Conjunctival calcinosis circumscripta in a dog: Treatment combining surgical resection and amniotic membrane grafting.

This report describes the clinical features, histopathology, and surgical treatment of a case of conjunctival calcification in a 5-month-old female English Setter, referred with a history of recurrent conjunctivitis in the right eye (OD). The ophthalmic findings were limited to multifocal white plaques embedded in a markedly inflamed conjunctiva of the eyelids and the anterior nictitating membrane OD. Calcification was suspected. The blood cell count, blood chemical profile, and urinalysis were within normal limits, and long-bone radiographs appeared normal. After removal of the affected area by means of a large conjunctivectomy, cryopreserved canine amniotic membrane (AM) was transplanted to fill in the defect. Multifocal ectopic calcium deposits in the conjunctival lamina propria were confirmed histopathologically. The postoperative healing was uneventful, and no recurrence was observed during a follow-up period of five years. Conjunctival mineralization is uncommon in canine ophthalmology, and the cause remained undetermined in the present case, for which AM transplantation was able to promote conjunctival healing after a large surgical excision.

Primary conjunctival sporotrichosis in three cats from Northeastern Brazil.

INTRODUCTION: Classically, sporotrichosis occurs as a chronic granulomatous lymphocutaneous infection. The extracutaneous form is uncommon and may affect the eye without cutaneous involvement. The most frequent form of ocular sporotrichosis reported in humans is a granulomatous conjunctivitis. There are no previous reports on primary ocular sporotrichosis in cats. PROCEDURES: Three mixed breed cats rescued from shelters were referred by the veterinarian for ophthalmic evaluation with a complaint of conjunctivitis nonresponsive to treatment with no evidence of skin disease or systemic disease. Complete ophthalmic examination, conjunctival cytology, and microbiological analysis were performed. RESULTS: Ophthalmic examinations revealed epiphora, purulent ocular discharge, conjunctival hyperemia, and a mass in the palpebral conjunctiva. Conjunctival cytology revealed segmented and degenerated neutrophils, conjunctival epithelial cells, and an abundant number of round and oval cells compatible with Sporothrix spp. Microbiological culture was performed and confirmed the presence of fungi from the Sporothrix schenckii complex. All animals were treated with oral itraconazole; two animals received topical itraconazole in association with oral treatment. Case 1 was refractory to treatment, and iodate potassium was combined with itraconazole therapy without resolution at the time of this publication. Cases 2 and 3 had complete resolution of conjunctival lesions with four months of oral and topical itraconazole therapy. CONCLUSION: Conjunctival sporotrichosis should be considered as a differential diagnosis of conjunctivitis in cats from endemic regions. Conjunctival cytology is an important tool that can aid early diagnosis.

Safety and efficacy of topically applied 0.5% and 1% pirfenidone in a canine model of subconjunctival fibrosis.

OBJECTIVE: To evaluate tissue levels, safety, and efficacy of topical ophthalmic 0.5% and 1% pirfenidone in decreasing subconjunctival fibrosis. ANIMAL STUDIED: Twelve normal beagle dogs PROCEDURES: A 5 × 1 mm diameter silicone disk was implanted subconjunctivally in one eye, and then dogs were treated with topical 0.5% pirfenidone (n = 9) in artificial tears or artificial tears alone (n = 3) for 28 days. To evaluate tissue drug levels, a single sample of tears, conjunctiva, and aqueous humor was collected 30 (n = 3), 90 (n = 3), and 180 min (n = 3) following administration of the last drop of pirfenidone, respectively. Fibrous capsule thickness and staining for Ki67 and fibroblast activation protein alpha (FAPα) were evaluated histologically. After a 2-week washout, the experiment was repeated in the opposite eye and using 1% pirfenidone. RESULTS: Treatment with pirfenidone resulted in thinner fibrous capsules and decreased staining for FAPα with no adverse effects. The implant in one dog treated with pirfenidone extruded. There was no difference in tissue levels, capsular thickness, or staining for Ki67 or FAPα between dogs treated with 0.5% or 1% pirfenidone. CONCLUSIONS: Pirfenidone may decrease fibrosis following glaucoma shunt surgery and can potentially be used indefinitely due to minimal side effects.

Subconjunctival Dirofilaria repens infection in a dog resident in the UK.

Dirofilaria repens infection was diagnosed in a 5-year-old female German shepherd crossbreed, originally from Romania but brought into the UK in February 2014. The dog presented with conjunctivitis in March 2014 and then again 2 months later with additional ocular and nasal mucopurulent discharge. Bacterial cultures from the nasolacrimal duct were negative for bacterial growth. The case was referred in August 2014 for ophthalmic examination, which revealed abnormalities in both eyes, especially the left. They included mild palpebral conjunctival hyperaemia and marked follicular conjunctivitis, as well as a dorsonasal bulbar conjunctival mass. Serum biochemistry was unremarkable and a conjunctival biopsy taken from the dorsonasal bulbar conjunctival mass revealed eosinophilic/lymphoplasmacytic conjunctivitis. At re-examination, nematodes were found in the area of the previous biopsy site and in the ventral palpebral conjunctival fornix. Polymerase chain reaction and sequencing confirmed these to be D. repens. Treatment with 10% imidacloprid and 2·5% moxidectin (Advocate Spot-On) was successful, and clinical signs resolved over a 6-week period. This case report indicates that D. repens infection should be considered as a possible aetiological cause of ocular lesions in dogs in the UK, especially those with a history of foreign travel. Implications for establishment and spread of D. repens in the UK are discussed.

In vivo confocal microscopy for detection of subconjunctival Onchocerca lupi infection in a dog.

A seven-year-old male castrated mixed-breed dog was diagnosed with bilateral subconjunctival masses. In vivo confocal microscopy facilitated visualization of Onchocerca lupi adult nematodes and their characteristic cuticular morphology. Long, thin, white nematodes were extracted during excisional biopsy. Histopathologic and parasitologic evaluation confirmed the diagnosis of O. lupi. In addition to surgical debulking of the parasitic granulomas, the dog received systemic doxycycline, prednisone, and ivermectin therapy. In vivo confocal microscopy was repeated one year after initial diagnosis, and no remaining nematodes were visible. To the authors' knowledge, this is the first report of use of in vivo confocal microscopy as a noninvasive diagnostic and monitoring tool for canine onchocerciasis.

Conjunctival habronemiasis in a square-lipped rhinoceros (Ceratotherium simum).

A captive female square-lipped rhinoceros born in 1993 had been showing intermittent signs of bilateral conjunctivitis and conjunctival proliferation since 1998. Periodic improvement was noted, especially in winter, but overall the condition had deteriorated over the years. Treatment with various topical, intralesional, and systemic antibiotics and glucocorticosteroids was largely ineffective, as were repeated dewormings. No primary cause for these lesions was found in biopsies taken in 2000 and 2006, although a severe infiltrate of numerous eosinophils was observed in the latter. As the condition worsened, secondary corneal changes were noted, and eventually vision was lost due to proliferative conjunctival tissue. Aggressive resection of the proliferating tissue in 2013 restored vision and submitted biopsies yielded a diagnosis of severe allergic conjunctivitis, eosinophilic granuloma, and habronematid (Habronema or Draschia) larval infection. As no other rhinoceros in the herd was affected, including two calves born to the patient who were in close contact with their mother, it was concluded the presentation was most likely due to a hypersensitivity reaction to the dead or dying larvae. Fly repellent is now regularly applied around the eye of this rhinoceros, and a protective face mask has been fitted. Ongoing periodic relapses are treated with oral ivermectin, topical antibiotics, and steroids.

Conjunctival dacryops in two golden retrievers.

Two 5-month-old golden retriever dogs were referred for the evaluation of a mass arising from the left ventrolateral conjunctiva of the lower eyelid. The masses were externally located, deemed to be cystic in nature, and were surgically removed, and in one case, 0.15 mL of clear fluid was collected. Cytological examination of the aspirated fluid revealed proteinaceous, basophilic amorphous material, and few epithelial cells with foamy cytoplasm and small nuclei. No micro-organisms were detected. Histological examination of the cysts showed a wall composed of single to double cell layers. The cells were cuboidal to flattened, nonciliated, lined with mild submucosal connective tissues and slight inflammation composed of lymphocytes, plasma cells, and rare macrophages. In some areas, lobules of acinar glandular tissue were observed. To the authors' knowledge, this is the first case report of conjunctival dacryops in dogs. The complete surgical removal of the cysts was curative in both cases.

[Conjunctival changes in a Swiss Braunvieh heifer with malignant lymphoma]. / Veränderungen an den Konjunktiven bei einem Braunviehrind mit malignem Lymphom.

This report describes a 2.8-year-old Swiss Braunvieh heifer with conjunctival changes as the lead clinical signs of malignant lymphoma. The heifer was referred to our clinic because of conjunctivitis that did not respond to treatment with antibiotics. The patient had bilateral lacrimation, severe swelling of the third eyelids and prolapse of the conjunctivae, which were erythematous and covered with haemorrhagic crusts. A clinical examination revealed enlarged prescapular and prefemoral lymph nodes. Based on cytological examination of a fine needle aspirate from a prescapular lymph node, a tentative diagnosis of malignant lymphoma was made. The heifer was euthanased and a postmortem examination carried out. The conjunctival lesions consisted of diffuse multifocal nodules of varying size. There was generalised lymphadenopathy and beige nodules were seen in several internal organs. Histological and immunohistological examinations confirmed the diagnosis of multicentric leukosis characterised by T-cell lymphoblasts, which had also infiltrated the conjunctivae. Examination of a blood sample for enzootic bovine leukosis virus yielded a negative result.

Arrhythmias and transient changes in cardiac function after topical administration of one drop of phenylephrine 10% in an adult cat undergoing conjunctival graft.

HISTORY: A 2-year-old, entire female, Somali cat weighing 3.8 kg was admitted for a conjunctival graft on the right eye, for treatment of an acute descemetocele. Medetomidine 4.2 µg kg(-1) and methadone 0.2 mg kg(-1) were administered by intramuscular injection as preanaesthetic medication. Anaesthesia was induced using diazepam 0.26 mg kg(-1) and propofol 4 mg kg(-1) administered by intravenous (i.v.) injection. Following endotracheal intubation, anaesthesia was maintained with isoflurane delivered in oxygen (1 L minute(-1)) and nitrous oxide (2 L minute(-1)) via a non-rebreathing system. Twenty minutes after induction of anaesthesia, one drop of a 10% phenylephrine hydrochloride solution was administered topically to the right eye. PHYSICAL EXAMINATION: After phenylephrine administration, a decrease in heart rate (from 95 to 80 beats minute(-1)) and an increase in arterial blood pressure occurred. The pulse then became difficult to palpate manually and multifocal ventricular premature contractions were observed on the electrocardiogram. MANAGEMENT: Nitrous oxide was discontinued and the isoflurane vaporizer setting was decreased from 1.5% to 0.5%. Lidocaine 1 mg kg(-1) i.v. was administered, this resulted in ventricular bigeminy. The quality of the femoral pulse improved and was regular in rhythm and character. Surgery was completed as fast as possible. The bigeminy progressively disappeared and before disconnecting the cat from the breathing system, there was a normal sinus rhythm with a heart rate of 85 beats minute(-1). FOLLOW-UP: Echocardiography was performed during recovery and showed mitral and aortic valve insufficiency and dilation of the left ventricle, suggesting a reduction in systolic function. Echocardiography was repeated the following day and was normal. CONCLUSIONS: In order to diminish the potential for cardiovascular sequelae associated with systemic absorption of ocular phenylephrine, less concentrated solutions, smaller drop size or different instillation techniques should be considered for topical use in small patients.

Subconjunctival mycetoma caused by Scedosporium apiospermum infection in a horse.

An 11-year-old American Saddlebred gelding was presented for evaluation of a nonpainful subconjunctival mass involving the lateral canthus of the left eye. Other findings included a central corneal scar and a small central cataract of the lens in the left eye. Fine-needle aspiration of the mass was performed and cytologic examination revealed marked pyogranulomatous inflammation with intralesional fungal hyphae, consistent with mycetoma. The fungal structures were elongated and characterized by nonstaining walls; several bulbous yeast-like structures were also observed. The mycetoma was surgically removed and submitted for histopathologic examination and fungal culture. The histopathologic diagnosis was subconjunctival phaeohyphomycosis. Scedosporium apiospermum was identified based on macroscopic and microscopic features of the organism in culture. Scedosporium spp. have been reported as causes of mycetomatous and nonmycetomatous infections in both immunocompromised and immunocompetent people and animals. S. apiospermum and Pseudallescheria boydii, which is its teleomorphic counterpart, have been implicated as potentially emerging human and veterinary pathogens. Timely diagnosis is essential as the organism is often resistant to commonly used antifungal drugs. This report provides a detailed cytologic description of the organism and recent information on the taxonomy of this fungus and the diagnostic peculiarities of this particular infection.

Isolated lepromatous conjunctivo-corneal granuloma in a cat from Italy.

OBJECTIVE: To describe a case of a conjunctivo-corneal mass in a cat associated with acid-fast bacilli. METHODS: A 2-year-old female black European Short-Hair cat, living outdoors in a suburban environment in Italy, was referred for evaluation of a nodular, vascularized mass of 2 weeks duration. The mass involved the dorsal bulbar conjunctiva at the temporal canthus of OS and invaded the sclera and cornea. Routine ophthalmic and systemic examination, serologic testing, cytology and histology of the mass were performed. Mycobacterium specific polymerase chain reaction (PCR) of variable regions 1, 2 and 3 of the 16S ribosomal RNA (rRNA) gene was also performed. RESULTS: Neutrophils, lymphocytes, macrophages and giant cells with intracytoplasmic acid-fast bacilli were seen on cytological examination. The histological examination confirmed the presence of a granulomatous lesion with acid-fast bacilli within macrophages. Bacteriological culture of the material from the lesion was negative for Mycobacterium spp. Mycobacterium 16S rRNA gene specific PCR was positive. A diagnosis of feline leprosy was made. The owners refused any treatment, and 1 year later the lesion was still present. CONCLUSIONS: Veterinary ophthalmologists should be aware of conjunctivo-corneal leproma as an unusual symptom of leprosy.

Symblepharon with aberrant protrusion of the nictitating membrane in the snowy owl (Nyctea scandiaca).

Two young snowy owl chicks were presented with aberrant protrusion of the nictitating membranes. This was caused by conjunctival adhesions causing symblepharon secondary to a previous septicemia episode. While symblepharon has been noted in birds before, this unusual presentation of the nictitating membrane has not been reported. Surgical intervention ameliorated the clinical signs, allowing vision in one bird by removal of the nictitating membranes, a technique which appeared to have no deleterious effects on the ocular surface.

Subconjunctival zoonotic onchocerciasis in man: aberrant infection with Onchocerca lupi?

In the past few decades, 10 cases of cryptic, zoonotic onchocerciasis, including two subconjunctival infections, have been reported in man. In the majority of cases, Onchocerca cervicalis, O. gutturosa or O. dewittei, which normally infect horses, cattle and wild boar, respectively, were responsible for the lesions. However, the taxonomic status of the parasites involved in the two subconjunctival infections, both of which were European, has never been unambiguously determined. In such infections, the acute phase appears to be characterized by conjunctivitis. A single, strongly coiled, immature, female worm was found incorporated in a large granulomatous nodule, in the ocular and peri-ocular tissues, in the chronic stage of each of the two eye infections. Several, patent, sporadic cases of subconjunctival O. lupi infection have recently been reported in dogs. In terms of the location of the worms, clinical signs and histopathology, these canine infections were very similar to those seen in the two human patients with eye infection. When the parasites recovered from human eyes were compared morphologically with the Onchocerca spp. infecting animals in Europe, they appeared to be most similar to O. lupi. Although O. lupi is normally a parasite of dogs, it may thus also be responsible for aberrant, zoonotic, subconjunctival infections in man.

Comparative morphology of epicorneal conjunctival membranes in rabbits and human pterygium.

A rarely described ocular lesion in the rabbit is presented following the observation of four cases. It is a membrane of conjunctival origin that advances progressively, without adhering, towards the center of the cornea. Clinically the lesion in rabbits looks like pterygium in man, but with several differences: in rabbits, the conjunctival fold is absolutely free and does not penetrate into the superficial corneal layers. It originates from all the limbal circumference in a symetric growth. The cornea itself remains unaltered. The fold consists of fibroblasts and collagen. The microscopic findings suggest the lesion is possibly of a collagenous dysplasia.

Suspected hypovitaminosis A in a colony of captive green anoles (Anolis carolinensis).

In a colony of 18 green anoles (Anolis carolinensis), 3 animals experienced focally thickened lips, ulcerative cheilitis, lethargy, depression, and weight loss over a 5-month period. In addition to crickets fed fresh fruit and leafy green vegetables, the diet of the green anoles consisted of a supply of mealworms that had been dusted with a commercial liquid vitamin supplement. The history, clinical findings, and histopathologic lesions were suggestive of hypovitaminosis A, which is known to cause squamous metaplasia of the mucus secreting glands and epithelial surfaces in many species.

Surgery of the adnexa.

Review of the functional anatomy of ocular adnexal tissues is followed by presentation of surgical procedures aimed at correcting conditions of the eyelids, conjunctiva, and third eyelids of small animals. Procedures used effectively by the primary author are described in detail including instances where combination procedures may be indicated. Some newer, recently described techniques are also briefly discussed. Illustrations of applied anatomy and multiple surgical techniques are provided by illustrator and coauthor Dr. Gheorghe Constantinescu. References are given to encourage readers to further explore alternative techniques focusing on the surgical correction of adnexal diseases of dogs and cats.

Update on llama medicine. Ophthalmology.

Review of the limited literature on camelid eyes suggests they are anatomically similar to those of domestic livestock species, except they lack meibomian glands and have iridial folds (rather than corpora nigra). The microbial flora of the healthy camelid conjunctival sac also appears to be similar to those of domestic livestock and pets, except that no Mycoplasma have been isolated from camelids. Ocular diseases for which camelids are presented to veterinarians are numerous and varied. The most frequently presented conditions are ocular trauma and congenital abnormalities. Trauma to cornea, conjunctiva, eyelids, and sclera has been reported. Therapies for these injuries are the same as for other animals. Most congenital abnormalities are cataracts and optic nerve colobomas, but congenital eyelid defects, conjunctival cysts, and multiple ocular defects have been reported. Although these conditions are not demonstrably hereditary, breeding of animals with congenital ocular defects is strongly discouraged. Intraocular inflammatory diseases are seen commonly in camelids. Uveitis and chorioretinitis may cause permanent visual loss, usually with no indication of cause. Equine herpesvirus 1 has been isolated from camelids with severe ocular inflammation and is a known cause of chorioretinitis and neurologic abnormalities. Systemic aspergillosis causes severe chorioretinitis in alpacas. More research is needed to improve our understanding of ocular physiology and pathology in camelids. Genetic studies also are needed to establish hereditary patterns of ocular maldevelopment. Additional information from researchers and practitioners should improve our ability to recognize and treat ocular disease in camelids.

Idiopathic granulomatous disease with ocular adnexal and cutaneous involvement in a dog.

Idiopathic granulomatous disease was the cause of bilateral eyelid masses and additional ocular adnexal disease in a dog. Histologically similar granulomas developed concurrently in distant sites including the limbs, prepuce, and testicles. Periodic resolution and redevelopment of the masses were observed and were unaffected by corticosteroid treatments. Rapid diminution of some of the masses was found after treatment with polyethylene glycol modified L-asparaginase, but poor client compliance and episodes of spontaneous resolution of some of the masses made it difficult to accurately assess effectiveness of treatment. Clinicians should be aware that ocular adnexal granulomas may simulate neoplasms and be a component of a more widespread disease process.

Severe masseter myonecrosis in a horse.

A 6-year-old Quarter Horse was examined because of acute, severely swollen masseter muscles (palpation of which elicited pain response), exophthalmos, severe chemosis, and protrusion of the third eyelids. Blood selenium and vitamin E concentrations, and results of feed analysis and muscle biopsy supported a diagnosis of nutritional myopathy. The horse was treated and was clinically normal 2 weeks after discharge from the hospital.