Page 1333 - Problem-Based Feline Medicine

65 – THE CAT WITH ABNORMAL EYELID APPEARANCE 1325

Clinical signs ● Amoxil–clavulanic acid combinations at 12.5 mg/kg
q 12 hourly.
Eyelid swelling, erythema and ulceration occur
● Doxycycline at 5 mg/kg q 12 hourly. There is
with bacterial blepharitis. Lesions are seen more
now some suggestion in the literature that doxy-
commonly at the medial canthus with staphylococcal
cycline may act as an immune-modulator by alter-
hypersensitivity.
ing immune responses to meibomian or sebaceous
Meibomitis, chalazion or hordoleum involve acute lipid.
or chronic swelling of single or multiple meibomian ● Cephalexin 15 mg/kg q 12 hourly.
glands.
Topical antibiotics.
In acute cases (hordoleum), the lids are painful and ● Fusidic acid is not available in North America but
inflamed with inflammation around the glands. The is used in Australia and Europe. Apply topically q
infection in the meibomian gland may organize into 12 hourly.
discrete abscesses containing purulent material. ● Terramycin ophthalmic ointment q 12 hourly.
Occasionally sinuses form which discharge onto the
Surgical drainage and/or curettage of lesions may
skin. Chronic cases may organize into large masses of
sometimes be necessary to control chalazia. This is
caseous material with a tendency to be walled off in
best done via a caudal approach through bulbar con-
a fibrous capsule within the eyelid (chalazion). In mei-
junctiva. A chalazion clamp will help to immobilize
bomitis, only individual glands are swollen.
the lid during drainage.
Mucoid to mucopurulent ocular discharge occurs.
ALLERGIC BLEPHARITIS*
Diagnosis
Diagnosis is usually based on the appearance of the Classical signs
eyelid and response to treatment.
● Variable eyelid erythema, swelling and
Samples of material drained from abscessed meibo- pruritis.
mian glands can be cultured to determine etiology and ● Excoriation and exudation, with crusting of
sensitivity to antibiotics. eyelid skin.
● ± Skin lesions involving other parts of the
Histopathology might be performed on eyelid skin
body.
where allergy or autoimmune disease is suspected in
the differential diagnosis.
See main reference on page 1025 for details (The Cat
With Miliary Dermatitis).
Differential diagnosis
Pathogenesis
Allergic skin disease must be ruled out by appropriate
consideration of possible antigens, e.g. food proteins, Allergic skin disease affecting eyelid skin can be due to
insect bites, inhalant or contact allergens. any of the following:
● Food allergy.
Immune-mediated skin disease can be ruled out by
● Staphylococcal allergy.
demonstration of characteristic histopathology.
● Insect bite hypersensitivity.
Neoplasia can be differentiated from chronic meibo- ● Atopy.
mian gland swelling with caseous material or acute ● Contact allergy (to topical drugs).
abscessation by cytology or histopathology.
Clinical signs
Treatment
Clinical signs are variable and can include combina-
Use systemic antibiotics based on results of culture tions of erythema, swelling, pruritis, excoriation, exu-
and sensitivity or empirically: dation and crusting of eyelid skin.