Page 1236 - Problem-Based Feline Medicine

1228 PART 15 CAT WITH EYE PROBLEMS

Symblepharon occurs after severe inflammation, fol- Healed wounds of the third eyelid usually have some
lowing destruction of large portions of the conjunctival form of deformity to the contour of the margin, and the
epithelium. third eyelid is rarely adhered to surrounding tissues.
The entire corneal surface may be reduced to a thin In ulcerative keratitis with a large corneal deficit, con-
conjunctival membrane, when the infection is so severe junctiva or third eyelid conjunctiva may have adhered
that it destroys the corneal stem cells at the level of the to the healing cornea, but this will usually occur near
limbus. The normal corneal epithelium is absent, and is the limbus, and not centrally over the entire cornea.
replaced with a thin conjunctival membrane.

It is seen most commonly after acute herpesvirus-1 Treatment
infection in kittens.
The need for treatment depends on the severity of the
condition.
Clinical signs
Specialized surgical techniques to reposition the
The conjunctiva can be distorted, thickened, and
conjunctiva are required, but even in experienced
cover part or all of the cornea. Symblepharon may be
hands the results are not rewarding, as the adhesions
unilateral or bilateral.
invariably reform.
The eyelids may be distorted in severe cases, and the
Surgery to re-establish tear drainage is rarely suc-
adhesion between bulbar and lid conjunctiva may cause
cessful because of severe damage to the nasolacrimal
poor eyelid function.
ducts, and occlusion of the puncta.
The third eyelid may be thickened and distorted, and
Conjunctivo-rhinostomy techniques have been
have poor movement across the globe.
described to establish tear drainage to the nose.
Poor eyelid function and puncta occlusion cause chronic
ocular discharges. If the puncta is occluded, the dis-
Prevention
charges will be serous, but when the condition is severe
and eyelid function is disturbed, the discharges may Try to prevent formation of symblepharon in kittens
become mucopurulent. The chronic epiphora with tear- with acute conjunctival inflammation using appropriate
ing down the face may cause brown staining of the fur. treatment.
● Treat kittens with severe ocular inflammation with
The entire cornea may appear cloudy, covered by
broad-spectrum antibiotics and anti-viral agents
a thin vascular membrane. Surprisingly, some of these
(see Herpes conjunctivitis, page 1214). Tetracycline
cats have limited vision.
antibiotic ointment is best, because Chlamydophila
felis or mycoplasma infection may complicate her-
Diagnosis pesvirus infection.
● Hourly lubrication with artificial tears appears to
There is usually a history of acute respiratory disease
be very beneficial.
as a kitten, followed by chronic ocular inflammation
and discharge.
Close examination will reveal an abnormal conjunctiva LOWER LID ENTROPION**
with adhesion to eyelids, cornea and/or third eyelid.
Classical signs
Examine the eyelid with magnification to see if the
puncta has been occluded causing epiphora. ● Lower eyelid is curled inwards.
● Chronic ulcerative keratitis caused by
eyelid hair rubbing on the cornea.
Differential diagnosis
● Mucoid to mucopurulent discharge.
Healed wounds with eyelid damage around the
puncta area may appear similar, but there is no history See main reference on page 1320 for details (The Cat
of acute inflammation or respiratory disease. With Abnormal Eyelid Appearance).