OR CHANGED CONJUNCTIVAL APPEARANCE 1223

bites by housing affected cats in insect-free conditions, Ecchymotic hemorrhage may be seen with blood
for example, by confining inside. clotting disorders, e.g. rodenticide toxicity. Petechia
and ecchymotic hemorrhages (larger areas of hem-
Densensitisation for some forms of atopy may be pos-
orrhage) may be seen with thrombocytopenia. In these
sible when the cat has a positive skin test (see The Cat
cases there is no history of trauma.
With Miliary Dermatitis, page 1031).
Prognosis Diagnosis

Prognosis is excellent if there is a confirmed allergy The clinical signs of diffuse or focal redness with a his-
caused by atopy, food allergy or insect bites, and expo- tory of trauma are diagnostic. There is frequently no
sure to allergens can be controlled. other associated problem.
Typically this is a chronic condition that requires inter- If in doubt, fine-needle aspirates of the abnormal area
mittent treatment with topical corticosteroids when may be beneficial.
epiphora is present.
If there is no history of trauma, laboratory tests should
be done to check for clotting or platelet disorders. (See
SUB-CONJUNCTIVAL HEMORRHAGE* The Bleeding Cat, page 488).

Classical signs Orbital radiology, CT scan and ocular ultrasound
may be needed in cases with severe peri-orbital
● Mild cases of trauma show focal red areas trauma. Look for interruption of the normal scleral
of bleeding under the conjunctiva. contour for signs of a ruptured globe using ultrasound.
● Severe cases of trauma show diffuse Check for the state of the bony orbit with radiology
reddening of the conjunctiva which may be and CT scan.
quite swollen.
● Petechial to echymoses hemorrhages may
be seen in bleeding states.
Differential diagnosis
It is important to differentiate between hemorrhage
Clinical signs caused by trauma and bleeding disorders (see The
Bleeding Cat, page 485).
Sub-conjunctival hemorrhage is common after blunt
trauma to the eye, especially from motor vehicle acci-
dents.
Treatment
The most common presentation is diffuse reddening of
the conjunctiva over the sclera, with very little In cases of trauma, treatment is palliative. Irrigation,
swelling. This may be focal, or diffuse over the entire hot and cold compresses, and corneal lubrication are
sclera. important if swelling is present.
In severe cases, there may be frank hemorrhage with If swelling prevents a normal blink, and the cornea is
swelling of the conjunctiva. This may be present after exposed, the eyelids should be closed with a temporary
orbital trauma results in frank orbital hemorrhage, tarsorrhaphy or third eyelid flap, otherwise corneal
causing severe bulging of the conjunctiva around the ulceration will rapidly develop. A temporary tarsorrhaphy
globe. is done using 4/0 or 5/0 monofilament nylon in a mattress
pattern through the midpoint of the eyelid margins.
Retrobulbar trauma may result in exophthalmos with
swollen conjunctiva. There may be superficial hemor- Treat bleeding disorders with appropriate drugs, and blood
rhage on the conjunctiva, or subconjunctival hemor- transfusions if needed (see The Bleeding Cat, pages 502,
rhage. 511, 513, 514).