Volume 11, Issue 3 WINTER 2013-14 OCULAR A QUARTERLY PUBLICATION FOR THE VETERINARY COMMUNITYOutlook FROM EYE CARE FOR ANIMALS OCULAR HEMORRHAGE: WHAT’S THE BLOODY CAUSE? thrombocytopenia), , and , but the latter three conditions could occur alone in the absence of infection. A few specific causes and presentations are discussed. Traumatic to the or adnexa include lacerations, proptosis, crushing injuries (e.g., animal bite), blunt-force trauma (e.g., being hit by a ball), and penetrating corneal Figure 3: Subconjunctival and foreign bodies (Figure 3). Trauma is intraocular hemorrhage in a cat the obvious cause with lacerations, following trauma. penetrating injuries, and most cases when assuming trauma in other of proptosis, but caution is advised instances. Consider the client who is adamant their pet “hit its head on B. Keith Collins, the table” to cause blood in the eye. DVM, MS, DACVO However, pre-existing disease might Ocular hemorrhage is common have contributed to the incident or and can affect the , adnexa, or exacerbated the result. A unilateral intraocular structures. Intraocular visual deficit (e.g., retinal detachment) is most often encountered, for which the owner was unaware and blood can be present in the could have caused the pet to hit its anterior chamber (), the eye on the affected side. Alternatively, posterior segment (or vitreous), undiagnosed thrombocytopenia could or the . Intralenticular cause hemorrhage after an otherwise bleeding is rarely observed unless Figure 1: hemorrhages in a dog insignificant . Always look for a associated with a congenital disorder. with Rocky Mountain Spotted Fever. cause! Hemorrhage can be minor and Rupture of a deep self limiting, or it can cause vision (descemetocele) can cause minor or loss and indicate life-threatening disease (Figures 1 and 2). Possible (CONTINUED ON PAGE 2) causes include trauma, secondary to ulceration, neoplasia, coagulopathy, systemic INSIDE THIS ISSUE , infection, uveitis of any cause, and retinal detachment. It is helpful with differential Upcoming Events Pg. 5 diagnosis to consider various causes as single entities, but there Figure 2: Unilateral hyphema in a cat Article Spotlight Pg. 5 is overlap. For example, ehrlichiosis with systemic hypertension. The could cause coagulopathy (due to contralateral eye had serous retinal detachment but no hemorrhage. Message from the President Pg. 6

www.eyecareforanimals.com • 1 OCULAR Outlook OCULAR Outlook OCULAR HEMORRHAGE (CONTINUED FROM PAGE 1) Editor: Keith Collins, DVM, MS, DACVO extensive bleeding. Surgical repair Managing Editor: Debbie Brinkoetter of the ulcer should be considered if Eye Care for Animals welcomes your anterior chamber bleeding is minimal comments on the Ocular Outlook. and intraocular structures visualized. Please e-mail your feedback to Complete hyphema associated with [email protected] globe rupture carries a worse visual or call Debbie at (480) 682-6911. prognosis, and enucleation may be more appropriate for some of these For electronic subscription please visit patients. www.eyecareforanimals.com Pets with ocular hemorrhage in Eye Care for Animals the absence of known or visible Figure 4: Preretinal (boat keel) trauma require additional evaluation. and intraretinal hemorrhages in a LOCATIONS Accurate assessment requires dog. The preretinal hemorrhage is complete ocular examination, adjacent to the opitc disc. Avondale, Arizona physical examination, knowledge undergo periodic blood pressure East Tucson, Arizona of breed predisposition for certain Gilbert, Arizona determination and/or retinal diseases, and selected tests. A Phoenix, Arizona examination for early diagnosis. complete blood count (CBC), platelet Scottsdale, Arizona Reduction in blood pressure and count, serum biochemical profile, South Scottsdale, Arizona treatment of the primary disease blood pressure determination, Tucson, Arizona can prevent progression of ocular coagulation profile, and serology Chula Vista, California changes, thereby preserving or even for tick-borne or other diseases Corte Madera, California restoring vision. Blood pressure should be considered. Even in pets Culver City, California determination should be considered where hemorrhage is unilateral and Palm Desert, California in all instances where the cause of physical examination unremarkable, Pasadena, California bleeding is undetermined. San Diego, California minimum evaluation should include San Juan Capistrano, California a platelet count and blood pressure One definition of uveitis is breakdown Santa Rosa, California determination. Ultrasound is helpful of the blood-aqueous barrier, so it Torrance, California if hyphema precludes intraocular is not surprising that hyphema can Tustin, California examination; however, the higher occur with uveitis of any cause. This Upland, California megahertz probes (10 MHz or includes uveitis caused by leakage Woodland Hills, California greater) needed for ocular ultrasound of protein from (i.e., Norwalk, Connecticut may necessitate referral to an lens-induced uveitis). Dogs with Chicago, Illinois ophthalmologist. Enucleation should hypermature or rapidly resorbing St. Charles, Illinois be considered for permanently blind cataracts are also at increased risk Wheeling, Illinois or painful eyes where histopathology for retinal tears and detachment, Mission, Kansas of the globe may facilitate diagnosis. and substantial hemorrhage can be Overland Park, Kansas associated with detachment. Thus, High blood pressure (or systemic Wichita, Kansas cataractous eyes can have hyphema hypertension) is a common cause of Annapolis, Maryland due to lens-induced uveitis, retinal intraocular hemorrhage, and though Frederick, Maryland detachment, or both. Towson, Maryland symptoms are usually bilateral, they Lee’s Summit, Missouri are not necessarily symmetric (Figure Retinal hemorrhages often develop Springfield, Missouri 2). The condition of hypertensive in diabetic dogs with normal blood Las Vegas, Nevada refers to retinal changes pressure and platelet function. The Reno, Nevada that may include vascular tortuosity, hemorrhages are a manifestation Albuquerque, New Mexico hemorrhages, edema, degeneration, of , but they are Santa Fe, New Mexico and detachment. Hypertensive usually self-limiting and confined to Akron, Ohio retinopathy is the most common the central or peripapillary retina. Cleveland, Ohio cause of retinal detachment and No specific treatment is required. Warwick, Rhode Island intraocular hemorrhage in cats Small intraretinal hemorrhages are Austin, Texas greater than 10 years of age. occasionally encountered in non- El Paso, Texas Affected cats often have renal diabetic dogs for which there is Houston, Texas disease or hyperthyroidism. no discernible cause. The author Round Rock, Texas Chronic renal failure, has encountered idiopathic retinal Salt Lake City, Utah mellitus, and Cushing’s disease are hemorrhage most often in elderly Sunset, Utah common causes of hypertension Golden retrievers, and they are Leesburg, Virginia in dogs. High-risk patients should usually confined to the peripapillary Pewaukee, Wisconsin (CONTINUED ON PAGE 5)

2 • www.eyecareforanimals.com OCULAR Outlook WELCOME! MARJORIE NEADERLAND DVM, DACVO Dr. Marjorie Neaderland is a Norwalk, CT native. She received her Bachelor of Arts and Associates of Science from the University of Maine at Orono. After graduating, Dr. Neaderland worked as a research assistant at the Yale University School of Medicine in the Departments of Comparative Medicine and later, Therapeutic Radiology. She is the coauthor of several published papers involving hypoxic cell sensitization from that research project. Dr. Neaderland received her Doctorate of Veterinary Medicine from the University of California, Davis, in 1984. Following graduation from UC Davis, Dr. Neaderland completed a small animal medicine and surgery internship, and a three-year residency in comparative at Cornell University in New York. Her residency research project and publication involved equine corneal healing. She became a board certified veterinary ophthalmologist in 1990 and opened the Animal Eye Clinic in Norwalk. In June 2013, Dr. Neaderland joined Eye Care for Animals. Dr. Neaderland is an avid equestrian and enjoys her equine patients. The Retinographics ERG was developed with Bill Eppler at her practice, bringing electroretinography into private ophthalmology practice. She is a supporter of the Pegasus Therapeutic Riding program, which provides handicapped children with physical therapy, companionship and confidence through horseback riding. She has been the veterinary ophthalmologist for the Guiding Eyes for the Blind in Patterson, NY since 1993, examining all dogs in their breeding program annually. DANIELLE PAGLIA DVM, DACVO Dr. Danielle Paglia earned her Bachelor of Science degree in Animal Biology from the University of Florida. She obtained her Doctorate of Veterinary Medicine in 2001 from Mississippi State University where she was inducted into the Phi Zeta honor society. She then completed a rotating small animal medicine and surgery internship at Red Bank Veterinary Hospital. Subsequently, she attended the University of Wisconsin, Madison where she completed an ocular pathology fellowship. Following the completion of a three year comparative ophthalmology residency at the University of California, Davis, she worked in private practice in Rocklin, CA. She and her husband, a veterinarian and native Texan, have moved to Texas to be closer to family. She has joined ECFA in 2013 and practices at our Austin, TX location. Dr. Paglia is the first at ECFA to do small animalMobile Ophthalmology. By appointment, Dr. Paglia goes to predetermined Austin area veterinary practices to handle their ophthalmology needs and more easily accommodate the needs of their clients’ pets. JOINING ECFA IN APRIL! Dennis Hacker, DVM, DACVO 10324 San Pablo Avenue El Cerrito, CA 94530

www.eyecareforanimals.com • 3 OCULAR Outlook CONGRATULATIONS TO OUR NEWLY BOARDED DIPLOMATES!

Melanie Church, DVM, DACVO, Warwick, RI

Dustin Dees, DVM, DACVO, Austin, TX

Kevin Fritz, DVM, DACVO, San Diego, CA

4 • www.eyecareforanimals.com OCULAR Outlook ARTICLE SPOTLIGHT Spotlight on Editor’s note: The spotlight is NEW LOCATIONS intended to provide practitioners with clinically relevant information CLEVELAND, OHIO from journals not available to most 5320 West 140th Street veterinarians. Old and new articles Brook Park, OH 44142 are included and are selected by the SAN JUAN CAPISTRANO, CALIFORNIA reviewer. This article was provided 31896 Plaza Drive, Suite C-1 by Dr. Neal Wasserman San Juan Capistrano, CA 92675 Title: Contralateral FREDERICK, MARYLAND and retinopathy associated with visual Neal Wasserman, DVM, DACVO 434 Prospect Blvd. and afferent pupillomotor dysfunction Frederick, MD 21701 following enucleation in six cats. Vet access to the posterior globe and Ophthalmol 2013;1-12. DOI:10.1111/ allow for limited rostral mobility of vop.12104 the ON. Visual and pupillary light reflex deficits noted after enucleation Upcoming Summary: This study evaluates six indicated tractional damage to the OC EVENTS cats in which visual and afferent and contralateral ON. Progressive pupillary dysfunction were noted after fundic changes and MRI results February 25, 2014 – Houston, TX enucleation of the contralateral eye. support retrograde ON and retinal MCVMA Mtg. All cats had immediately degeneration, and OC atrophy. The Ophthalmology Dinner and CE after surgery. Four of six cats incidence of ON damage after feline had absent menace, dazzle, and March 26, 2014 – Chicago, IL enucleation is not clear, and the fact pupillary light reflexes; the remaining Wet Lab that all cats were not completely two had partial reflexes. Fundus, blind suggests the incidence may April 26, 2014 – Phoenix, AZ electroretinogram (ERG), and be greater than suspected. During Arizona Specialty Center magnetic resonance imaging (MRI) surgery, the ON from the cats in this “A Day With The Specialists” CE Event findings were documented in some cats after surgery. Fundic changes study were clamped, and the ON was April 27, 2014 – Tustin, CA noted between two and six weeks ligated in four of the six cats where Advanced Veterinary Specialty Group included peripapillary hyporeflective this information was available. Multi Specialty Wet Lab and bullous lesions that eventually Conclusion: Much greater care is became flat and hyperpigmented. required when removing a cat’s (ON) atrophy and retinal eye compared with a dog. Rostral Special Thanks! degeneration were noted as long-term traction of the globe and ligation of On behalf of the entire Eye Care for sequelae. MRI findings three months Animals family we thank Keith Collins, or more after surgery revealed the ON should be avoided. Some atrophy of the optic chiasm (OC). ophthalmologists clamp the nerve DVM, MS, DACVO for serving as Editor prior to cutting it, but even this should of Ocular Outlook these past two Comments: The orbital space probably be avoided. The consensus years. Congratulations on a job well and sigmoid flexure of the ON are of most ophthalmologists is that smaller in the cat than the dog. bleeding can be controlled with direct done. We are extremely grateful for These differences reduce surgical tamponade alone. your service and commitment.

OCULAR HEMORRHAGE (CONTINUED FROM PAGE 2) retina. Ophthalmologists categorize cause. For non-ulcerated eyes additional treatment may include retinal hemorrhages as preretinal, in which hyphema is the primary systemic antibiotics, corticosteroids, intraretinal, or subretinal, but such finding, topical steroid and mydriatic or hypotensive agents. Empiric designations are not specific for treatment is appropriate as for doxycycline treatment should be any disease condition (Figure 4). other forms of uveitis. Additional considered in dogs where tick-borne Intraretinal hemorrhages can be specific treatment of anterior disease is suspected and test results subclassified as superficial or deep. segment or posterior segment are pending. The visual prognosis will Treatment of ocular hemorrhage disease is determined by the results depend on the cause and severity of is directed toward the underlying of additional tests. Depending on hemorrhage. the cause and severity of disease,

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