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10867 Ocular Vol 9 #1.Indd Volume 9, Issue 1 October 2010 ® A Quarterly Publication for the Veterinary Community from Eye Care for Animals When Hairs Meet the Eye become shortened the facial skin has sequestra. In some dogs we see corneal not correspondingly been reduced - this vascularization and medial corneal results in the formation of large nasal pigmentation as a result of the chronic folds of haired skin. Hair on the nasal cilia irritation. This pathology is often folds may impinge on the eye and cause compounded by the abnormally large problems in some dogs. As the facial palpebral fissure (macroblepharon), the skin is pushed towards the eye there is shallow orbit which limits the extent to a tendency for the lower eyelid to roll which the eye can be retracted and the against the eye (entropion). This is lids closed over the cornea, the extreme usually compounded by tight attachment rounded (rather than elliptical) shape of the medial canthus (the location where of the upper and lower eyelids around the upper and lower eyelids join on the the medial canthus which may reduce nasal side of the face) to the underlying the effective medial corneal coverage bone via the medial palpebral ligament. during blinking, and in some dogs Nicholas J. Millichamp, The net result is a rolling of the medial reduced tear secretion from the lacrimal BVetMed, PhD, DVOphthal, DECVO, part of the lower (and occasionally glands (keratoconjunctivitis sicca). All MRCVS, DACVO upper) eyelid such that normal eyelid of these factors (and probably some that Eye Care for Animals cilia contact the conjunctiva or cornea. In we don’t yet understand) contribute to addition many affected animals have cilia the development of keratitis. In dogs In this article we look at the effects which grow from the anterior surface with good tear production the corneal that two common eyelid abnormalities of the medial palpebral conjunctiva changes (vascularization, scarring and have on the eye - one due to an (this area in people is referred to as the pigmentation) may be limited to the abnormal eyelid conformation, the conjunctival caruncle although a discrete medial cornea where cilia contact the other due to abnormal hair growth in structure is rarely evident in animals). eye. In dogs additionally affected with what may otherwise be normal lids. These cilia also contribute to medial low tear production, reduced corneal Unfortunately many of the conditions we corneal irritation in many dogs. sensitivity and reduced coverage of the see in domestic species and especially eye when blinking, the corneal pathology in dogs are due to years of selective is more diffuse – often resulting in breeding for a variety of traits considered widespread corneal pigmentation even desirable for a particular breed - one at an early age. unintentional consequence of which is the development of conformational (continued on page 2) abnormalities or inherited abnormalities of the eyelids which can negatively impact ocular structure and function. INSIDE THIS ISSUE: Medial Canthal Entropion Scientific Article .................... Pg 1-3 and Trichiasis (MCET) The effect of this irritation on the eye News & Events ......................... Pg 4 Many of the eyelid and cilia varies from animal to animal. In cats CERF Corner ............................ Pg 5 abnormalities in dogs and cats stem irritation from the lower eyelid cilia may Memo to Managers .................. Pg 6 from breeding for an extreme form contribute to the formation of chronic of brachycephalism. As the skull has ulceration and formation of corneal Eye Care for Animals One THE OCULAR OUTLOOK cells (especially polymorphonuclear Celsus) types of excision often are leukocytes entering the tear film difficult to perform in a way that in response to infection) as well as actually corrects the problem at bacteria and degenerating corneal this location. The most effective epithelial cells causes rapid breakdown approach is one in which the lid of the corneal tissue (keratomalacia) margins are incised just medial to and in extreme cases perforation of the nasolacrimal puncta and a strip the eye. of lid margin is excised, continuing The treatment of medial canthal the incision in an arrowhead shape Some dogs may go their entire trichiasis and entropion depends medial to the medial canthus. This life without any significant signs (at on how severely the lids are dissection is necessarily performed least as perceived by the owners) of deformed and the extent of corneal with high magnification under the ocular discomfort or development pathology. In any of these cases, operating microscope in order to of more severe corneal lesions. It medical treatment for any identified identify the areas with hair follicles is likely that the chronic reactive reduction in tear production with which need to be excised and in order scarring and pigmentation “protect” corneal desiccation is important. to avoid damage to the nasolacrimal the cornea against development Medical treatment involves use of puncta (especially lower) and the of more severe corneal pathology cyclosporine or tacrolimus to increase underlying nasolacrimal duct. If the (ulceration) in many animals and tear production, antibiotics to control medial palpebral ligament is very reduce the sensitivity of the medial bacterial infection and application of tight it may be necessary to relieve cornea. However some dogs and cats artificial tear preparations to moisten the tension slightly - this has to be develop more severe ocular lesions the corneal surface. Corticosteroids done with extreme care to avoid due to cilia contact medially. I have should be used very cautiously or not damage to the nasolacrimal duct. seen dogs and cats of all ages with at all so long as cilia are abrading the Hair extending onto the conjunctiva at severe corneal ulceration associated corneal surface. Surgical treatment the medial canthus or arising from the with medial canthal entropion and can be divided into efforts to reduce palpebral surface of the third eyelid trichiasis. the cilia contacting the ocular medially are also excised. The upper structures and correction of the and lower eyelids are then re-apposed eyelid malformation itself. In mild just medial to the puncta – a medial cases of medial trichiasis, the eyelid tarsorrhaphy. hairs can be treated with cryothermy – a double freeze thaw cycle with a 3-4mm ophthalmic cryoprobe applied over the palpebral conjunctiva to destroy hair follicles. This also results in eyelid depigmentation, although repigmentation occurs over Chronic irritation of the cornea a few months. damages the corneal epithelial surface Various surgical techniques have layer. If erosions and superficial ulcers been described which aim to correct occur, bacteria may proliferate in the the medial eyelid entropion and In some extreme cases of deeper corneal stromal tissue - the remove the cilia which contact the macroblepharon a partial lateral release of enzymes from inflammatory eye. The usual elliptical (Hotz- tarsorrhaphy may also be created to reduce overall corneal exposure. Editor’s box Modifications have also been described to increase support during healing which involve creating a bridge of palpebral conjunctiva from Ocular Outlook the lower eyelid which is sutured Editor: Sara Calvarese, DVM, DACVO into a pocket created in the upper Managing Editor: Julie Gamarano lid between the skin and orbicularis muscle and tarsoconjunctival inner Eye Care for Animals welcomes your comments on the Ocular Outlook. lining of the lid. Depending on Please e-mail your feedback to [email protected] the extent of the correction, in or call Julie at (480) 682-6911. some cases, the upper nasolacrimal For electronic subscription please visit www.eyecareforanimals.com punctum may be occluded as part of this surgery – rarely would this be Two Eye Care for Animals THE OCULAR OUTLOOK a problem since the upper punctum With more firm and stout cilia, a breed commonly affected with a contributes less than the lower the hairs may cause conjunctival multiplicity of eyelid cilia disorders. punctum to tear drainage. Because and cornea irritation or ulceration. Treatment of distichia is most many brachycephalic dogs with Treatment of these hairs by cutting effectively performed with medial entropion also have low or plucking is not recommended in cryothermy to destroy the follicle tear production and increased tear most cases due to their tendency to at the base of the Meibomian gland. evaporation, any reduction of tear re-grow from the remaining follicle. When viewed under the operating drainage might actually be beneficial. Each time distichia are trimmed microscope the location of the cilia In more extreme cases the medial there is a tendency for them to regrow can easily be seen and a double blepharoplasty is combined with as thicker and more troublesome freeze thaw cycle applied with a surgical removal of part or the entire hairs with resultant corneal disease. fine ophthalmic cryoprobe over the nasal fold when either the fold is The irritation from the hairs causes follicle at the base of the gland. Cilia contributing to the medial lower increased lacrimation, conjunctivitis eyelid entropion or nasal fold cilia are and in some cases corneal ulceration also rubbing on the corneal surface. (which may be compounded due to Since owners are often concerned self trauma). In some breeds (for about the cosmetic alteration when instance the Weimaraner shown removing the fold I usually try to below) the cilia often present as remove only the anterior half of the numerous short stout hairs along fold in order to preserve some of the a considerable length of the eyelid brachycephalic facial appearance. margin. Cilia abnormalities may can then be epilated at the time of The incisions are sutured in such a be seen at any age but are usually surgery or a few days later. way that the nasal fold is rolled away present in young animals and will Ectopic cilia can be treated with from the lower eyelid which directs persist unless treated appropriately.
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