Ocular Hemorrhage
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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), uveitis, and retinal detachment, but the latter three conditions could occur alone in the absence of infection. A few specific causes and presentations are discussed. Traumatic injuries to the globe 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 orbit, adnexa, or exacerbated the result. A unilateral intraocular structures. Intraocular visual deficit (e.g., retinal detachment) bleeding 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 (hyphema), the eye on the affected side. Alternatively, posterior segment (or vitreous), undiagnosed thrombocytopenia could or the retina. Intralenticular cause hemorrhage after an otherwise bleeding is rarely observed unless Figure 1: Iris hemorrhages in a dog insignificant injury. Always look for a associated with a congenital disorder. with Rocky Mountain Spotted Fever. cause! Hemorrhage can be minor and Rupture of a deep corneal ulcer 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, globe rupture secondary to ulceration, neoplasia, coagulopathy, systemic INSIDE THIS ISSUE hypertension, 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 lens protein from cataracts (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 retinopathy 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 diabetic retinopathy, 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, diabetes 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 ophthalmology 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