Page 1252 - Problem-Based Feline Medicine

1244 PART 15 CAT WITH EYE PROBLEMS

● Usually with history of previous ulcer, and is there- intra-ocular sarcoma at a later date, so owners must be
fore not an acute injury. warned of the danger.
● May be some hypopyon (protein and cells in the
anterior chamber) present. Prognosis
Descemetocele. Cases with no damage to the iris or lens have a good
● Usually history of ulceration. prognosis.
● The lesion is mostly axial (central) and there is
Cases with iris tears, prolapsed iris and ruptured lenses
rarely blood or protein in the anterior chamber.
have a favorable to poor prognosis.
● The globe is not soft and maintains normal to
slightly lower IOP. Glaucoma may be a sequela in cases with complications.
● The surrounding cornea is frequently quite healthy.
KERATITIS SECONDARY TO UVEITIS**
Treatment
Classical signs
If the corneal tear is small, near the limbus, and is
well sealed with a fibrin plug, conservative treatment ● Cloudy blue cornea and a red
can be used. sclera/conjunctiva.
● Protect the cornea with a third eyelid flap or tem- ● +/- Keratic precipitates (mutton fat
porary tarsorrhaphy. deposits) on cornea.
● Dilate the pupil with topical 1% atropine. ● A hypopyon (cloudiness) in the anterior
● Use a topical broad-spectrum antibiotic drop and chamber.
protect the eye from infection with systemic broad-
spectrum antibiotics. NEVER use an ointment See the main reference on page 1259 for details (The
when there has been a penetrating corneal injury, as Cat With a Cloudy Eye).
ointment bases that enter the anterior chamber will
cause an intense and chronic foreign body uveitis.
Clinical signs
● Cats with acute eye injuries should be given sys-
temic NSAIDs to minimize the effects of an intra- The cat presents with a cloudy blue cornea and injected
ocular prostaglandin reaction. red sclera and conjunctiva.
Do not use topical corticosteroids when the cornea is The corneal cloudiness is caused by edema from com-
ulcerated as this will predispose keratomalacia. promised endothelial function.
When there is a large tear or there is an iris pro- Keratic precipitates (mutton fat deposits) may be
lapse, microsurgery is required to suture the cornea. present on the inferior endothelium of the cornea.
The iris needs to be gently teased back into the anterior
A hypopyon (protein and white blood cells) may be
chamber, which should be flushed to remove blood and
present in the anterior chamber, and evident as a cloudi-
fibrin. Viscoelastic solutions are then used to space the
ness of the aqueous fluid.
anterior chamber, and the corneal deficit is sutured with
interrupted 8/0 to 10/0 nylon or absorbable suture mate- The pupil will usually be miotic (constricted).
rial. This is very specialized surgery that requires spe-
The cat will usually have a systemic disease such as
cialist training, magnification and specialized
toxoplasmosis, cryptococcosis, FeLV, FIV or FIP or
instrumentation.
systemic mycoses.
● The pupil is then dilated with atropine, infection
prevented with broad-spectrum topical and sys-
temic antibiotics, and NSAIDs given to minimize Diagnosis
inflammation.
A tentative diagnosis is based on signs of a red,
If the lens has been ruptured, a lensectomy has to be cloudy eye and other classic signs of uveitis such as
performed. Remember that these cases may develop hypopyon and keratic precipitates.