Page 1258 - Problem-Based Feline Medicine

1250 PART 15 CAT WITH EYE PROBLEMS

Subcutaneous and scleral hemorrhage may also be Prognosis
present.
For eyes with superficial ulceration and mild
In cats with orbital hemorrhage, the eye will bulge hyphema, the prognosis is very good.
forward (exophthalmos) and the cat may have diffi-
Eyes with a limbal rupture have a good prognosis if
culty closing the eye. Rapid drying of the cornea then
the lesion is not very large and is not complicated with
occurs causing further loss of epithelium, which results
iris prolapse.
in severe ulceration.
Eyes with severe trauma and hyphema, complicated
by lens luxation or rupture and vitreous hemorrhage,
Diagnosis have a poor prognosis.

Diagnosis is based on a history of trauma, and the Eyes with exophthalmos from orbital swelling and
clinical appearance. Typically there is a corneal ulcer corneal desiccation, can develop very deep and com-
or rupture, and hyphema with subcutaneous hemor- plicated ulcers if not treated correctly.
rhage, with or without exophthalmos.
Ocular ultrasound is a useful tool when the anterior NEUROTROPIC KERATITIS
chamber cannot be visualized because of hyphema.
Look for lens displacement and check if there is a nor- Classical signs
mal scleral contour at the back of the eye. Vitreous
● Chronic mild keratitis with superficial
hemorrhage is seen as a dark hyperechoic area between
ulceration and superficial vascularization.
the lens and scleral contour.
● Cornea looks dry and lusterless.
● Poor blink reflex or poor corneal reflex or
Treatment both.

Superficial ulcers can be treated with lubrication using
artificial tear solutions. If infection is present, a topical Pathogenesis
antibiotic drop or ointment may be used.
Cats that have facial nerve damage may have a poor
In cats with limbal rupture, treatment depends on to absent blink reflex. This results in drying of the
whether there is iris prolapse or not. If there is a sim- cornea, as the tear film is not distributed over the
ple tear without complication, then the condition cornea. The consequence is poor epithelial health and
may be treated conservatively with antibiotic drops, superficial ulceration.
systemic NSAIDs and systemic broad-spectrum
Some cats cope well with paralyzed lids, as the third
antibiotics. Do not use ointment in cats with corneal
eyelid acts as a sweep to distribute tears over the
rupture, as the ointment base may enter the eye and
cornea.
cause severe uveitis.
Cats with injury or infection affecting the trigeminal
In cats with limbal rupture complicated with iris
nerve may show complete lack of corneal sensation
prolapse, microsurgery needs to be done to correct the
(reflex). When the cornea has no innervation, chronic
iris prolapse and suture the corneo–scleral wound. If
keratitis may develop producing superficial ulceration
possible, referral to an ophthalmologist is encouraged.
and neovascularization.
Topical and systemic antibiotics should be used in
conjunction with a systemic NSAID.
Clinical signs
Where exophthalmos is present, the eye must be
closed with a third eyelid flap or preferably a tarsor- Neurotropic keratitis appears as a chronically sore eye
rhaphy. Use nylon sutures in a mattress (preferably) with poor blink reflex. To test for this condition, gen-
or interrupted pattern through the middle of the eye- tly touch the eyelids and they should automatically
lids. close if normal.