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Equine conjunctivitis

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Equine conjunctivitis

  1. 1. EQUINEEQUINE CONJUNCTIVITISCONJUNCTIVITIS OPTOM FASLU MUHAMMEDOPTOM FASLU MUHAMMED
  2. 2. OutlineOutline  Anatomy/PhysiologyAnatomy/Physiology  Clinical signsClinical signs  Clinical and diagnosticClinical and diagnostic examinationexamination
  3. 3. OutlineOutline  EtiologiesEtiologies  Diagnosis/treatment ofDiagnosis/treatment of selected etiologiesselected etiologies
  4. 4. Conjunctival Anatomy/PhysiologyConjunctival Anatomy/Physiology  Composed of nonkeratinized,Composed of nonkeratinized, stratified squamous epithelium andstratified squamous epithelium and underlying substantia propriaunderlying substantia propria  Capable of rapid and dramaticCapable of rapid and dramatic response to insultsresponse to insults  Richly supplied by blood vesselsRichly supplied by blood vessels  Loose arrangement of conjunctivalLoose arrangement of conjunctival stromastroma  Resident lymphoid tissueResident lymphoid tissue  Specialized antigen-presenting cellsSpecialized antigen-presenting cells (M-cells)(M-cells)
  5. 5. Conjunctival Anatomy/PhysiologyConjunctival Anatomy/Physiology  Often secondarily involved in otherOften secondarily involved in other intraocular, extraocular, andintraocular, extraocular, and systemic diseasessystemic diseases  Anatomical proximity and sharedAnatomical proximity and shared blood supply with other ocularblood supply with other ocular structuresstructures  Extensive vascular/lymphoidExtensive vascular/lymphoid tissuetissue  Relatively accessible andRelatively accessible and observableobservable
  6. 6. Conjunctivitis Clinical SignsConjunctivitis Clinical Signs  Conjunctivitis associated withConjunctivitis associated with some combination of thesome combination of the following clinical signs:following clinical signs:  Ocular discharge:Ocular discharge: epiphora,epiphora, mucoid, or mucopurulentmucoid, or mucopurulent  Chemosis:Chemosis: edema resultingedema resulting from increased permeability offrom increased permeability of conjunctival vessels with fluidconjunctival vessels with fluid extravasationextravasation  Hyperemia:Hyperemia: red discolorationred discoloration from conjunctival vesselfrom conjunctival vessel vasodilatationvasodilatation  Ocular discomfort:Ocular discomfort: blepharospasm, rubbingblepharospasm, rubbing
  7. 7. Conjunctivitis Clinical SignsConjunctivitis Clinical Signs  Conjunctivitis associated withConjunctivitis associated with some combination of thesome combination of the following clinical signs:following clinical signs:  Tissue proliferation:Tissue proliferation: lymphatic, epitheliallymphatic, epithelial hyperplasia, or keratinizationhyperplasia, or keratinization  Ulceration:Ulceration: any severeany severe conjunctivitis or thoseconjunctivitis or those associated with particularassociated with particular etiologies (viral, chemical,etiologies (viral, chemical, trauma)trauma)  PigmentationPigmentation oror depigmentationdepigmentation
  8. 8. Conjunctivitis ExaminationConjunctivitis Examination  Physical examinationPhysical examination  To rule-out primary orTo rule-out primary or concurrent systemicconcurrent systemic diseasesdiseases
  9. 9. Conjunctivitis ExaminationConjunctivitis Examination  Complete ophthalmicComplete ophthalmic examination:examination:  Focal light source andFocal light source and magnificationmagnification  Adnexa, extraocular, andAdnexa, extraocular, and intraocular structuresintraocular structures  Including Schirmer tearIncluding Schirmer tear tests, fluorescein stain,tests, fluorescein stain, tonometrytonometry  Examine behind nictitansExamine behind nictitans membranemembrane
  10. 10. Conjunctivitis ExaminationConjunctivitis Examination Conjunctivitis diagnostics:Conjunctivitis diagnostics:  Conjunctival cytologyConjunctival cytology  Scrapings, swabs, aspiratesScrapings, swabs, aspirates often helpful in diagnosisoften helpful in diagnosis  Microbiologic diagnosticsMicrobiologic diagnostics  Cultures, PCR, IFA, etc… asCultures, PCR, IFA, etc… as indicated for select cases whereindicated for select cases where infectious etiology suspectedinfectious etiology suspected  Biopsy/histopathologyBiopsy/histopathology  For conjunctivitis that isFor conjunctivitis that is severe, chronic, unresponsivesevere, chronic, unresponsive to treatment, or associated withto treatment, or associated with mass formationmass formation
  11. 11. Conjunctivitis EtiologiesConjunctivitis Etiologies  Inflammation of theInflammation of the conjunctiva is a commonconjunctiva is a common condition and may be a:condition and may be a:  Primary or secondaryPrimary or secondary disease processdisease process  Result of ocular orResult of ocular or systemic diseasesystemic disease
  12. 12. Conjunctivitis EtiologiesConjunctivitis Etiologies  The conjunctiva hasThe conjunctiva has limited mechanisms bylimited mechanisms by which it can respond towhich it can respond to insults, thus the etiologyinsults, thus the etiology of conjunctivitis canof conjunctivitis can usually not beusually not be determined from clinicaldetermined from clinical signs alonesigns alone
  13. 13. Conjunctivitis EtiologiesConjunctivitis Etiologies  Secondary conjunctivitisSecondary conjunctivitis more common than primarymore common than primary in the horsein the horse  Secondary conjunctivitisSecondary conjunctivitis typically occurs as a result oftypically occurs as a result of adjacent ocular inflammationadjacent ocular inflammation or systemic disease:or systemic disease:  Intraocular disease: uveitis,Intraocular disease: uveitis, glaucomaglaucoma  Extraocular disease: cornealExtraocular disease: corneal ulcers or abscesses, blepharitisulcers or abscesses, blepharitis  Systemic disease: infectious,Systemic disease: infectious, neoplastic, immune-mediatedneoplastic, immune-mediated
  14. 14. Conjunctivitis EtiologiesConjunctivitis Etiologies  The diagnosis and treatmentThe diagnosis and treatment of secondary conjunctivitisof secondary conjunctivitis should be directed towardshould be directed toward the underlying ocular orthe underlying ocular or systemic conditionsystemic condition
  15. 15. Secondary ConjunctivitisSecondary Conjunctivitis Conjunctivits secondary toConjunctivits secondary to a corneal ulcera corneal ulcer Conjunctivits secondary toConjunctivits secondary to anterior uveitisanterior uveitis
  16. 16. Primary Conjunctivitis EtiologiesPrimary Conjunctivitis Etiologies  Idiopathic, immune-mediated:Idiopathic, immune-mediated: eosinophilic, lymphocyticeosinophilic, lymphocytic  AllergicAllergic  InfectiousInfectious  Bacterial:Bacterial: Streptococcus equiStreptococcus equi,, Moraxella equiMoraxella equi,, ChlamydiaChlamydia, etc…, etc…  Fungal:Fungal: AspergillusAspergillus,, RhinosporidiumRhinosporidium,, Histoplasmosis, Blastomycosis,Histoplasmosis, Blastomycosis, Cryptococcus, etc…Cryptococcus, etc…  Viral: Equine herpesvirus 2 and 5Viral: Equine herpesvirus 2 and 5  Parasitic: Onchocerciasis,Parasitic: Onchocerciasis, Habronemiasis,Habronemiasis, Thelazia lacrimalisThelazia lacrimalis,, TrypanosomiasisTrypanosomiasis  Toxic/Chemical:Toxic/Chemical: Stachybotryotoxicosis, alkali/acid burnStachybotryotoxicosis, alkali/acid burn
  17. 17. Primary Conjunctivitis EtiologiesPrimary Conjunctivitis Etiologies  Trauma: blunt or penetratingTrauma: blunt or penetrating  Frictional irritants: entropion,Frictional irritants: entropion, ectopic cilia, distichia, foreignectopic cilia, distichia, foreign bodiesbodies  Keratoconjunctivitis siccaKeratoconjunctivitis sicca  Exposure: facial nerve dysfunction,Exposure: facial nerve dysfunction, lagophthalmoslagophthalmos  ActinicActinic  NeoplasticNeoplastic
  18. 18. Eosinophilic ConjunctivitisEosinophilic Conjunctivitis  Idiopathic infiltration ofIdiopathic infiltration of conjunctiva with eosinophilsconjunctiva with eosinophils  May be present with or withoutMay be present with or without corneal lesionscorneal lesions  Diagnosis: eosinophils on cytologyDiagnosis: eosinophils on cytology or histopathology without parasitesor histopathology without parasites presentpresent
  19. 19. Eosinophilic ConjunctivitisEosinophilic Conjunctivitis  Treatment:Treatment: Topical corticosteroids orTopical corticosteroids or cyclosporine: tapered to leastcyclosporine: tapered to least frequent effective dosefrequent effective dose Topical mast cell stabilizersTopical mast cell stabilizers (cromolyn, olopatadine,(cromolyn, olopatadine, lodoxamide) may also be effectivelodoxamide) may also be effective in some casesin some cases
  20. 20. Eosinophilic ConjunctivitisEosinophilic Conjunctivitis Conjunctival biopsy from a horse with eosinophilicConjunctival biopsy from a horse with eosinophilic keratoconjunctivitis displaying numerous eosinophilskeratoconjunctivitis displaying numerous eosinophils
  21. 21. Lymphocytic ConjuctivitisLymphocytic Conjuctivitis  Lobulated or smooth, pinkLobulated or smooth, pink conjunctival massesconjunctival masses  Composed of lymphocytesComposed of lymphocytes and macrophagesand macrophages  Most common locations:Most common locations: dorsal bulbar conjunctivadorsal bulbar conjunctiva and third eyelidand third eyelid
  22. 22. Lymphocytic ConjuctivitisLymphocytic Conjuctivitis  Diagnosis: lymphocyticDiagnosis: lymphocytic aggregates onaggregates on cytology/histopathologycytology/histopathology  Treatment: topical orTreatment: topical or intralesional corticosteroids,intralesional corticosteroids, topical cyclosporine, ortopical cyclosporine, or surgical excisionsurgical excision
  23. 23. Lymphocytic ConjuctivitisLymphocytic Conjuctivitis Conjunctival biopsy from a horse with lymphocytic conjunctivitisConjunctival biopsy from a horse with lymphocytic conjunctivitis displaying numerous lymphocytes and occasional plasma cellsdisplaying numerous lymphocytes and occasional plasma cells
  24. 24. Bacterial and Fungal ConjunctivitisBacterial and Fungal Conjunctivitis  Bacterial and fungalBacterial and fungal conjunctivitis usuallyconjunctivitis usually secondary infectionssecondary infections  Diagnosis based uponDiagnosis based upon cytology and culturecytology and culture findingsfindings Fungal conjunctivitis secondaryFungal conjunctivitis secondary to keratomycosisto keratomycosis
  25. 25. Bacterial and Fungal ConjunctivitisBacterial and Fungal Conjunctivitis  Treatment: identify andTreatment: identify and treat underlying causetreat underlying cause along with thealong with the opportunistic infectionopportunistic infection Fungal conjunctivitis secondaryFungal conjunctivitis secondary to keratomycosisto keratomycosis
  26. 26. Viral ConjunctivitisViral Conjunctivitis  Equine herpesvirus 2 andEquine herpesvirus 2 and 5 may cause primary5 may cause primary conjunctivitis in theconjunctivitis in the horsehorse  Diagnosis: virus isolation,Diagnosis: virus isolation, PCR, IFAPCR, IFA  Treatment: topicalTreatment: topical idoxuridine, trifluridine,idoxuridine, trifluridine, or interferonor interferon
  27. 27. Viral ConjunctivitisViral Conjunctivitis Equine viral arteritis, equineEquine viral arteritis, equine adenovirus, equineadenovirus, equine infectious anemia, equineinfectious anemia, equine influenza, and Africaninfluenza, and African horse sickness often causehorse sickness often cause mild conjunctivitismild conjunctivitis associated with systemicassociated with systemic diseasedisease
  28. 28. Parasitic ConjunctivitisParasitic Conjunctivitis  Parasitic conjunctivitis mostParasitic conjunctivitis most commonly occurs withcommonly occurs with Onchocerca cervicalisOnchocerca cervicalis::  Insect vectors:Insect vectors: CulicoidesCulicoides spp.spp.  Larvae migration incitesLarvae migration incites inflammationinflammation  Lesions: temporolimbalLesions: temporolimbal conjunctival thickening,conjunctival thickening, nodules, and depigmentationnodules, and depigmentation +/- keratitis+/- keratitis
  29. 29. Parasitic ConjunctivitisParasitic Conjunctivitis  Diagnosis: conjunctivalDiagnosis: conjunctival biopsy or cytologybiopsy or cytology (microfilaria, eosinophils,(microfilaria, eosinophils, lymphocytes)lymphocytes)  Treatment: systemicTreatment: systemic ivermectin and topicalivermectin and topical corticosteroidscorticosteroids
  30. 30. Parasitic ConjunctivitisParasitic Conjunctivitis OnchocercaOnchocerca limbal conjunctival noduleslimbal conjunctival nodules in a horsein a horse Cytology of conjunctivalCytology of conjunctival nodules with eosinophilsnodules with eosinophils andand OnchocercaOnchocerca microfilaramicrofilara
  31. 31. Parasitic ConjunctivitisParasitic Conjunctivitis  Habronemiasis may also causeHabronemiasis may also cause conjunctivitisconjunctivitis  HabronemaHabronema andand DraschiaDraschia spp.spp. (equine gastric worms)(equine gastric worms)  Larvae deposited onLarvae deposited on conjunctiva by flies, migrationconjunctiva by flies, migration incites intense granulomatousincites intense granulomatous or eosinophilc inflammationor eosinophilc inflammation  Lesions: proliferative nodules,Lesions: proliferative nodules, granulation tissue appearance,granulation tissue appearance, may be ulcerative, may havemay be ulcerative, may have yellow-white exudates (“sulfuryellow-white exudates (“sulfur granules”)granules”)  Occur on conjunctiva,Occur on conjunctiva, nictitans, and periocular skin;nictitans, and periocular skin; most commonly adjacent tomost commonly adjacent to medial canthus (where fliesmedial canthus (where flies feed)feed)
  32. 32. Parasitic ConjunctivitisParasitic Conjunctivitis  Diagnosis: seasonal, clinicalDiagnosis: seasonal, clinical appearance, cytology/histopathappearance, cytology/histopath  Treatment: systemic ivermectin,Treatment: systemic ivermectin, topical/intralesional/systemictopical/intralesional/systemic corticosteroids, surgical debulkingcorticosteroids, surgical debulking for large massesfor large masses
  33. 33. Parasitic ConjunctivitisParasitic Conjunctivitis Habronemiasis “sulfur granules”Habronemiasis “sulfur granules” at medial canthus in a horseat medial canthus in a horse HabronemaHabronema conjunctival noduleconjunctival nodule and blepharitis in a horseand blepharitis in a horse
  34. 34. Parasitic ConjunctivitisParasitic Conjunctivitis  Thelazia lacrimalisThelazia lacrimalis  Nematode inhabiting conjunctivalNematode inhabiting conjunctival fornices and nasolacrimal ductfornices and nasolacrimal duct  Diagnosis: identification ofDiagnosis: identification of parasites during clinicalparasites during clinical examinationexamination
  35. 35. Parasitic ConjunctivitisParasitic Conjunctivitis  Treatment:Treatment:  Manual removal of parasites withManual removal of parasites with lavage, swabs, or forcepslavage, swabs, or forceps  Systemic ivermectin or topicalSystemic ivermectin or topical levamisolelevamisole
  36. 36. Traumatic ConjunctivitisTraumatic Conjunctivitis  May occur from blunt orMay occur from blunt or penetrating injuriespenetrating injuries  Often dramatic chemosis initiallyOften dramatic chemosis initially  May be associated withMay be associated with subconjunctival hemorrhagessubconjunctival hemorrhages or emphysemaor emphysema  Diagnostics: exclude other ocularDiagnostics: exclude other ocular injuries and foreign bodiesinjuries and foreign bodies  May be difficult on initialMay be difficult on initial presentationpresentation
  37. 37. Traumatic ConjunctivitisTraumatic Conjunctivitis  TreatmentTreatment  Most lacerations/punctures doMost lacerations/punctures do not require sutures as thenot require sutures as the conjunctiva healsconjunctiva heals spontaneously and rapidlyspontaneously and rapidly  Cold compresses acutely mayCold compresses acutely may decrease clinical signsdecrease clinical signs  Topical antibiotics untilTopical antibiotics until resolvedresolved  Systemic antibiotics ifSystemic antibiotics if penetrating or full-thicknesspenetrating or full-thickness woundswounds  Consider systemic nonsteroidalConsider systemic nonsteroidal anti-inflammatoriesanti-inflammatories
  38. 38. Traumatic ConjunctivitisTraumatic Conjunctivitis Traumatic conjunctivitis withTraumatic conjunctivitis with subconjunctival hemorrahgesubconjunctival hemorrahge Traumatic conjunctivitis withTraumatic conjunctivitis with conjunctival emphysemaconjunctival emphysema
  39. 39. Actinic ConjunctivitisActinic Conjunctivitis  Occurs following chronicOccurs following chronic UV-light exoposureUV-light exoposure  Diagnosis: ulcerativeDiagnosis: ulcerative conjunctivitis adjacent toconjunctivitis adjacent to lid margins, develops inlid margins, develops in areas of conjunctiva thatareas of conjunctiva that are not pigmentedare not pigmented
  40. 40. Actinic ConjunctivitisActinic Conjunctivitis  Precursor to squamous cellPrecursor to squamous cell carcinomacarcinoma  Treatment: shade (flyTreatment: shade (fly mask, stabling), monitormask, stabling), monitor for neoplasiafor neoplasia developmentdevelopment
  41. 41. Conjunctival NeoplasiaConjunctival Neoplasia  Conjunctival neoplasia mayConjunctival neoplasia may masquerade as conjunctivitismasquerade as conjunctivitis initiallyinitially  Most common types:Most common types: squamous cell carcinoma,squamous cell carcinoma, lymphoma, hemangioma,lymphoma, hemangioma, hemangiosarcoma, papilloma,hemangiosarcoma, papilloma, and melanomaand melanoma  Diagnosis based uponDiagnosis based upon excisional/incisional biopsy,excisional/incisional biopsy, scrapings, or aspiratesscrapings, or aspirates
  42. 42. Conjunctival NeoplasiaConjunctival Neoplasia  Treatment:Treatment:  Surgical excision (alwaysSurgical excision (always treatment of choice whentreatment of choice when complete excision possible)complete excision possible)  Ancillary therapies oftenAncillary therapies often indicated based upon tumorindicated based upon tumor type, location, extent:type, location, extent:  Diode laser ablation,Diode laser ablation, cryotherapy, radiation,cryotherapy, radiation, chemotherapychemotherapy
  43. 43. Conjunctival NeoplasiaConjunctival Neoplasia Conjunctival squamous cell carcinoma Conjunctival lymphoma
  44. 44. Questions????Questions????

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