Conjunctiva

Question 1

What cells predominate on a conjunctival cytology in a patient with conjunctivitis?

Answer 1

Epithelial cells and neutrophils

Question 1

What is epiphora?

Answer 1

Excessive tearing

Question 2

What part of the conjunctiva is responsible for producing the normal mucinous layer of the tear film?

Answer 2

Goblet cells

(increased production results in mucoid ocular discharge)

Question 3

What is the function of goblet cells within the conjunctiva of the eye?

Answer 3

• Produces the mucinous layer of the tear film normally
• Inflammation triggers increased production and mucoid discharge

Question 4

Why is mucopurulent discharge often seen with quantitative KCS?

Answer 4

Inflammation of the cornea and conjunctiva leads to increased mucin production by goblet cells, which then creates a favorable media for bacterial growth

Question 5

Where are lymphoid follicles of the eye normally located?

Answer 5

Bulbar surface of the 3rd eyelid

always abnormal if present anywhere else

Question 6

Lymphoid follicles found in places other than the bulbar surface of the 3rd eyelid indicates?

Answer 6

• Nonspecific antigenic stimulation
• Likely primary conjunctivitis

Question 7

What does conjunctival hyperemia suggest?

Answer 7

Superficial irritation

Ex: conjunctivitis, superficial corneal ulcer, KCS

Question 8

What is episcleral injection and what is it suggestive of?

Answer 8

Congestion of deeper larger eye vessels

Suggestive of deeper inflammation

Ex: Deep corneal ulcer, uveitis, glaucoma, episcleritis

Question 9

What is the most common cause of conjunctivitis in dogs?

Answer 9

KCS / dry eye

Question 10

List canine disorders of the conjunctiva

Answer 10

1. KCS
2. Allergic conjunctivitis
3. Infectious conjunctivitis (Adenovirus, Herpesvirus, Distemper)

Question 11

What are infectious causes of conjunctivitis in dogs?

Answer 11

1. Adenovirus
2. Herpesvirus
3. Distemper

(primary conjunctivitis… which is less common)

Question 12

What are clinical signs that can be seen with primary conjunctivitis?

Answer 12

• Blepharospasm
• Epiphora
• Mucoid discharge
• Hyperemia
• Lymphoid follicles

(Viral conjunctivitis and allergic conjunctivitis are primary causes although rare)

Question 13

What are the possible treatment options for canine patients with conjunctivitis?

Answer 13

• Treat underlying cause (allergy vs viral)
• NeoPolyDex
• Diclofenac
• Optimmune (Cyclosporine)

(topical anti-inflammatories are mainstay tx options)

Question 14

List the most common causes of feline conjunctivitis in order of prevalence

Answer 14

1. Herpesvirus
2. Chlamydia
3. Mycoplasma
4. Calicivirus

**Only herpesvirus causes inflammation of both the conjunctiva AND cornea)

Question 15

What is the most common cause of keratoconjunctivitis in cats?

Answer 15

Feline herpesvirus

Question 16

What clinical signs in cats are suggestive of feline herpesvirus?

Answer 16

1. Blepharospasm
2. Epiphora
3. Mucoid discharge
4. URT infection !!
5. Hyperemia
6. Conjunctival AND corneal ulceration
7. Dendritic (branching) corneal ulceration (pathognomonic)
8. Symblepharon

Question 17

What cranial nerve can be affected in cats with herpesvirus?

Answer 17

CN V, invades sensory nerve endings, remains latent in trigeminal nerve

Question 18

What is the redrudescence phase of feline herpesvirus?

Answer 18

• Latent virus becomes reactivated by stress, steroids, co-infection, etc

Question 19

What is a pathognomonic findings in cats with herpesvirus?

Answer 19

• Dendritic (branching) corneal ulcers
• Keratic precipitates ventrally

Question 20

What is symblepharon?

Answer 20

Permanent adhesion between the conjunctiva and cornea

(happens with herpesvirus in cats)

Question 21

What is the treatment protocol for cats with herpesvirus infection?

Answer 21

1. Topical Cidofovir
2. Famciclovir PO
3. Topical erythromycin Abx for supportive care

Question 22

What is feline eosinophilic keratoconjunctivitis?

Answer 22

Autoimmune disorder of the conjunctiva that may be related to feline herpesvirus

Question 23

What is the most specific finding in cats with feline eosinophilic keratoconjunctivitis?

Answer 23

Raised white or yellow corneal and/or conjunctival infiltrates on the eye

Question 24

What is the treatment protocol for cats with feline eosinophilic keratoconjunctivitis?

Answer 24

- Cyclosporine (to suppress immune system) - Topical NSAID (or steroid if 100% certain of no ulcer) - Cidofovir or Famcyclovir (antivirals)

Question 25

What clinical signs can be suggestive of chlamydia in cats?

Answer 25

**- Chemosis (most specific CS, all others non specific)** - Blepharospasm - Epiphora - Mucoid/purulent discharge - Hyperemia **will not see corneal or conjunctival ulceration**

Question 26

What is the treatment protocol for cats with chlamydia?

Answer 26

- Topical **tetracyclines** or erythromycin - Doxycycline PO (not great... esophageal strictures in cats) Treat for 3 weeks minimum!!

Question 27

What is the treatment protocol for cats with mycoplasma?

Answer 27

- Topical **tetracyclines** or erythromycin - Doxycycline PO (not great... esophageal strictures in cats) Treat for 3 weeks minimum!! (same tx as chlamydia)

Question 28

What is a pathognomonic clinical sign seen in cats with calicivirus?

Answer 28

Oral ulcers

Question 29

What is the treatment protocol for cats with calicivirus conjunctivitis?

Answer 29

Topical erythromycin