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Second, revised and expanded edition Frans C.Frans Stades H. · Michael Wyman Milton Spiess · Bernhard Neumann Willy · Boevé for Ophthalmology Practitioner the Veterinary vet

Ophthalmology for the Veterinary Practitioner Stades · Wyman · Boevé · Neumann · Spiess vet 5 1 1 0 3 9 9 9 8 3 8 7 ISBN 978-3-89993-011-5 9 daily practice farm animals therapeutic methods drawings to illustrate symptoms and techniques The book’s structure book’s follows The the steps of a clinical investigation. It is a reliable and indispensable handbook both for the novice in veterinary ophthalmology and the general practitioner. Recognized as a standard work, this new, completely revised and expanded edition contains: • All important eye diseases encountered in • Coverage of pet animals, horses, birds and • Practical tips for effective diagnosis • latest The drugs, diagnostic and • Step-by-step surgical procedures • color First-class photographs and instructive _ gqp

Second, revised and expanded edition Frans C.Frans Stades H. · Michael Wyman Milton Spiess · Bernhard Neumann Willy · Boevé for Ophthalmology Practitioner the Veterinary vet

Ophthalmology for the Veterinary Practitioner

Second, revised and expanded edition

Titel.indd III 13.12.2006 8:57:43 Uhr 1. English Edition 1996 1. Dutch Edition 1996 2. English Edition 2007 1. Spanish Edition 1998 1. German Edition 1996 1. Portuguese Edition 1998 2. German Edition 1998 1. Italian Edition 2000 3. German Edition 2006 1. Japanese Edition 2000

Printed in Germany

ISBN 978-3-89993-011-5

Bibliographic information published by Die Deutsche Nationalbibliothek Die Deutsche Nationalbibliothek lists this publication in the Deutsche Nationalbibliografie; detailed bibliographic data are available in the Internet at http://dnb.ddb.de. The authors assume no responsibility and make no guarantee for the use of drugs listed in this book. The authors / publisher shall not be held responsible for any damages that might be incurred by the recommended use of drugs or dosages contained within this textbook. In many cases controlled research concerning the use of a given drug in animals is lacking. This book makes no attempt to validate claims made by authors of reports for off-label use of drugs. Practitioners are urged to follow manu- facturers´ recommendations for the use of any drug. All rights reserved. The contents of this book, both photographic and textual, may not be reproduced in any form, by print, photoprint, phototransparency, microfilm, video, video disc, microfiche, or any other means, nor may it be included in any com- puter retrieval system, without written permission from the publisher. Any person who does any unauthorised act in relation to this publication may be liable to criminal prosecution and civil claims for damages.

Titel.indd IV 13.12.2006 8:57:43 Uhr Contents V Contents

Authors ...... X 3.1.2 Subconjunctival ...... 21 3.1.3 Retrobulbar ...... 21 Abbreviations ...... XI 3.1.4 Intraocular ...... 21 3.1.5 General rules ...... 22 Origin of Plates and Figures ...... XII 3.2 Ocular therapeutic agents ...... 22 3.2.1 Vasoconstrictors ...... 22 3.2.2 Antihistamines (nowadays mostly replaced 1 Introduction 1 by corticosteroids) ...... 22 3.2.3 Antiglaucoma agents ...... 23 2 Clinical and Differential Diagnostic 3.2.3.1 Miotics. Facilitating drainage of Procedures aqueous ...... 23 3.2.3.2 Moderating production of aqueous: 2.1 Description of the patient ...... 5 carbonic anhydrase inhibitors ...... 23 2.2 Patient history ...... 5 3.2.3.3 Osmotic agents ...... 23 2.3 Animal handling, equipment, 3.2.3.4 Other agents used to reduce ocular and instruments ...... 8 pressure ...... 23 2.3.1 Restraint and sedation ...... 8 3.2.4. Mydriatics ...... 23 2.3.2 Materials and instruments ...... 8 3.2.5 Antimicrobial agents ...... 24 2.4 Examination of the eye and its adnexa . 8 3.2.5.1 “Initial choice” antibacterials ...... 24 2.4.1 Head, skull, and orbital area ...... 8 3.2.5.2 Antimycotics ...... 25 2.4.2 Tear film and tear production ...... 9 3.2.5.3 Antiviral drugs: DNA-synthesis inhibitors . . . 25 2.4.3 Ocular discharge ...... 10 3.2.6 Corticosteroids ...... 25 2.4.4 Eyelids (palpebrae) ...... 10 3.2.6.1 Topical, into the conjunctival sac ...... 25 2.4.5 Conjunctiva ...... 11 3.2.6.2 Subconjunctival ...... 25 2.4.6 Globe (bulbus) ...... 12 3.2.6.3 Oral ...... 25 2.4.7 Sclera ...... 13 3.2.7 Non-steroidal anti-inflammatory drugs 2.4.8 Cornea ...... 13 (NSAIDs) ...... 25 2.4.9 Anterior and posterior chambers ...... 13 3.2.7.1 Prostaglandin synthesis inhibitors ...... 25 2.4.10 Pupil and iris ...... 14 3.2.8 Local anesthetics ...... 26 2.4.11 Lens ...... 14 3.2.9 Vitamins, epithelializing agents, and 2.4.12 Vitreous ...... 14 neutral agents ...... 26 2.4.13 Fundus ...... 14 3.2.10 Collyria ...... 26 2.4.14 Additional and specific examinations ...... 15 3.2.11 Other “drugs” for ocular use ...... 26 2.5 Differential diagnosis ...... 16 3.2.11.1 Diagnostic agents ...... 26 2.5.1 Introduction ...... 16 3.2.11.2 Chemical cauterizing agents ...... 27 2.5.2 The “red” eye ...... 16 3.2.11.3 (Discharge-)dissolving agents ...... 27 2.5.3 Epiphora without distinct blepharospasm . . . 16 3.2.11.4 Anti-hypertensive agents (in secondary 2.5.4 Blepharospastic / painful eye (Schirmer tear retinopathy) ...... 27 test not decreased) ...... 16 3.2.11.5 Other drugs used on the eye ...... 27 2.5.5 Protrusion of the nictitating membrane with 3.2.12 Radiation ...... 27 enophthalmos ...... 16 3.2.13 Protective devices ...... 27 2.5.6 Exophthalmos ...... 16 3.3 Surgical possibilities ...... 27 2.5.7 The “blue-white” cornea ...... 17 3.3.1 Anesthesia ...... 27 2.5.8 The “pigmented” eye ...... 17 3.3.2 Preparation of the operative field ...... 28 2.5.9 The “blind” eye ...... 17 3.3.3 Positioning on the operating table ...... 28 3.3.4 Draping ...... 28 3.3.5 Magnification equipment ...... 28 3 Diagnostics and Therapeutics for 3.3.6 Surgical equipment ...... 28 Eye Diseases 3.3.7 Suture material ...... 28 3.3.8 Hemostasis ...... 29 3.1 Introduction ...... 19 3.3.9 Cryosurgery ...... 29 3.1.1 Into the conjunctival sac ...... 19 3.3.10 Laser techniques ...... 29

Inhalt.indd V 17.11.2006 11:35:50 Uhr VI Contents

4 Ocular Emergencies 7 Eyelids 4.1 Introduction ...... 31 7.1 Introduction ...... 73 4.2 Luxation or proptosis of the globe . . . . 31 7.2 Ankyloblepharon ...... 74 4.3 Chemical burns ...... 34 7.3 Aplasia palpebrae ...... 74 4.4 Blunt trauma ...... 34 7.4 Dermoids / dysplasia of the lid ...... 76 4.4.1 Orbital fractures ...... 34 7.5 Distichiasis ...... 76 4.4.2 Contusion of the globe ...... 35 7.6 Entropion ...... 78 4.4.2.1 Suffusion (hyposphagma) ...... 35 7.6.1 Entropion in sheep and horses ...... 86 4.4.2.2 Traumatic corneal edema ...... 35 7.7 Ectropion and /or oversized 4.4.2.3 Hyphema ...... 35 palpebral fissure (macroblepharon) 4.4.2.4 Trauma with deeper penetration ...... 36 (Ect / OPF) ...... 86 4.5 Penetrating or perforating trauma . . . . . 37 7.7.1 Shortening of the lower palpebral 4.5.1 Lid lacerations and conjunctival sac conjunctiva ...... 87 wounds ...... 37 7.7.2 V-Y Method ...... 87 4.5.1.1 Lacerations of the lid edge including 7.7.3 Simple wedge resection ...... 87 the lacrimal canaliculus ...... 39 7.7.4 Kuhnt-Szymanowski method, Blaskovic’s 4.5.1.2 Lacerations with loss of tissue ...... 39 modification ...... 87 4.5.2 Conjunctival lacerations ...... 39 7.7.5 Kuhnt-Szymanowski method ...... 87 4.5.3 Corneal lacerations ...... 40 7.7.6 Z-plasty / free transplants ...... 88 4.5.3.1 General rules of treatment ...... 40 7.7.7. Total fissure shortening methods ...... 88 4.5.3.2 Non-perforating corneal wounds ...... 40 7.8 Trichiasis ...... 89 4.5.3.3 Perforating corneal defects ...... 43 7.8.1 Nasal fold trichiasis ...... 89 7.8.1.1 Removal of nasal folds ...... 89 7.8.1.2 Medial canthoplasty ...... 90 5 Orbital and Periorbital Structures 7.8.2 Upper eyelid trichiasis ...... 90 5.1 Introduction ...... 47 7.8.3 Caruncle trichiasis and trichiasis in 5.2 Congenital abnormalities ...... 48 other locations ...... 91 5.3 Trauma ...... 48 7.9 Blepharophimosis ...... 94 5.4 Enophthalmos ...... 48 7.10 Oversized / overlong palpebral 5.4.1 Enophthalmos due to loss of support ...... 48 fissure ...... 94 5.4.2 Enophthalmos due to Horner’s syndrome . . . 49 7.11 Injuries ...... 94 5.5 Exophthalmos ...... 49 7.12 Ptosis ...... 94 5.5.1 Exophthalmos due to swelling of the 7.13 Lagophthalmos ...... 95 temporal muscles ...... 50 7.13.1 Medial canthoplasty ...... 95 5.5.2 Exophthalmos due to retrobulbar 7.13.2 Lateral canthoplasty ...... 95 processes ...... 50 7.14 Blepharitis ...... 95 5.6 Enucleation of the globe including 7.14.1 Non-specific blepharitis ...... 95 the conjunctiva ...... 53 7.14.2 Chronic blepharitis ...... 95 5.7 Evisceration of the globe ...... 56 7.14.3 Specific blepharitis ...... 96 5.8 Enucleation of the globe ...... 56 7.14.3.1 Chalazion / hordeolum ...... 96 5.9 Exenteration of the orbit ...... 56 7.14.3.2 Blepharitis adenomatosa 5.10 Orbitotomy ...... 56 (meibomianitis) ...... 96 7.14.3.3 Juxtapalpebral defects / granulomatous changes ...... 96 6 Lacrimal Apparatus 7.14.3.4 Eosinophilic granuloma ...... 96 6.1 Introduction ...... 59 7.14.3.5 Blepharitis in birds ...... 99 6.2 Keratoconjunctivitis sicca (KCS) ...... 61 7.14.3.6 Blepharitis in horses ...... 99 6.3 (Sialo)dacryoadenitis ...... 64 7.15 Neoplasia of the eyelids ...... 99 6.4 Tear stripe formation ...... 65 7.15.1 Sarcoids in horses ...... 103 6.4.1 Micropunctum or stenosis of the lacrimal punctum ...... 65 6.4.2 Atresia and secondary closure of the 8 Conjunctiva and Nictitating Membrane punctum ...... 66 8.1 Introduction ...... 105 6.5 Dacryocystitis ...... 67 8.2 Non-pigmented margin of the 6.6 Lacerations ...... 70 nictitating membrane ...... 106 6.7 Cysts and neoplasia ...... 70 8.3 Dermoid ...... 106 8.4 Ectopic cilia ...... 106

Inhalt.indd VI 17.11.2006 11:35:51 Uhr Contents VII

8.5 Protrusion of the nictitating 10.6.1.1 Chronic superficial keratitis (Überreiter) / membrane ...... 107 pannus / keratitis pannosa / photoallergic 8.6 Cysts ...... 108 keratitis / vascular and pigmentary keratitis / 8.7 Eversion / inversion of the nictitating German Shepherd dog keratitis ...... 135 membrane ...... 108 10.6.1.2 Eosinophilic keratitis ...... 136 8.8 Hyperplasia / hypertrophy of the 10.6.2 Deep or interstitial keratitis or keratitis gland of the nictitating membrane profunda (without defects) ...... 136 (“cherry eye”) ...... 110 10.6.3 Ulcerative keratitis ...... 137 8.9 Subconjunctival hemorrhages ...... 113 10.6.3.1 Superficial ulcers ...... 137 8.10 Injuries ...... 113 10.6.3.2 Deep ulcers ...... 140 8.11 Conjunctivitis ...... 113 10.6.3.3 Hernia of Descemet’s membrane 8.11.1 Catarrhal (or serous) conjunctivitis ...... 114 (descemetocele) ...... 140 8.11.2 Purulent conjunctivitis ...... 114 10.6.3.4 Corneal perforation (staphyloma) ...... 142 8.11.3 Follicular conjunctivitis ...... 116 10.6.3.5 Nictitating membrane, conjunctival, and 8.11.4 Plasmacellular conjunctivitis ...... 116 corneal oversuturing techniques ...... 142 8.11.5 Papillary / nodular / granulomatous 10.6.4 Corneal sequestration / cornea nigrum / conjunctivitis ...... 117 corneal necrosis / corneal mummification . . . 147 8.11.6 Conjunctivitis neonatorum ...... 117 10.6.5 Keratitis punctata ...... 149 8.11.7 Infectious bovine / ovine keratoconjunctivitis 10.6.6. Keratitis herpetica ...... 150 (pinkeye) ...... 118 10.6.7 Infectious bovine / ovine 8.12 Eosinophilic granuloma ...... 119 keratoconjunctivitis ...... 150 8.13 Allergic conjunctivitis ...... 119 10.6.8 Corneal cysts ...... 150 8.14 Conjunctival adhesions ...... 119 10.6.9. Corneal abscess ...... 150 8.14.1 Symblepharon ...... 119 10.7 Dystrophic / degenerative deposits 8.14.2 Conjunctival stricture in the rabbit ...... 120 in the cornea ...... 151 8.15 Neoplasia of the conjunctiva ...... 122 10.7.1 Corneal dystrophies ...... 151 10.7.1.1 Epithelial / stromal dystrophy ...... 151 10.7.1.2 Endothelial dystrophy or senile endothelial 9 Globe degeneration ...... 152 9.1 Introduction ...... 125 10.7.2 Local degenerative crystal deposits ...... 153 9.2 Exophthalmos, enophthalmos ...... 125 10.7.3 Deposits resulting from systemic diseases . . . 153 9.3 Pseudo-exophthalmos / pseudo- 10.7.4 Corneal edema in the Manx cat ...... 153 enophthalmos ...... 125 10.7.5 Mucopolysaccharidosis ...... 154 9.4 Setting sun phenomenon ...... 126 10.7.6. GM1 and GM2 gangliosidosis ...... 154 9.5 Strabismus ...... 126 10.8 (Epi)scleritis ...... 154 9.6 Nystagmus ...... 126 10.9 Neoplasms ...... 155 9.7 Anophthalmia, cyclopia, microphthalmia ...... 127 9.8 Phthisis bulbi ...... 127 11 Intraocular Pressure and Glaucoma 9.9 Macrophthalmia ...... 128 11.1 Introduction ...... 157 9.10 Buphthalmos / hydrophthalmia ...... 128 11.2 Glaucoma ...... 159 9.11 Endophthalmitis, panophthalmitis . . . . . 128 11.2.1 Etiology ...... 159 11.2.1.1 Primary glaucoma ...... 159 11.2.1.2 Secondary glaucoma ...... 160 10 Cornea and Sclera 11.2.1.3 Absolute glaucoma ...... 160 10.1 Introduction ...... 129 11.2.2 Irido-corneal angle abnormalities ...... 161 10.1.1 Symptoms of corneal disease ...... 129 11.2.2.1 Open irido-corneal angle glaucoma ...... 161 10.1.2 Localization and causes of corneal 11.2.2.2 Narrowed or closed irido-corneal angle abnormalities ...... 132 glaucoma ...... 161 10.1.3 Corneal regeneration ...... 132 11.2.3 Conditions of the drainage angle ...... 161 10.1.4 Retardation of healing ...... 133 11.2.3.1 Open pectinate ligament glaucoma ...... 161 10.2 Microcornea ...... 133 11.2.3.2 Primary morphologically abnormal 10.3 Persistent pupillary membrane (PPM) . 133 pectinate ligament ...... 161 10.4 Dermoid ...... 133 11.2.4 Length of time of development and 10.5 Trauma ...... 134 progression of glaucoma ...... 161 10.6 Keratitis ...... 134 11.2.4.1 Acute glaucoma ...... 161 10.6.1 Superficial keratitis (without ulceration) . . . . 134 11.2.4.2 Chronic glaucoma ...... 162

Inhalt.indd VII 17.11.2006 11:35:51 Uhr VIII Contents

11.2.4.3 Hydrophthalmia or buphthalmos ...... 162 12.10.3.6 Protozoa ...... 180 11.3 Clinical aspects of glaucoma ...... 162 12.10.3.7 Parasites ...... 180 11.3.1 Acute glaucoma ...... 162 12.10.4 Immune reactions ...... 180 11.3.2 Chronic glaucoma ...... 164 12.10.4.1 Uveo-dermatologic syndrome (UDS) . . . . . 181 11.3.3 Therapeutic possibilities in glaucoma ...... 165 12.10.4.2 Lupus erythematosus (LE) ...... 181 11.4 Secondary glaucoma ...... 168 12.10.5 Idiopathic uveitis ...... 181 11.4.1 Secondary glaucoma associated with 12.10.6 Pseudo-uveitis caused by neoplasia ...... 181 the lens or vitreous ...... 168 12.10.7 Equine recurrent (chronic) uveitis (ERU) . . . 182 11.4.1.1 Dislocation of the lens ...... 168 12.10.8 Anterior uveitis in the rabbit ...... 183 11.4.1.2 Lens proteins ...... 168 12.11 Iris atrophy ...... 183 11.4.1.3 Cataract ...... 168 12.12 Dysautonomia or pupil dilatation 11.4.2 Secondary glaucoma associated with uveal syndrome (Key-Gaskell Syndrome) . . . . 184 changes ...... 168 12.13 Horner’s syndrome ...... 184 11.4.2.1 Uveitis ...... 168 12.14 Other pupillary abnormalities ...... 184 11.4.2.2 Iris atrophy / iridoschisis ...... 168 12.15 Neoplasia ...... 184 11.4.3 Secondary glaucoma associated with trauma . 169 12.16 Posterior Uvea ...... 186 11.4.4 Secondary glaucoma associated with intraocular neoplasia ...... 169 11.4.5 Secondary glaucoma associated with 13 Lens and Vitreous medication ...... 169 13.1 Introduction ...... 189 11.4.6 Secondary glaucoma associated with ocular 13.1.1 Ontogenesis ...... 189 surgery ...... 169 13.1.2 Anatomy and physiology ...... 190 11.4.6.1 Extracapsular lens extraction ...... 169 13.1.3 Vitreous ...... 191 11.4.6.2 Intracapsular lens extraction ...... 169 13.2 Developmental disorders of the lens . . . 192 11.5 Phthisis bulbi ...... 169 13.2.1 Aphakia / coloboma /spherophakia / microphakia /lenticonus / lentiglobus ...... 192 13.2.2 Persistent hyaloid artery (PHA) ...... 192 12 Uvea 13.2.3 Persistent hyperplastic tunica vasculosa 12.1 Introduction ...... 171 lentis / persistent hyperplastic primary 12.1.1 Iris ...... 171 vitreous (PHTVL / PHPV) ...... 193 12.1.2 Ciliary body ...... 172 13.3 Cataract ...... 193 12.1.3 Choroid ...... 173 13.3.1 Types of cataract ...... 196 12.2 Persistent (epi)pupillary membrane . . . . 173 13.3.2 Secondary cataract ...... 197 12.3 Coloboma ...... 174 13.3.2.1 Diabetic cataract ...... 197 12.4 Acorea / aniridia ...... 175 13.3.3 Therapeutic possibilities ...... 197 12.5 Heterochromia of the iris ...... 175 13.3.4 Prevention of cataract ...... 201 12.6 Blue iris / white coat ...... 175 13.4 Lens luxation or ectopic lens ...... 201 12.6.1 Oculocutaneous albinism and deafness . . . . . 175 13.5 Vitreous floaters, asteroid hyalosis, 12.6.2 Partial oculocutaneous albinism ...... 175 and synchysis scintillans ...... 206 12.7 Acquired color differences in the iris . . 175 13.5.1 Vitreous floaters ...... 206 12.8 Iris cysts ...... 176 13.5.2 Asteroid hyalosis ...... 206 12.9 Hyphema ...... 176 13.5.3 Synchysis scintillans ...... 206 12.9.1 Dysplastic abnormalities ...... 176 13.6 Hemorrhages and /or exudates in 12.9.2 Trauma ...... 176 the vitreous ...... 206 12.9.3 Leaking of vessels ...... 176 13.6.1 Blood ...... 206 12.9.4 Coagulation disorders ...... 176 13.6.2 Hemorrhagic or other exudate in 12.9.5 Uveitis ...... 177 the vitreous ...... 207 12.9.6 Neoplasms ...... 177 13.7 Retinal detachment and intraocular 12.10 Uveitis (anterior) ...... 177 neoplasms ...... 207 12.10.1 Traumatic uveitis ...... 179 12.10.2 Metabolic uveitis ...... 179 12.10.3 Infections ...... 179 14 Fundus and Optic nerve 12.10.3.1 Viral ...... 179 14.1 Introduction ...... 209 12.10.3.2 Rickettsia ...... 180 14.1.1 Ontogenesis ...... 209 12.10.3.3 Bacterial ...... 180 14.1.2 Retina ...... 209 12.10.3.4 Mycotic ...... 180 14.1.3 Optic nerve or tract ...... 211 12.10.3.5 Algae ...... 180 14.1.4 Vascular supply ...... 213

Inhalt.indd VIII 17.11.2006 11:35:51 Uhr Contents IX

14.1.5 Choroid (vascular membranes) ...... 214 14.16 Hypertensive Retinopathy ...... 229 14.2 Symptoms, pathologic changes, and 14.17 Non-hereditary degenerative reaction patterns of the fundus ...... 214 abnormalities ...... 230 14.3 Aplasia ...... 218 14.17.1 Feline central retinal degeneration (FCRD) . 230 14.4 Micropapilla and hypoplastic papilla . . . 218 14.18 Papilledema ...... 230 14.5 Coloboma ...... 218 14.19 Papillitis, optic neuritis ...... 231 14.6 Retinal dysplasia (RD) ...... 219 14.20 Neoplasia ...... 231 14.7 Collie eye anomaly (CEA) ...... 219 14.21 Amblyopia / amaurosis ...... 232 14.8 Inherited enzyme deficiencies ...... 221 14.21.1 Sudden acquired retinal degeneration 14.9 Hereditary (progressive) retinal (SARD) ...... 232 dysplasias / atrophy /degeneration (PRA) ...... 221 14.9.1 Hereditary progressive retinal degeneration / 15 Breed Predispositions and Hereditary progressive retinal atrophy ...... 222 Eye Diseases 14.9.2 Hereditary (stationary) night blindness . . . . . 224 15.1 Introduction ...... 237 14.9.3 Hereditary day blindness ...... 224 15.2 Modes of inheritance ...... 237 14.9.4 Pigment epithelial dystrophy (PED) ...... 224 15.2.1 Simple inheritance ...... 237 14.10 Hemorrhages and other vascular 15.2.1.1 Autosomal dominant (not sex-linked) . . . . . 237 abnormalities ...... 224 15.2.1.2 Autosomal recessive (not sex-linked) ...... 237 14.10.1 Vascular occlusion ...... 225 15.2.1.3 Sex-linked inheritance ...... 237 14.10.2 Hyperlipoproteinemia ...... 225 15.2.1.4 Incomplete recessive or dominant, 14.11 Trauma ...... 225 or incomplete penetrance ...... 238 14.12 Intoxications ...... 225 15.2.2 Multiple (polygenic) transmission ...... 238 14.12.1 Iatrogenic intoxications ...... 225 15.3 Is the abnormality inherited? ...... 238 14.13 Abnormalities of nutritional origin . . . . 225 15.4 Breed predispositions and inherited 14.13.1 Vitamin A and vitamin E deficiencies ...... 225 eye abnormalities ...... 240 14.13.2 Thiamine (aneurine) or vitamin B1 deficiency ...... 227 14.13.3 Taurine deficiency ...... 227 16 Glossary of Terms Relating to the Eye 247 14.14 Posterior uveitis /chorioretinitis / retinitis ...... 227 14.15 Retinal detachment ...... 228 Index ...... 251

Inhalt.indd IX 17.11.2006 11:35:52 Uhr X Contents Authors

Frans C. Stades, DVM, PhD, Dip. ECVO Michael H. Boevé, DVM, PhD, Dip. ECVO Associate Professor of Veterinary Ophthalmology Associate Professor of Veterinary Ophthalmology Department of Clinical Sciences of Companion Department of Clinical Sciences of Companion Animals Animals Faculty of Veterinary Medicine, Utrecht University, Faculty of Veterinary Medicine The Netherlands Utrecht University, The Netherlands Honorary Professor of Veterinary Ophthalmology, Stiftung Tierärztliche Hochschule Hannover, Germany Milton Wyman, DVM, MS, Dip. ACVO Professor of Veterinary Clinical Sciences Willy Neumann, DVM, Dip. ECVO Ohio State University College of Veterinary Specialist for Veterinary Surgery, Veterinary Ophthalmology Medicine Am Drosselschlag 25 Professor of Ophthalmology Giessen-Heuchelheim, Germany Ohio State University College of Medicine Columbus, Ohio, USA Bernhard Spiess, DVM, PhD, Dip. ACVO/ECVO Department for Small Animals, Ophthalmology Unit Vetsuisse Faculty University of Zurich, Switzerland

Inhalt.indd X 17.11.2006 11:35:52 Uhr Contents XI Abbreviations

a. artery long. longus ACE angiotensin converting enzyme m. muscle ant. anterior med. medial BAB blood-aqueous barrier MRI magnetic resonance imaging BCE before the Common Era OD oculus dexter (right eye) brev. brevis OS oculus sinister (left eye) BSS balanced salt solution OU oculus uterque (both eyes) CE Common Era PDT parotid duct transposition CEA Collie eye anomaly PHA persistent hyaloid artery CH choriodal hypoplasia PHTVL/PHPV persistent hyperplastic tunica vasculosa CRD chorioretinal dysplasia lentis/ persistent hyperplastic primary CSNB congenital stationary night blindness vitreous CT computed tomography PM pupillary membrane dv dorsoventral PMMA polymethylmetacrylate ERG electroretinogram post. posterior ERU equine recurrent uveitis PRA progressive retinal atrophy ext. external PU/PD polyuria /polydipsia FCRD feline central retinal degeneration RD retinal dysplasia FHV-1 feline herpes virus type 1 RPE retinal pigment epithelium HA hyaloid artery SARD sudden acquired retinal degeneration IOL intra-ocular lens STT Schirmer tear test IOP intraocular pressure TVL tunica vasculosa lentis KCS keratoconjunctivitis sicca UDS Uveo-dermatologic syndrome lat. lateral v. vein LE lupus erythematosus VEP visual evoked potential

Inhalt.indd XI 17.11.2006 11:35:52 Uhr XII Contents Origin of Plates and Figures

Plates: Figures:

7.16, 7.17: G. Kása; Kleintierklinik, Lörrach, Germany. 2.2, 7.2, 7.6, 7.16, 13.2 and 13.9 are, with permission of the publisher, taken from: F. C. Stades/M. H. Boevé, Ogen, 7.33, 7.34, 8.19, 10.34: W. Klein, Department of Equine in: Anamnese en lichamelijk onderzoek bij gezelschapsdieren, Sciences, Faculty of Veterinary Medicine, University of A. Rijnberk & H. W. de Vries, Editors, Bohn, Scheltema & Utrecht, The Netherlands. Holkema, 1990.

3.4, 3.5, 4.10, 6.11, 6.12, 7.8, 7.9, 7.26, 7.27, 10.15, 2.2, 4.5, 6.1, 6.2, 6.5, 7.2, 7.4, 7.6, 7.16, 7.23, 10.3, 12.3, 10.16, 10.17, 10.18, 12.11, 14.6, 14.9, 14.26, 14.27: 13.2, 13.9: B. Jansen, Department of Clinical Sciences of W. Neumann, Am Drosselschlag 25, Giessen-Heuchelheim, Companion Animals, Faculty of Veterinary Medicine, Germany. University of Utrecht, The Netherlands.

10.30, 14.2: B. Spiess, Department for Small Animals, Remaining figures: F. C. Stades. Ophthalmology Unit, Vetsuisse Faculty, University of Zurich, Switzerland.

13.3: Th. M. van Balen, University Medical Center, Amster- dam, The Netherlands.

14.25: A. Heijn, Veterinaire Specialisten Oisterwijk, The Netherlands.

Remaining plates: F. C. Stades and M. H. Boevé, Depart- ment of Clinical Sciences of Companion Animals, Faculty of Veterinary Medicine, University of Utrecht, The Nether- lands.

Inhalt.indd XII 17.11.2006 11:35:52 Uhr Introduction 1

1 Introduction 1

The previous editions of this book have clearly proved their formation available for the veterinary student or the non-spe- value. After the Dutch, German and English first editions in cialist practitioner. 1996, the second and third editions in German, Spanish, Por- This book is written primarily to provide the veterinary tuguese, Italian and Japanese versions of the book have been student and the general practitioner with the necessary infor- published. mation for the recognition and basic treatment of ophthalmic Over the past 10 years, continued progress has been made disorders. Over 180 photographs illustrate the abnormalities in the knowledge and medications associated with veterinary and more than 200 schematic drawings are included to clarify medicine, and in veterinary ophthalmology, in particular. Of the text and the different approaches to treatment. direct interest to the practitioner are not only those drugs that A fully problem-oriented approach appears to be less suit- are not available anymore, but also and more importantly, able in the work up of eye diseases. The chapter sequence in the new drugs and medications that have become available this book follows, as closely as possible, the recommended in the recent years. All together, these are good reasons for a order of the ophthalmic examination, with the exception of thoroughly revised, new edition of this book. the chapters on ocular diagnostics and therapy, surgical pro- We are very happy about the willingness of Prof. Dr. cedures, and breed predisposition and hereditary eye diseases. B. Spiess, Dip. ACVO/ ECVO to join the team as coauthor. There is a separate chapter on primary ocular emergencies as All the coauthors have each screened a part of the chapters and this should be readily available in hectic practical situations. the editor has screened all and has tried to bring any differ- Each chapter begins with a very brief introduction to the ences in opinion, if necessary and possible, to a consensus. morphology and physiology of the specific structure; this helps The morphologic and physiologic features of the eye and in understanding the etiology, clinical behavior, and therapy of the characteristics of ocular diseases are similar among domes- the associated diseases. The eye abnormalities are then pre- tic animals. Nevertheless, there are species differences in struc- sented in the same sequence in each chapter according to ture, in reactions of the eye, and in diagnostic procedures. pathogenesis, with congenital anomalies being dealt with first. There are also specific diseases and treatments in the different These are followed by diseases caused by environmental influ- species. ences such as trauma, intoxications, and deficiencies. Inflam- Ophthalmologic diseases comprise a large proportion of matory processes, including infections, are presented next. The the patients seen by the small animal practitioner. Eye prob- final parts of each chapter deal with degenerative, autoim- lems are especially frequent in dog breeds with redundant na- mune, and neoplastic diseases. sal and forehead skin folds, misdirected hairs, or poorly ap- The most commonly encountered ocular problems re- posed lids, and they cause discomfort to the animal. The large ceive the most detailed attention. Priority is given to the way animal practitioner will see eye problems in horses similar to the authors recognize and work up ophthalmologic emergen- those in small animals, but usually less frequently, and some cies and how they are treated. For other ophthalmic problems, conditions are specific to the horse. In cattle, sheep, goats, the authors have tried to provide adequate information to aid swine, small mammals, and birds, eye diseases are also generally in their recognition and to give general rules for treatment, less frequent than in pet animals, but they may cause consider- with special emphasis on preventing mistakes. Details about able problems when larger groups of animals are affected. the specific species are preceded by the species icons. Breed predisposition and hereditary ophthalmic disorders are All of this has been done with an understanding of the frequent in all species, but are mainly recognized in the dog. A limitations in equipment and training of the non-specialist knowledge of breeds predisposed to eye anomalies and he- practitioner. Therefore, the authors have also indicated which reditary eye diseases is of major importance. In addition, the patients should be referred and when, and how the eye should authors have tried to pay special attention to the recognition be protected during transport. The authors have tried to in- of eye abnormalities such as trichiasis, glaucoma, lens luxation, form practitioners about what the referred owner might ex- and progressive retinal atrophy, all of which are difficult to pect, which different treatments are possible, and the necessary diagnose without specialized ophthalmic equipment. after-care referring veterinarians must provide when the ani- Much has been published on the subject of veterinary mal returns to them. At the end of the description of each ophthalmology and there are many excellent and detailed disease, brief information is given about the prognosis, the books on ophthalmology as well as beautiful atlases. The ma- genetic aspects, and the consequences for breeding. jority of ophthalmic disorders can be diagnosed using rela- The authors are very grateful to the students, interns, and tively simple equipment and without the need for additional residents who have played a part in making this book possible. or specialized procedures. However, there is little practical in- Their critiques of the diagnostic and therapeutic keys were

Kap_001.indd 1 17.11.2006 11:36:15 Uhr 2 Introduction

Fig. 1: Partly opened section of the eye and the nomenclature.

Kap_001.indd 2 17.11.2006 11:36:16 Uhr Introduction 3

most helpful. We are also most grateful for the helpful criticism Dr. Peter Beyon for his thorough, final correction of the manu- of Prof. Dr. J. Fink-Gremmels and Dr. C. Görig. The many script 1 hours spent by Dr. Bruce Belshaw in editing the original man- The authors are especially grateful for the encouragement, uscript were vital for the book. His devotion to this task understanding, and active help of their families during the is gratefully acknowledged. We are also greatly indebted to preparation of this book.

Kap_001.indd 3 17.11.2006 11:36:16 Uhr 4 Introduction

Kap_001.indd 4 17.11.2006 11:36:17 Uhr 5 2 Clinical and Differential Diagnostic Procedures

2 Emphasis should be placed at the start on both the patient’s history and those diagnostic procedures that are specific to the eye and adnexa when presented with an animal with an ocular problem. The general history and examination should be dealt with only briefly. If there are indications that another system is involved or that there is a systemic disease (e.g. sneezing, hemorrhage, loss of weight, neoplasia), then a general physical examination must also be performed. It is important to follow a routine examination protocol as a checklist (Fig. 2.1) in order to provide a complete evaluation of the eye and adnexa. The recommended ophthalmic examination is described briefly; for further details of ophthalmic examination procedures, the reader is referred to specialized literature on the subject.1,2,3

2.1 Description of the patient

In addition to the age and sex of the patient, the species, breed and origin are of special importance. Many disorders of the eye have a predisposition in certain breeds or are inherited in specific breeds, and specific breed characteristics such as brachy- cephaly and /or redundant skin folding have to be consid- ered.

2.2 Patient history

The following questions are important when taking the history: Plate 2.1: A dog in the “Sphinx” position for eye examination (see also Plate 2.6). a Was the onset of the problem acute or gradual, or was it present when the dog was obtained? Does it affect one or both eyes and if the latter, which eye is worse? Is the problem improving, static, or becoming worse? a Are there changes in the color, position, or form of the a Have there been signs of general illness as well? Has the globe? patient been vaccinated recently? Are there signs such a What are the normal living conditions of the animal: does as rubbing or scratching at the eyes, excessive blinking, it have to climb stairs, is it on a leash outdoors, is it re- blepharospasm, photophobia, or pain during barking, stricted to its own terrain or free to roam, or has the animal yawning, chewing, or biting? a specific function (e.g. hunting, watchdog, jumping a Is there a discharge from the eye (watery, mucoid, puru- horse)? lent)? Does it result in periocular soiling and to what de- a What is the composition of the family: are there children, gree? Is the surface of the eye dry and encrusted? are there other animals? a Is there deterioration of vision, disorientation, or a change a What previous illnesses has the patient had, and what eye in the patient’s behavior, and if there are such changes, are diseases? What information is available about illnesses of they more pronounced in bright or dim light? other animals in the same household or of parents or sib- a If the owner describes the eye as bulging, is it protruding lings of the patient? from the orbit (exophthalmic) or is the globe itself en- a Are there any abnormalities in eating, volume of water larged (microphthalmos / buphthalmos)? Or, in contrast, is drunk, urination, or defecation? the eye too small (microphthalmos / phthisis bulbi) or ly- a Has the patient received eye washes or topical and /or sys- ing too deep in the orbit (enophthalmos)? temic medication for the present ophthalmic problem?

Kap_002.indd 5 17.11.2006 12:56:29 Uhr 6 Clinical and Differential Diagnostic Procedures

Fig. 2.1: Clinic for Companion Animals, University of Utrecht Example of an eye examination protocol.

Kap_002.indd 6 17.11.2006 12:56:33 Uhr Patient history 7

Kap_002.indd 7 17.11.2006 12:56:33 Uhr 8 Clinical and Differential Diagnostic Procedures

2.3.2 Materials and instruments The instruments that should be available include a penlight, a direct ophthalmoscope with a slit beam and a blue filter, Von 2 Graefe or other suitable forceps, a curette, and a spatula. Dis- posable materials include the Schirmer tear test, fluorescein test strips (or single dose drops), rose bengal strips or single dose vials, and tubes containing transport medium for micro- biological culturing. For ocular irrigation, 0.9% NaCl solution in a soft plastic infusion bottle with a 2-mm cannula can be used. Proparacaine, lidocaine, or tetracaine, which can cause irritation during induction, can be used for topical anesthesia. Tropicamide can be used as a short-acting mydriatic. In puppies and kittens, and in adult animals or patients with apparent congenital intraocular abnormalities, 0.5–1% atropine can be used.

Plate 2.2: Palpation of the weak bottom of the orbit in the mouth (with a closed mouth) behind the last upper molar (M 2). 2.4 Examination of the eye and its adnexa 2.3 Animal handling, General examination of the eye should start with a gross ob- equipment, and instruments servation of the position and symmetry of the eyes and adnexa. In principle the specific examination begins with the adnexa The examination should be performed in a room that can be and progresses inwards into the globe. However, the lacrimal dimmed and completely darkened, with a strong spotlight tear film should be examined before it is influenced by other available above the patient. The examiner should be seated procedures, and thus before inspection of the lids. The globe during the examination. Dogs and cats are held in a “Sphinx” as a whole can be examined either after the examination of position (Plate 2.1) at the edge of the examination table. All the lids or after examination of the conjunctiva, but this im- four feet of cats should be fixed to prevent injury. Materials for portant step should not be forgotten. The presence or absence culturing like moist sterile swabs and cytobrushes are impor- of periocular swelling and the gross appearance of the cornea tant aids in ophthalmologic diagnostics. and conjunctiva should be determined. Observe the animal’s ability to move freely in a room with obstructions and its ability to follow moving objects such as cotton balls. For purposes of recording findings, the points of reference 2.3.1 Restraint and sedation are anterior or posterior, nasal / medial or temporal / lateral, dorsal / superior or ventral / inferior, and positions corre- Dogs should be muzzled if they are nervous, unreliable, or sponding to the numbers on a clock. unfriendly. In dogs and cats, tranquilizers usually cause enophthalmos, inwards rotation of the globe, and protrusion of the nictitating membrane. For these reasons, they should only be used in low doses. In cats, a low dose of ketamine-xylazine 2.4.1 Head, skull, and orbital area results in excellent positioning of the globe for ophthalmic examination. More convenient is a very low dose of medeto- The position of the head and its relationship to the body (e.g. midine (0.01 mg/kg; for which an antagonist is available). It tilted left or right) and the muscle tone are noted while the can be used in cats and dogs without significantly interfering animal walks into the examination room, when it is at rest, and with the ophthalmic examination, although some miosis may when it is placed on the examination table. The patient is be caused. stroked on the head not only as an introduction, but also for the inspection of its chewing muscles for pain, warmth, swell- In horses a very low dose of detomidine (1–1.5 mg/ ing or atrophy, and asymmetry. The mandibular lymph nodes 100 kg) results in excellent positioning of the globe are palpated. If abnormalities are found, all nodes are exam- for ophthalmic examination. Blocking or infiltration ined. The sinuses and the bony and soft tissue parts of the or- anesthesia (supraorbital and /or auriculopalpebral) is also pos- bits are examined by percussion and are inspected for swelling, sible. However, general anesthesia is preferred for more exten- atrophy, abnormally hard or soft areas, pain, and asymmetry. If sive surgery, because of the lack of swelling and the better there are signs of a retrobulbar process, the mouth is opened positioning for the surgeon.4 to determine whether it can be fully opened and whether

Kap_002.indd 8 17.11.2006 12:56:34 Uhr Examination of the eye and its adnexa 9

opening causes pain. The soft tissue area behind the upper last molars (Plate 2.2), forming the bottom of the orbit, is examined for abnormalities such as discoloration, abscesses, swelling, etc. With the dog’s mouth closed, the same area can be palpated via the corners of the mouth with the tips of ones 2 fingers. When pressure is applied, the globe will be displaced 1–2 mm or more anteriorly in the orbit. If there is a retrobulbar mass, this may be painful, the globe will move much more, and /or the area will be found to be hard and indurated. The medial canthus area is inspected for the presence of tear-moistened hairs. In cats, these areas may contain particles of pigment. Hairs surrounding the eye can irritate the conjunctiva and /or eyeball (trichiasis, especially in the Blood- hound, Chow Chow, and short-nosed animals such as the Pekingese and the “Peke-faced” Persian cat), and will show wetness.

2.4.2 Tear film and tear production

The tear film and tear production are inspected before they can be influenced by further examinations. The tear film is Plate 2.3: examined at the junction of the cornea and the lid margin or Eye with an intact precorneal tear film showing a clear and transparent adhesion line of tears between the cornea and free lid margin in the 12- and 1-o’clock at the edge of the nictitating membrane (Plate 2.3). The cor- positions (OS, dog). The central reflection on the precorneal tear film is disturbed nea and the image it reflects are inspected to see whether the by the fundus reflection. NB: The borderline of the eyelash hairs and the hairs on image is intact, not distorted, and has regular margins. If there the upper and lower lids in dogs and cats, are placed more outside the free lid is doubt about the integrity of the tear film or there is a mu- margin than eyelashes in man. copurulent exudate, the Schirmer tear test (STT) is performed (Plate 2.4). The test strip is grasped with a dry forceps and the round sterile end is placed in the ventral conjunctival sac about one-third of the distance from the lateral canthus. After 60 seconds, the strip is removed and the length of strip that has become moistened, from the notch, is measured in millimeters. The reference values are 13–23 mm in dogs, 10–20 mm in cats, 20–30 mm in horses, and 15–20 mm in rabbits (Table 2.1). Values of 9 mm or less in dogs and 6 mm or less in cats indicate keratoconjunctivitis sicca (KCS).5,6,7 If the value is between 10 and 13 mm in dogs or cats, rose bengal stain can be performed after fluorescein staining has been completed.8 Rose bengal staining reveals intact but devitalized epithelial cells in areas where the tear film has broken down. However, this examination requires magnification, preferably a slit lamp (biomicro-

Plate 2.4: Table 2.1: Reference values for tear production The Schirmer tear test. The rounded end of the strip is placed in the ventral con- (Schirmer tear test [type 1]) junctival sac about one-third of the distance from the lateral canthus. After 60 seconds, the length of the strip that has become moistened from the notch is meas- µl SD Author ured in millimeters. Dog 20.2 3.0 Hamor9 18.8 2.6 Saito10 Cat 16.2 3.8 McLaughlin11 scope), which is not usually available in general practice. It Horse 22/26 (summer / winter) 6.0 Beech12 should be noted that rose bengal will stain devitalized epithe- Rabbit* 4.85 2.90 Biricik13 lial cells that are infected with the rhinotracheitis virus (herpes 14 5.30 2.96 Abrams virus) in cats. The resulting stained areas with a dendritic ap- * There are significant breed differences in rabbits (Abrams14) pearance are pathognomonic for this disease.

Kap_002.indd 9 17.11.2006 12:56:36 Uhr 10 Clinical and Differential Diagnostic Procedures

Plate 2.6: Lid margin in a horse. On the upper lid there are lashes as in humans.

Plate 2.5: Incorrect fixation of the head of an eye patient. By traction on the skin, the eye 2.4.3 Ocular discharge fissure is under tension and thus possible faults in the lid positioning are masked. Compare with the fixation shown in Plate 2.1. Discharge, in spite of normal tear production, can have an infectious cause and thus, a sample should be collected for microbiologic culture. If the transport time is likely to exceed one hour, the specimen should be placed in transport medium and kept refrigerated to prevent drying and thus the death of the organisms. After collection of the sample, the conjunctival sac is irrigated with 0.9% NaCl solution.

2.4.4 Eyelids (palpebrae)

During examination of the lids, ectropion or entropion may be artificially corrected if the patient is restrained in a way that places traction on the skin behind the lids (Plate 2.5). The lid reflex and the apposition of the lid margins to the globe are inspected. The lid edges should be in contact with and follow the curvature of the cornea. The margins should be hairless in cats, while some eyelash hair is to be expected in dogs, horses, and cattle. The lid margins should also be pigmented, smooth, glossy, and intact. Plate 2.6 shows the lid margins in a horse with lashes on the upper lid as in humans. The lid margins should be inspected for discoloration, swellings, alopecia, and moisture. Scrapings are made of suspicious areas for examination for parasites (demodex, sarcoptes). Defects in the lid margins or absence of meibomian glands (Plate 2.7) may be due Plate 2.7: Ectropionizing of the upper lid, showing the overfilled meibomian glands and their to aplasia palpebrae or injury to the lid. Wet lid margins or lid openings in the free lid margin. The center of the cornea of this Persian cat has a hairs indicate a disturbance of the normal lid function due to brownish pigmentation, the beginning of a corneal sequester (OS). At the limbus, abnormalities, such as distichiasis, chalazion, or hordeolum, or a ring of vessels is growing into the cornea. direct contact between the hairs on the outer surface of the lid

Kap_002.indd 10 17.11.2006 12:56:39 Uhr Examination of the eye and its adnexa 11

Plate 2.8: Entropion test. A small skin fold, about 15 mm below the lid margin, is retracted so that the lid margin entropionizes. This should be immediately corrected by blinking and its persistence indicates entropion.

Plate 2.9: Inspection of the lid edge and the palpebral conjunctiva of the upper lid. The lid margin is everted and the conjunctiva stretched with a Von Graefe’s forceps. A group of follicles centrally located in the conjunctiva is now shown (OS, dog). and the conjunctiva and /or cornea (entropion, trichiasis, exophthalmos). Wet, hairless, discolored areas may be due to chronic blepharospasm. Suspected entropion can be confirmed by the entropion test. For this purpose, a small skin fold, approximately 10–15 mm below the lower lid margin, is retracted slightly so that the lid margin turns inwards and the outer edge lies against the cornea (Plate 2.8). This should be corrected by a single blink, and its persistence indicates (habitual) entropion.

2.4.5 Conjunctiva

The conjunctiva is a thin, transparent membrane, through which the sclera and subconjunctival tissues should be clearly recognizable. The bulbar conjunctiva is usually very pale, especially in the cat. The palpebral conjunctiva is much redder in appearance because of the arborization of its vessels. Because of anastomoses between the uveal and bulbar conjunctival vascular systems, inflammation in the globe (uveitis) or increased intraocular pressure (IOP) will result in an engorge- ment of the conjunctival vessels at the limbus. These vessels are located more or less perpendicular to the limbus and they will be seen to move with the conjunctiva when it is moved. Chronic irritation by dust or bacteria causes a diffuse inflammatory redness, primarily in the lower conjunctival sac. The conjunctiva is examined for abnormalities such as discolora- Plate 2.10: tion, wetness, smoothness, or the presence of follicles (Plate 2.9). The “blinking” of the nictitating membrane (NM) of birds comes from the dorso- Follicles are small, glassy eruptions on the surface, especially medial (OD). The NM in birds is almost transparent, blinks frequently and makes on the inner surface of the nictitating membrane near its mar- the precorneal tear film. In the anterior chamber in this eye is a worm, which is gin. also visible through the NM, demonstrating its transparency.

Kap_002.indd 11 17.11.2006 12:56:46 Uhr 12 Clinical and Differential Diagnostic Procedures

Plate 2.11: Plate 2.12: Palpation of the retrobulbar pressure. The tips of the forefingers are placed on the Bilateral palpation of the ocular tension by placing the tips of the slightly curved closed upper lids covering the globes, gently pressing the globes backwards into forefingers over the closed lids on the globes, pressing them medially against the the orbit. orbital wall.

Protrusion of the nictitating membrane may be the result orbit and the head of the patient. It is usually easy to recognize of enophthalmos or a swelling at the base of the membrane. if one globe is too large (buphthalmos or macrophthalmia) or The combination of protrusion and exophthalmos indicates too small (microphthalmia or phthisical). The diagnosis of increased retrobulbar pressure, e.g. as a result of retrobulbar bilateral microphthalmia is more difficult. In cases of doubt, swelling. If there is swelling or discoloration of the conjunc- ultrasonography (or MRI) measurements have to be per- tiva, a swab, smear, or scraping should be taken for cytologic formed. A difference in color between the eyes, especially in- examination.15 volving the cornea, may give the impression that the globes are of different sizes. An edematous, white, cloudy cornea will suggest enlargement of the globe. A microphthalmic eye may suggest enophthalmos or, vice versa, enophthalmos may sug- 2.4.6 Globe (bulbus) gest microphthalmos. When this is in doubt, measurement of the horizontal corneal diameter may be helpful (normally The symmetrical movement of the eyes, both horizontally and about 17 mm in the adult dog, 18 mm in the cat). vertically, and the ability to fix both eyes on a distant point (as Measurement of IOP is still a major problem for the prac- far as possible for the species) are evaluated. Abnormalities of titioner (Table 2.2). Manual tonometry is a crude method of gaze such as strabismus (Siamese; Plate 9.1) or rapid oscilla- determining very hard and very soft eyes (Plate 2.12). It is tions of the globe (nystagmus) should be assessed. The position performed by placing the tips of the slightly curved forefingers of the globe in the orbit is examined for enophthalmos or over the closed eyelids of the globes, and pressing them medi- exophthalmos. Enophthalmos may be a response to pain, but it can also be secondary to loss of retrobulbar pressure or support, neurological (e.g. loss of sympathetic tone, Horner’s syndrome), or loss of condition, or a lack of well-being (especially Table 2.2: Intraocular pressure reference values in the cat); thus symmetry is an important consideration. The retrobulbar pressure (or retropulsion) is evaluated by placing mmHg SD Author the tips of the two forefingers on the closed upper lids cover- Dog 18.7 5.5 Gelatt20 ing the globes, and gently pressing the globes into the orbits Cat 19,7 5.6 Miller21 (Plate 2.11). Space-occupying lesions within the orbit behind Horse 23.3 6.89 Miller22 the eye will prevent its displacement into the orbit and /or Rabbit 24.4 1.3 Poyer23 24 make this painful. Guinea pig 5–20 (Variationsbreite) – Wagner Rat 17.30 5.25 Mermoud25 Both globes should be of the same diameter (approxi- Pigeon 13.4 1.4 Korbel26 mately 22–24 mm in the dog and cat) and in proportion to the

Kap_002.indd 12 17.11.2006 12:56:51 Uhr Examination of the eye and its adnexa 13

ally against the orbital wall (not posteriorly toward the apex of the orbit; this is retropulsion and does not measure indentation of the globe). When the spherical curvature of the globes is felt, the globes are indented slightly so that the pressure is perceived. This perception of the pressure can be compared 2 with that of a dog without ocular problems, or with that of the examiner. If manual tonometry is the only method available to the practitioner, and glaucoma is suspected, the patient should be referred immediately. Indentation (Schiötz) tonometry is influenced by the different radius of the cornea in different species and in different individuals, and of the globe during the progress of glaucoma. However, it can be performed with reasonable reliability when performed frequently and with carefully cleaned equipment. Then it is more applicable to the management of this devastating disease than gross observation. In addition, the Tonopen® (applanation tonometer) is available; this can be used very effectively with practice, but is expensive. Recently, a new rebound tonometer, TonoVet®, has become Fig. 2.2: available. The apparatus is easy to handle and can be used with- Slit-lamp section through the anterior media of the eye: (1) Reflection of the slit out topical anesthesia. These tonometers are most accurate at light on the surface of the cornea and the corneal section; (2) anterior chamber; the ranges of IOP of direct interest in glaucoma, but are less (3) reflection on the convex anterior capsule of the lens, the section, and the reflection on the concave posterior capsule of the lens; (4) vitreous. reliable with low or very high pressures.16,17,18,19

2.4.7 Sclera strips are held in place longer, and the conjunctival sac and the The sclera is inspected for defects, discoloration, swelling, as cornea must be irrigated and the nose lowered. Defects in the well as injected and /or congested vessels. The scleral vessels cornea will be seen as intense yellow-green fluorescent ir- run more or less parallel to the limbus and they are darker than regularities. To potentiate the florescence, the blue filter of an the overlying conjunctival vessels. ophthalmoscope or a Wood’s lamp may be used.

2.4.8 Cornea 2.4.9 Anterior and posterior chambers

The normal cornea has an intact lacrimal tear film, is without The anterior chamber is examined for transparency, flare, con- defects, and is smooth, spherical, reflective, transparent, and tour, and depth. The inferior inner surface of the cornea is highly sensitive. The corneal surface is inspected in a darkened checked for precipitates adhering to the endothelium, and the room, preferably with a loupe (as in the direct ophthalmo- anterior chamber is examined for free precipitates (hypopyon), scope: +20 to +40 and its slit beam; Fig. 2.2.). This inspection flare, clots, or blood (hyphema; signs of uveitis). Transparent, should be done by looking from all sides, and also with the variably pigmented and sized spheres that are free-floating in light source coming from all sides. Corneal edema (island pat- the anterior chamber or fixed at the edge of the pupil are usu- tern, bluish-white, irregular) must be differentiated from scar ally harmless iris or ciliary body cysts. Pigmented or discolored tissue (dense, white, sclera-like tissue) and corneal lipidosis or bulging areas on the iris surface may indicate neoplasms of the dystrophy (glittering, white, resembling sugar, or glass fiber anterior uvea. A large, transparent or white disc in the anterior crystals). Pigmentation of the cornea resulting from chronic chamber may indicate a luxated lens. If the lens is luxated irritation is found especially in the dog as a reaction to chronic posteriorly, the anterior chamber will be deep, the iris hangs irritation. Corneal pigmentation is rare in the cat; however, straight down and it will “flutter” after an eye movement (iri- a darkly pigmented deposit (corneal sequestration; Plate 2.7, dodonesis). If the lens is dislocated to one side, an aphakic, 10.23) can occur in the central or pericentral cornea. If there luminescent crescent may be seen between the contour of the are irregularities of the corneal surface, the cornea is stained lens and the pupil. The posterior chamber cannot normally be by fluorescein dye to search for epithelial defects. Strips im- inspected. If a mass between the anterior surface of the lens pregnated with the dye are held either in the ventral con- and the back of the iris presses the iris forward, the lesion can junctival sac or adjacent to the dorsal bulbar conjunctiva for be seen in the posterior chamber. 1–2 seconds. If the lacrimal passage to the nose is also being tested (passage time 30–60 seconds in the dog and cat), the

Kap_002.indd 13 17.11.2006 12:56:55 Uhr 14 Clinical and Differential Diagnostic Procedures

The iris is examined for discoloration, smoothness of its surface, bulging areas, remains of the embryological vascular systems (persistent pupillary membrane or vascular tunic of the lens), defects (coloboma), or synechia from the iris to the 2 lens or to the cornea.

2.4.11 Lens

During examination in the dark with the slit beam (Plate 13.3), special attention is paid to the transparency, diameter, and form of the lens. This examination should also be performed after inducing total mydriasis (15–20 minutes after one drop of 0.5% tropicamide; in young animals 20–45 minutes after 1% atropine).

In birds, a topical mydriatic does not induce mydriasis. Mydriasis can be induced by injecting d-tubocurarine into the anterior chamber27, but because of the risks associated with this, it is almost exclusively used as a last resort. Alternatively, topical or intra-ocular tubocurarine, Plate 2.13: vecuronium, can be used.28 Iridal granulae on the edge of the iris in a horse eye. If there are signs of luxation of the lens (clouds over the pupil edge, aphakic crescent, “disc” in the anterior chamber, or a deeper anterior chamber) or of glaucoma (mydriasis and complete diffuse corneal edema), the use of a mydriatic is con- 2.4.10 Pupil and iris traindicated. The lens can be displaced anteriorly or posteriorly. If there is no associated cataract, the luxation may go The normal iris is generally pigmented, but it may be blue in unnoticed by the owner for some time. In the cat, secondary the Siamese (in the Siamese the anterior layers of the iris are glaucoma usually occurs less acutely and rapidly than in the unpigmented, the pigment of the pigmented epithelium on dog. the posterior surface of the iris causes the blue aspect) or white, as in blue merle dogs. In miosis, the pupil of the cat has a vertical slit form, while that in horses, sheep, goats, and cattle is horizontally oval. In mydriasis, the pupils in all species are 2.4.12 Vitreous more or less round. The edge of the pupil bears iridic granules, varying from microscopically small ones in small animals to The vitreous is inspected by slit beam for white strings (per- large ones in horses and ruminants (Plate 2.13). They are most sistent hyaloid artery from the center of the posterior pole of prominent in the dorsal pupillary margin and are referred to the lens), glittering (cholesterol) crystals, or larger clumps. as “corpora nigra”. The absence of these in horses indicates Flares of exudate, blood, membranes, vessels, or tissue may be previous inflammatory disease. signs of posterior uveitis, retinal detachment, or intraocular The margin of the iris (pupil) is inspected for adhesions neoplasia. to the surface of the lens (posterior synechia) or adhesions to the cornea (anterior synechia). The pupil should react in 2–3 seconds when a pen-light is shone into the visual axis of the eye. The contralateral eye should also respond within a few 2.4.13 Fundus seconds. Unilateral miosis can be a sign of uveitis or Horner’s syndrome (other signs of Horner’s syndrome are enophthal- In animals, the fundus can usually be examined quite satisfac- mos, ptosis, and protrusion of the nictitating membrane). Uni- torily with a direct ophthalmoscope. Dogs and cats must be lateral or bilateral mydriasis can be due to dysfunction of the positioned symmetrically on the table, like a sphinx. If the afferent part of the reflex arc, the retina, the optic nerve, or the animal is uncooperative, the inexperienced clinician should brain and the oculomotor nerve, but it can also be due to consider sedation, unless the condition of the animal prevents glaucoma. In nervous, frightened, or angry animals, the release this. If there are signs of defective vision, mydriasis should be of epinephrine may block the pupillary response. induced after carrying out vision tests.

Kap_002.indd 14 17.11.2006 12:56:56 Uhr Examination of the eye and its adnexa 15

Vision is ideally tested, especially in the horse, when the animal is allowed to move around freely in an unfamiliar area containing obstacles. Testing vision in cats is not simple, because of their independent behavior; it is also difficult in puppies. Alternatives are: 2 a Observing the animal moving freely and almost falling from the examination table may be informative, but is more time-consuming. a Observing how the eyes follow a small piece of cotton (distance about 20 cm). a Optical placing reflex. Although less dependable, this test is useful in light-weight animals such as puppies, kittens, cats, and small dogs. a The menace reaction, pointing at the eye with a finger, must be done without eliciting air currents, otherwise it is very unreliable.

The optic disc or papilla is located slightly ventral and nasal to the posterior pole of the fundus (Plate 2.14). The optic disc in dogs is more or less rounded and, in some animals, surrounded by a small edge of white glial tissue. The retinal arterioles are thinner and bright red; the venules thicker and dark red. In dogs, the venules may anastomose in the disc. In cats, the optic Plate 2.14: disc is small (about 1 mm) and pale pink. The retinal vessels The posterior calotte of the globe of a dog (OD). The outer white ring is the sclera. The darkly pigmented inside part is the tapetum nigrum of the choroid and the disappear into the disc just inside the edge of the disc. In pigment epithelium of the retina. The yellow-green area in the posterior pole is ruminants and pigs, there is a central vein within the confines the tapetum lucidum. Centrally, the optic disc or papilla is located at the junction of the disc. In horses, the small retinal vessels course to and of the lucidum and the nigrum. The folded inner membrane is the neural retina from the disc like the rays of the sun, while in other species with the retinal veins. they follow a more or less inverted T-pattern. The area of the retina located temporal to the optic disc, referred to as the area centralis, has the highest concentration of cones but is not usually grossly visible. In humans, this area is referred to as the macula; it contains the fovea, a region which is composed en- Distinct, local or total, hyperreflectivity of the retina may tirely of cones. indicate neuroretinal loss of function, e.g. degeneration, whilst A tapetum lucidum is found in most animals (tapetum; Gr.: blood or cloudy, bullous, membranous, or elevated areas may carpet or covering structure; lucidum: L.: clear; tapetal fundus indicate inflammation, and /or retinal detachment, or neopla- in Anglo-American literature) in approximately the upper half sia. circle of the posterior part of the globe, which reflects the The individual variation in the normal fundus pattern is incoming light as orange-yellow to green-blue. The remaining enormous. For this reason, patients should be referred for oph- surface of the posterior part of the globe is generally heavily thalmoscopy when interpretation of findings is uncertain. pigmented because of the pigment in the interstices of the choroid and in the pigmented epithelium of the retina. This area is referred to as the tapetum nigrum (nigrum: L.: black) or non-tapetal fundus in Anglo-American literature. In very 2.4.14 Additional and specific young animals, before the tapetal areas have matured, the examinations whole fundus appears dark purple-blue. In white, blue merle, and albino animals, both parts of the tapetum may be partially Additional examinations that may be indicated include biopsy, or completely absent; in which case, ophthalmoscopy reveals binocular indirect ophthalmoscopy, slit-lamp biomicroscopy, the large choroidal vessels. These vessels have a more or less tonometry, gonioscopy, electroretinography, visual evoked re- sun-ray pattern and in between these vessels, a sun-ray, striped sponses, fundus angiography, endothelial microscopy, ultra- pattern of white sclera may be distinguishable. The optic disc sonography, computed tomography (CT), magnetic resonance is usually located on, or just below, the junction of the tapetum imaging (MRI), and other radiologic techniques.29,30,31,32,33 If lucidum and tapetum nigrum. the equipment or assessment is not available, the patient should be referred.

Kap_002.indd 15 17.11.2006 12:56:58 Uhr Index 251 Index

A – –, reduction 165 Brinzolamide 23 Abscess Area Brow sling 91 –, corneal 150 ff. –, centralis 15 Bruch’s membrane 210 –, retrobulbar 50 ff. –, seventeen 211 Bulbus cf. Globe Accommodation 171 –, striata 211 Buphthalmos 12, 128, 162 Acetazolamide 23 Artery Butylcyanoacrylate 27 Acetylcholine 23 –, hyaloid 189 ff. Acetylcysteine 19, 22, 27 – –, persistent 192 Acorea 175 –, retinal 209 C Acyclovir 25 Artificial Canthoplasty Adenocarcinoma 184 ff. –, lens 200 ff. –, lateral 95 Adenoma –, tears 26, 63 –, medial 90, 95 –, eyelid 98–100 Atenolol 27 Canthotomy Adrenaline cf. epinephrine Atrophic globe 10, 127, 170 –, lateral 94 Albinism Atropine 14, 22, 24, 26, 61 Capsulorrhexis 193, 200 –, oculocutaneous 175 Autotransplantation Carbonic anhydrase inhibitors 23 – –, partial 175 –, free conjunctival 146 Carprofen 25 Algae 180 Caruncle trichiasis 91 Alpha-lysine 25 Cataract 173, 193–201 Amaurosis 218, 232 B –, alimentary 196 Amblyopia 218, 232 Bacitracin 24 –, congenital 173, 196 Amlodipine 27 Bacteria 180 –, diabetic 197 Amphotericin 25 Basal cell carcinoma 100 –, inherited 196 Anamnesis 5 BCG = Calmette-Guérin bacillus –, juvenile 196 Anesthesia 27 ff. 100 –, radiation 196 Aneurine deficiency 227 Belladonna 61 –, secondary 197 Angiography 15 Benoxinate hydrochloride 26 –, senile 196 Aniridia 175 Beta blockers 23 –, therapy 197–201 Ankyloblepharon 74 Beta radiation 27 –, traumatic 196 Anophthalmia 127 Betamethasone 25 CEA cf. Collie eye anomaly Antazoline 22 Bimatoprost 23 Chalazion 96 Antibiotics Bipolar cells 210 Chemical burns 34 –, specific 22, 24 Bird pox 98 Chemical cauterizing agents 27 –, standard 22, 24 Blepharitis 95 ff., 99 Cherry eye 110–112 Antiglaucoma agents 23 –, adenomatosa 96 Chloramphenicol 24 Antihistamines 22 Blepharophimosis 94 Chlorhexidine 24 Anti-hypertensive agents 27 Blepharoplasty 85, 101 ff. Chlortetracycline 24 Antimicrobial agents 24 ff. –, rotation-flap correction 75 Choriocapillaris 173, 211, 214 Antimycotics 25 Blepharospasm 62 Chorioretinitis 214 ff. 226–228 Antiphlogistics 25 –, differential diagnosis 16 Choroid 2, 173 ff., 214 Antiviral drugs 25 Blindness Cilia Aphakia 192 –, differential diagnosis 17 –, ectopic 106 ff. Aplasia palpebrae 10, 74 ff., 173 Blood vessel Ciliary Applanation tonometer 13 –, architecture 172 –, body 2, 171 ff., 210 Application cf. Therapeutics –, occlusion 225 – –, destruction 166 ff. Apraclonidine 23 –, walls 176 –, muscles 22 Aqueous humor 157, 171 Blood-aqueous barrier 172 Ciprofloxacin 24 –, drainage Blue eye 179 Clinical diagnosis 5–18 – –, with implant 167 Botulism 61 –, aids 5, 8 ff. – –, improved capacity 165 ff. Brachycephalic breeds 8 –, anamnesis 5 –, outflow 157 ff. Breed disposition 237–246 –, differential diagnosis 16 ff. –, production 157 Brimonidine 23 –, methods 5, 8 ff.

–, restraint 8 –, dystrophy 151–153 Discharge-dissolving agents 27 –, sedation 8 – –, endothelial 152 ff. Distichiasis 10, 76–78 –, signalment 5 – –, epithelial/stromal 151 ff. DNA test 240 Cloxacillin 24 –, edema 35, 130, 135, 141, 153 DNA-synthesis inhibitors 25 Coagulation disorders 176 –, foreign bodies 40 ff. Dorzolamide 23 Cocaine 26 –, graft Duct Collarette 174 – –, lamella 147 –, nasolacrimal 60 ff. Collars 27 –, healing 132 – –, flush 68 ff. Collie eye anomaly (CEA) 219–221 –, lacerations 40–44 –, parotid 64 Collyria 26 – –, non-perforating 40–42 – –, transposition (PDT) 64 Coloboma 174, 192, 218 ff. – –, perforating 43–44 Dysautonomia syndrome 61 Computed tomography 15 –, lipidosis 151 Dysplasia 176 Cones 210 ff. –, micro- 133 –, of the eyelid 76 Conjunctiva 2, 105–125 –, mummification 147–149 –, retinal 219 –, adhesions 119 –, necrosis 147–149 –, autotransplant 146 –, neoplasia 155 –, clinical diagnosis 11 ff. –, nigrum 147–149 E –, lacerations 39 –, perforation 43 ff., 132, 142 Ecothiophate iodine 23 –, neoplasia 122 –, reflection 9 Ectopic lens 201–205 –, oversuturing methods 142, –, scarring 130 Ectropion 86–89 144–147 –, sequestrum 147–149 –, correction 87–89 – –, bulbar 145 ff. –, symptoms 129–131 – –, surgical 87–89 – –, strip 144 –, transplant – –, Kuhnt-Szymanowski 87 – –, pedicle flap 144 – –, free 147 – – –, –Blaskovics 87 –, scleral 73 ff. –, ulcer 106, 137–140, 141, 147 EDTA solution 26 –, stricture 120 ff. Corticosteroids 25 Ehrlichiosis 180, 227 Conjunctival sac Cromoglicic acid 22 Electroepilation 76 ff. –, flushing 19 ff. Cryoepilation 76–77 Electroretinogram (ERG) 211 Conjunctivitis 113–119 Cryosurgery 29, 100 Electroretinography 16, 211 –, acute Cyclocryodestruction 166 ff. Emergencies 31–44 – –, purulent 114 ff. Cyclopentolate 26 Encephalitozoon cuniculi 180 –, allergic 119 Cyclopia 127 Endophthalamos 12, 48–49, 125 –, bovine 118 Cycloplegia 22, 24 –, differential diagnosis 16 –, catarrhal 114 Cyclosporine 27, 63 Endophthalmitis 128 –, follicular 11, 116 Cysts Endothelial degeneration –, granulomatous 117 –, conjunctival 108 –, senile 152 –, neonatorum 117 ff. –, corneal 150 Endothelial microscopy 16 –, nodular 117 –, iris 176 Endothelial precipitation 177 –, ovine 118 Enalapril 27 –, papillary 117 Entropion 10 ff., 78–86, 90–93 –, plasmacellular 116 ff. D –, angular 83, 85 –, purulent 114 ff. Dacryoadenitis 64 –, correction 81–86 Conjunctivomaxillorhinostomy Dacryocystitis 67–70 – –, Celsus-Hotz 81–83 69 ff. Day blindness 214 – –, Stades 91–92 Conjunctivorhinostomy 69 –, hereditary (stationary) 224 – –, surgical 81–85 Cornea(l) 2, 129–154 Deafness 175 – –, tacking 81 –, abscess 150 Demecarium bromide 23 –, habitual 81 –, abnormalities 132 Dermoid 76, 133 ff. –, iatrogenic 79, 84 –, blue-white Descemetocele 140 –, medial 84 – –, differential diagnosis 17 Detomidine 8 –, mild 81 –, clinical diagnosis 13 Dexamethasone 25 –, severe 81 –, clouding 130 Diagnosis cf. Clinical diagnosis – –, partial lateral 84 –, cysts 150 Diagnostics 19–30 – –, total 78 ff. –, degeneration Dichlorphenamide 23 Enucleation of the globe 56 – –, endothelial 152 ff. Diclofenac 25 –, including conjunctiva 53–55 – –, deposits 153 Dipivalyl epinephrine 23 Eosinophilic granuloma 96, 119, –, diameter 12 Dirofilaria immitis 180 136

Epilation F –, zygomatic 47, 64 –, electro- 76–78 Face lifting 91 Glaucoma 159–170 –, cryo- 76 Famcyclovir 25 –, absolute 160 Epinephrine 22–24 FCRD cf. Retinal degeneration, feline –, acute 161–164 Epiphora 113 central –, chronic 162, 164 –, differential diagnosis 16 Feline dysautonomia 184 –, closed irido-corneal angle 161 Episcleritis cf. Scleritis FeLV 179, 227 –, clinical signs 162–164 Epithelializing agents 26 Fibrae latae 161 –, duration 161 ff. Equine recurrent (chronic) uveitis Filtration angle 2 –, open irido-corneal angle 161 (ERU) 182 ff. –, abnormalities 161 –, open pectinate ligament 161 ERG cf. Electroretinogram FIP 179, 227 –, primary cf. Primary glaucoma Ethoxyzolamide 23 Fistula methods 168 –, primary morphologically abnormal ERU cf. Equine recurrent (chronic) FIV 179, 227 pectinate ligament 161 uveitis Fixation 5 –, secondary 160, 168–170 Etodolac 61 –, false 10 –, therapy 23, 165–168 Eversion of the nictitating membrane Flitting flies cf. Vitreous floaters – –, cyclocryodestruction 167 108 ff. Flumethasone 25 – –, fistula methods 168 –, correction 109 Flunixin 25 – –, surgical 167 ff. Evisceration of the globe 53, 56 Fluorescein 26 Globe 125–128 Exeneration of the orbit 53, 56 Fluorometholone 25 –, clinical diagnosis 12 ff. Exophthalmos 47, 49–53, 125 Fluostigmine 23 –, contusion 35 –, differential diagnosis 16 Flurbiprofen 25 –, luxation 31–34 Exudation flakes Flushing 19 –, position 47 ff. –, preretinal 215 Flushing bottle 19 Glycerol 23 Eye Fly net 27 GM1 and GM2 gangliosidosis 154 –, blind cf. Blindness Follicle 11, 113 Goniodysgenesis 161 –, drops 19 ff. Folliculosis 11, 113 Goniodysplasia 161 – –, duration of effect 20 Fornix 73 Gonioscopy 15, 159 ff. –, muscles 2, 125 Fracture Gramicidin 24 –, ointments 19 ff. –, orbital 34 ff. Granuloma –, painful cf. Painful eye Framycetin 24 –, eosinophilic 96, 118 ff., 137 –, pigmented cf. Pigmented eye Frontal bone 47 –, eyelid 96 ff. –, pressure Fundus 14 ff., 209–235 – –, intraocular cf. Intraocular –, abnormal 214–235 pressure –, changes 214–218 H – –, retrobulbar 12 ff. –, clinical diagnosis 14 ff. Hemorrhage –, red cf. Red eye –, ontogenesis 209 –, retinal 214 ff. –, tear stained cf. Epiphora –, reaction patterns 214–218 –, subconjunctival 113 Eyelid 2, 10 ff., 73–104 –, reflection 209, 213, 217 –, subretinal –, adenoma 98–100 –, symptoms 214–218 – –, band-shaped 215 –, carcinoma 100 Funduscopy 14 ff. –, vitreous 206 ff. –, clinical diagnosis 10 ff. Fungi 180 Hemostasis 29 – –, colobomas 10, 74 ff., 173 Fusidic acid 24 Hereditary eye diseases 237–246 –, dysplasia 76 Heterochromia of the iris 175 –, granuloma 96 Homatropine 26 –, lacerations 36, 37–39, 94 G Hordeolum 96 ff. –, margin Gamma-interferon 25 Horner’s syndrome 49, 184 – –, granuloma 178 Ganglion Hyaloid – –, investigation 11 –, cell layer 209 ff. –, artery cf. Artery, hyaloid – –, lacerations 37–39 Gentamycin 21, 24 –, system 189 ff. – –, upper Gland Hyaloidosis – – –, ectropinizing 10 –, lacrimal 59 –, asteroid 206 – –, wounds 38, 39 –, nictitating membrane 73, 105–112 Hydrophthalmia 128, 162 –, melanoma 99 – –, hyperplasia 110–112 Hyperlipoproteinemia 225 –, neoplasia 99 ff. – –, deep 64, 105 Hyphema 13, 35 ff., 176 –, third cf. Nictitating membrane – –, superficial 59, 105 Hypophysectomy 61 –, parotid 64 Hypoplasia

–, choroid 219 ff. –, deep –, nucleus sclerosis 191 Hypoprolose 26 –, eosinophilic 136 –, ontogenesis 189 ff. Hypopyon 13, 178 –, herpetica 150 –, perforation 41 Hyposphagma 35 –, interstitial 136 –, soft 200 –, pannosa 134–136 Lenticonus 192 –, photoallergic 135 ff. Lentiglobus 192 I –, punctate 149 Leptospira interrogans 180 Idoxuridine 25 –, superficial 134–136 Lidocaine 26 i-drops® 64 –, ulcerative 137–147 Ligament Immune reactions 180 ff. –, vascular and pigmentary 135 ff. –, palpebral Indentation tonometry 13 Keratoconjunctivitis – –, lateral 73 Indomethacin 25 –, infectious bovine/ovine 150 – –, medial 73 Infectious canine hepatitis 179 –, sicca (KCS) 61–64 –, pectinate 159 Infiltrates 114 – –, ipsilateral 63 – –, abnormalities 161 Injection Ketoprofen 25 – –, open 161 –, conjunctival 19–21 Ketorolac 25 Limbus melanoma 155 –, intraocular 21 ff. Key-Gaskell syndrome 184 Local anesthesia 8 –, retrobulbar 21 Local anesthetics 22, 26 –, subconjunctival 21 Locoweed 61 –, subpalpebral system 20 L Luxation Injuries cf. Lacerations Lacerations –, globe 31–34 Intoxications 225 –, conjunctival 39 ff. –, lens 13, 163, 201–205 Intraocular –, corneal 40–44 –, pressure 12 ff., 157–170 –, eyelid 37–39 – –, antiglaucoma agents 23 – –, margin 37–39 M – –, reference values 12 –, perforating 37 Macroblepharon 86–89 –, volume Lacrimal Macrophthalmia 12, 128 – –, reduction 166 ff. –, apparatus 59–71 Magnetic resonance imaging (MRI) Inversion of the nictitating membrane –, duct 59 ff. 15 108 – –, catheterization 69 ff. Magnification equipment 28 Iodine tincture 27 –, gland 2, 59 Mandibular lymph nodes 8 Iridic granules 14 – –, accessory 59 Mannitol 23 Irido-corneal angle 158 –, punctum 60 ff. Medetomidine 8 –, malformation 161 – –, atresia 66 Meglumine 25 Iridodonesis 13 – –, opening 67 Meibomian glands 10, 73 ff. Iris 2, 171 ff. – –, secondary closure 66 Melanoma –, acquired color differences 175 – –, stenosis 65 –, eyelid 99 –, atrophy 183 –, sac 61 –, iris 184 –, blue Lagophthalmos 95 –, limbus 155 – –, /white coat 175 Lamina 161 Meloxicam 25 –, clinical diagnosis 14 Larvae Membrane –, cyst 13, 176 –, migrating 227 –, persistent (epi)pupillary 173–174 –, granulomatous swelling 185 Laser techniques 29 –, nictitating cf. Nictitating –, infections 179 ff. Latanoprost 23 membrane –, melanoma 184 Lateral geniculate bodies 211 –, pupillary (PM) 190 Iritis Lavage system – –, persistent (PPM) 130, 133, –, traumatic 179 –, subpalpebral 20–21 173–174, 194 Isosorbide 23 Leishmania 180 Metazolamide 23 Lens 2, 189–205 Methylprednisolone 25 –, artificial 200 Miconazole 25 J –, clinical diagnosis 14 Microcornea 133 Juxtapalpebral changes 96 –, extraction 198–200 Micropapilla 218 – –, extracapsular 199 ff. Microphakia 192 – –, intracapsular 169, 199, Microphthalmia 12, 127, 173, 194 K 205 Micropunctum 65 KCS cf. Keratoconjunctivitis sicca –, hard 200 Miotics 23 Keratitis 134–150 –, luxation 13, 163, 201–205 Moll glands 73

MRI cf. Magnetic resonance O Persistent hyperplastic primary vitreous imaging Occlusion 161 (PHPV) 193–194 Mucopolysaccharidosis 154 Ocular Persistent hyperplastic tunica vasculosa Mucus cells 73 –, capsule 199 ff. lentis (PHTVL) 193–194 Muscae volantes cf. Vitreous floaters –, chambers 2, 157 ff., 171 Pharmacoemulsification 200 Muscle – –, changes 172 Phenazopyridine 61 –, ciliary 171 – –, clinical diagnosis 13 Phenol 27 –, levator – –, drainage area 157 ff. Phenylephrine 22, 24 – –, anguli oculi medialis 73 – –, osmotic agents 22 Photophobia 172 – –, palpebrae 73 –, therapeutic agents 22–27 Photoreceptors 210 ff. –, malaris 73 Oculocutaneous syndrome 175 –, degeneration 221–224 –, orbicularis oculi 73 Ofloxacin 24 –, dysplasia 221–224 –, pupillary Operating table PHPV cf. Persistent hyperplastic – –, dilator 171 –, positioning of patient 28 primary vitreous – –, sphincter 171 Ophthalmoscopy 15 Phthisis bulbi 12, 127, 170 –, retractor anguli 73 Optic PHTVL cf. Persistent hyperplastic Mydriatics 23–24 –, chiasm 211 tunica vasculosa lentis –, nerve 14 Pigment epithelium 210 –, neuritis 231 –, dystrophy (PED) 224 N –, papilla cf. Papilla Pigmented eye Nafazoline 29 Orbit cf. Periorbita –, differential diagnosis 17 Nasal folds –, fracture 34 Pilocarpine 23, 63 –, resection 89 ff. –, neoplasia 51 ff. Pimecrolimus 27 –, trichiasis 89 ff. – –, primary 52 Pinocytosis 159 Nasopharynx 61 Orbitomy 56 Placing reflex Natamycin 25 Osmotic agents 23 –, optical 15 Neomycin 24 Oxybuprocaine 26 PM cf. Membrane, pupillary Neoplasia Poisoning cf. Intoxications –, conjunctival 122 Polycoria 174 –, corneal 155 P Polymyxin B 24 –, eyelid 99 ff. Painful eye Posterior synechia 179 –, intraocular 207 –, differential diagnosis 16 Povidone-iodine 24–26 –, orbital 51 ff. Palpebra cf. Eyelid PPM cf. Membrane, persistent pupillary –, retinal 231 ff. Palpebral PRA cf. Retinal degeneration, –, retrobulbar 51 ff. –, aplasia 10, 74 ff., 173 hereditary (progressive) –, uveal 177, 181 ff., 184–186 –, fissure 73 Prednisolone 25 Nerve – –, length 10 Preparation of the operative field 28 –, facial 64 Pannus 131, 135–136 Pressure cf. Intraocular pressure –, optic 2, 209–235 Panophthalmitis 128 Primary glaucoma 159 Nictitating membrane 2, 105–112 Papilla 15, 210 –, acute 159 –, flaps/oversuturing techniques –, coloboma 218 ff. –, chronic 164 – –, attached to dorsolateral –, edema 230 Process conjunctiva 144 –, hypoplastic 218 –, ciliary 172 – –, attached to upper lid 142–144 –, micro- 218 –, coronoid 47 –, gland 2, 110–112 Papillitis 231 Proparacaine 26 –, margin Parasites 180 Proptosis 31–34 – –, non-pigmented 106 Parasympatholytics 22 ff. Protozoa 180 –, protrusion 12, 47 Parasympathomimetics 23 Protrusion of the nictitating membrane – –, differential diagnosis 16 Pasteurella multocida 180 107 Night blindness 214 Pecten 211, 213 Pseudo-enophthalmos 125 –, hereditary (stationary) 224 PED cf. Pigment epithelial dystrophy Pseudo-exophthalmos 125 Non-tapetal area cf. Tapetum Pedicle graft 75 Pseudomonas 180 nigrum Perforating injuries 37 Ptosis 94 Norfloxacin 24 Periorbita 45–57 Pupil 2 Nystagmus 12, 126 ff. PermaTweez® 76–77 –, abnormalities 184 Persistent hyaloid artery cf. Artery, –, clinical diagnosis 14 hyaloid, persistent –, dilatation syndrome 184

Pupillary reaction 214 Squamous cell carcinoma 100, 122, Tonometer 13 Radiation cataract 196 155 Tonometry 12 ff., 16 Radiotherapy 27 Staphyloma 141–142 Tonopen® 13 RD cf. Retina, dysplasia Strabismus 12, 126 TonoVet® 13 Recurrent uveitis STT cf. Schirmer tear test Toxoplasma 180 –, equine 182 ff. Subconjunctival hemorrhage 113 Toxoplasmosis 227 Red eye Sudden acquired retinal degeneration Trabecular system 159 –, differential diagnosis 16 (SARD) 232 Trauma 41–45, 176, 225, Retina(l) 2, 209–211 Suffusion 35 –, blunt 34–36 –, aplasia 218 Sulfonamides 24, 61 –, deep 36–37 –, atrophy 219, 221–223, 226 Surgery 27–29 –, eyelid 37–39 –, degeneration 15 Suture materials 28 Travoprost 23 – –, feline central (FCRD) 230 Symblepharon 114, 118–120 Trichiasis 11, 89–93 – –, hereditary (progressive (PRA) –, correction 120 –, caruncle 91 221–224 Synchysis scintillans 206 –, correction –, detachment 14 ff., 176, 207, 210, – –, Stades forced granulation 228 ff. procedure 92 –, dysplasia (RD) 219 T –, nose fold 89 ff. – –, geographic 219 Tacking cf. Entropion, correction, –, upper eyelid 90 ff. – –, multifocal 219 tacking Trifluorothymidine 25 – –, total 219 Tacrolimus 27, 63 Tropicamide 14, 24, 26 –, folds 216 Tapetal area cf. Tapetum lucidum Tubocurarine 14 –, hemorrhage 215 Tapetum Tunica vasculosa lentis 189 ff. –, inner layer 209 ff. –, cellulosum 214 –, persistent hyperplastic (PHTVL) –, neoplasia 231 ff. –, fibrosum 214 193 –, outer layer 210 –, lucidum 2, 15, 173, 214 –, vessels 2, 214 –, nigrum 15, 173, 214 Retinitis 227 ff. Tarsorrhaphy U Retinopathy –, permanent 33 UDS cf. Uveo-dermatologic syndrome –, hypertensive 229 ff. –, temporary 32–33 Ulceration Rickettsia 180 Taurine deficiency 227 –, deep 140 Rods 210 Tear –, superficial 137–139 Rose bengal 26 –, film 59–61 Ultrafiltration 157 Rotation-flap correction 75 –, flow 59–61 Ultrasonography 16 Rubeosis iridis 177 –, fluid Uvea 171–187 – –, blockage 61 –, functions 171 – –, drainage 61 –, neoplasia 177, 181 ff., 184–186 S –, production 9 ff. –, posterior 186 Sarcoid 100, 103 –, replacement therapy 26, 63 –, structure 171 ff. SARD cf. Sudden acquired retinal –, stripe 9, 65 Uveitis 177–179 degeneration Tears –, anterior 177–179, 182 ff. Schirmer tear test (STT) 7, 26 –, artificial 26, 63 –, chronic relapsing 182 ff., 227 Sclera(l) 2, 129–156, 210 Tension 159 –, idiopathic 181 –, clinical diagnosis 13 Tetracaine 8, 26 –, metabolic 179 –, venous plexus 159 Therapeutics 19–27 –, posterior 227 ff. Scleritis 154 –, application Uveo-dermatologic syndrome (UDS) Sebaceous gland 2 – –, general rules 22 181 Secondary glaucoma 160, 168–170 – , injection cf. Injection Sedation 8 Therapy 19–30 cf. Therapeutics Setting sun phenomenon 126 –, cryo- 29, 100 V Sialodacryoadenitis cf. Dacryoadenitis –, laser 29 Van Waardenburg’s syndrome 174 Signalment 5 –, radio- 27 Vasoconstrictors 22 Sjögren’s syndrome 61 ff. –, surgical 27–29 Vein Slit-lamp biomicroscopy 15 Thiamine deficiency 227 –, facial 64 Sodium chloride solution 26 Timolol 23 –, retinal 210 Spherophakia 182 Tissue plasmogen activator 27 VEP cf. Visual evoked potentials Sphinx position 5, 8 Tobramycin 24 Vecuronium 14

Visual evoked potentials (VEP) 211 Vitreous 14, 189–208 X Vitamin –, clinical diagnosis 14 Xerophthalmia 22 –, A 22, 26 –, floaters 206 – –, deficiency 225 –, hemorrhage 206–207 –, B1 26 –, ontogenesis 189 ff. Z – –, deficiency 227 –, persistent hyperplastic primary Zeis glands 73 –, C 22, 26 (PHPV) 193 Zinc sulfate 26 –, E 22, 26 –, synchysis scintillans 206 Zygomatic arch 47 – –, deficiency 225 Vortex system 214