Cytologic findings, and feline herpesvirus DNA and Chlamydophila felis antigen detection rates in normal cats and cats with conjunctival and corneal lesions

Samples were collected from 36 cats with feline herpesvirus (FHV-1)-related ocular disease (conjunctivitis, epithelial or stromal keratitis, or corneal sequestration), and 17 cats without ocular changes. Corneoconjunctival swabs, scrapings and biopsies were tested in various combinations for presence of FHV-1 DNA using single round (sr) polymerase chain reaction (PCR) and nested PCR (nPCR). Additional swabs from the inferior conjunctival fornix were tested by enzyme-linked immunosorbent assay for Chlamydophila felis antigen. Cytologic evaluation was carried out on conjunctival (cats with conjunctivitis) and corneal (cats with keratitis) cytobrush preparations. FHV-1 DNA was detected by PCR in 14 (39%) cats with ocular disease and 1 (6%) of the control group. Agreement between srPCR and nPCR results was significant (P < 0.01). FHV-1 DNA was detected in 3/7 cats with conjunctivitis, 5/6 cats with epithelial keratitis, 3/11 cats with stromal keratitis, and 3/12 cats with corneal sequestration. There was a significant association (P = 0.0027) between viral presence and epithelial keratitis. However, no significant association was found between viral presence and conjunctivitis (P = 0.059), stromal keratitis (P = 0.15), or corneal sequestration (P = 0.18). With respect to FHV-1 DNA detection, intersample agreement was significant (P < 0.03). No sampling technique seemed more likely than another to harvest detectable viral DNA, except for cats with corneal sequestrum in which viral DNA was not detected using corneoconjunctival swabs. FHV-1 DNA was detected in 6/9 samples with intranuclear inclusion bodies and in 6/7 cats with eosinophils on cytologic examination. All samples tested negative for C. felis antigen.     

Histologic evaluation of the immediate effects of diamond burr debridement in experimental superficial corneal wounds in dogs

Purpose To evaluate the corneal changes immediately after diamond burr debridement of superficial corneal wounds in dogs. Spontaneous chronic corneal epithelial defects (SCCEDs) are the most common form of canine recurrent corneal ulcers. The diamond burr has been used in the management of corneal lesions in humans since 1983. Recently, it has been successfully used in the treatment of SCCEDs in dogs; however, little has been documented as to its mechanism of action. Methods Five adult female research dogs euthanized for reasons unrelated to the study were included, providing 10 normal eyes. An excimer laser spatula was used for epithelial removal after delineation with an 8 mm punch biopsy trephine. Diamond burr debridement was performed for 30 and 45 s in five eyes each (groups 1 and 2 respectively). The procedure was performed on the ventral half of the experimental defect as well as ventral normal cornea, immediately after euthanasia, and prior to enucleation. Samples were processed routinely for histologic evaluation and stained with periodic acid–Schiff. Results No stromal defects could be identified under light microscopy. In experimental corneal wounds, multi‐focal areas remained covered by the epithelial basement membrane (BM) after diamond burr treatment in both groups (group 1 = 48%±16SD, group 2 = 26%±12SD). Removal of BM on group 2 was significantly higher than group 1 (P < 0.05). Conclusions The diamond burr allows a safe method of debridement and does not create defects beyond the epithelial BM in corneal wounds in normal dogs. Evaluation of the diamond burr debridement in cases of SCCEDs is warranted.     

Bacteroides sp. as a cause of anaerobic keratitis in a pony

This Case Report describes anaerobic infection of the conjunctiva and cornea in a pony. A 13‐year‐old pony was admitted for evaluation following suspected ocular trauma. Bacterial conjunctivitis and keratitis were diagnosed based on clinical appearance of the eye and cytological evaluation of a corneal scraping. The pony responded poorly to topical therapy, and enucleation was performed. Culture of the corneal scraping yielded Corynebacterium sp. and Bacteroides sp. Anaerobic keratitis and conjunctivitis is uncommonly reported in horses, but should be suspected when there is a history of ocular trauma or skin disease, or when a malodorous ocular discharge is identified.     

Conjunctivitis and ulcerative keratitis secondary to conjunctival plant foreign bodies in a herd of alpacas (Lama Pacos)

Purpose To describe six cases of conjunctivitis and ulcerative keratitis secondary to plant foreign bodies from weed‐contaminated grass hay which were lodged within the temporal conjunctival fornix in a herd of alpacas. Methods A total of 21 alpacas from the same farm developed blepharospasm and mucopurulent ocular discharge. Six of the 21 were evaluated at the University of Tennessee College of Veterinary Medicine within a 2‐week period. The six animals evaluated received an ophthalmic examination including slit‐lamp biomicroscopy, fluorescein staining, and topical corneal anesthesia for foreign body removal when necessary. Results Six animals had conjunctivitis characterized by hyperemia and mucopurulent discharge. Five animals had superficial ulcerative keratitis with intense corneal neovascularization and edema. In all cases, the keratitis was located at the temporal limbus. Seven plant foreign bodies were observed and were removed following topical corneal anesthesia in five animals. The plant seeds were identified as three common weed species found in orchard grass hay. Complete resolution of all clinical signs was achieved with foreign body removal and medical therapy. Conclusions Fan‐shaped temporal corneal ulcers may signify the presence of conjunctival foreign bodies in alpacas. Plant foreign bodies should be considered in addition to ocular infection when multiple animals of a herd are affected as outbreaks may occur with weed‐contaminated hay.     

Superficial, nonhealing corneal ulcers in horses: 23 cases (1989-2003)

Objective To characterize superficial, nonhealing corneal ulcers in the horse and to assess the affect of age, breed, sex, inciting cause of the ulcer, and treatment on healing time of these ulcers. Design Retrospective study. Animals Twenty‐three horses with superficial, nonhealing corneal ulcerations. Procedure Medical records from 1989 to 2003 of horses diagnosed with superficial, nonhealing corneal ulcers were reviewed. Signalment, duration of clinical signs, ophthalmic abnormalities, treatment and response to treatment were recorded. Horses were treated, in addition to medical therapy, using debridement, debridement and grid keratotomy, superficial keratectomy, and superficial keratectomy with conjunctival graft placement. Results Mean age ± SD of horses was 13.7 ± 5.8 years. The mean time of presence of the corneal ulceration was 38.9 ± 21.3 days. Mean time to complete re‐epithelialization of the corneal ulcers after treatment was 20 ± 14.7 days. Horses treated with debridement alone, grid keratotomy and superficial keratectomy healed in a mean time of 15.3 ± 14.6 days, 16 ± 12.6 days, and 22.8 ± 6.7 days, respectively. Conclusions and clinical relevance Horses treated with a single debridement at initial evaluation healed in a significantly shorter time period than horses treated with grid keratotomy or superficial keratectomy. The latter two procedures may be beneficial in the treatment of nonhealing ulceration in horses, but the results of this study suggest that these procedures should only be performed following failure of the ulcer to heal after epithelial debridement.     

Limbal conjunctival plaques and idiopathic eosinophilic conjunctivitis

A 4‐year‐old Welsh pony crossbred gelding was examined for acute onset of blepharospasm, epiphora and corneal oedema. Ophthalmic examination identified 2 conjunctival plaques located near the superior limbus of the left eye. The plaques did not resolve following treatment with topical triple antibiotic ointment, topical atropine ointment and oral flunixin meglumine and therefore a conjunctival biopsy was performed. Histology of the biopsy resulted in a diagnosis of eosinophilic conjunctivitis, which was treated with a topical corticosteroid ointment. Plaques resolved after 73 days of therapy but lesions did not improve with concurrent treatment with anthelmintics early in the course of therapy. Failure to identify an aetiological agent led to a diagnosis of idiopathic eosinophilic conjunctivitis. The conjunctival plaques have not recurred in the 10 months following discontinuation of therapy.     

Traumatic corneal laceration with associated lens capsule disruption: a retrospective study of 77 clinical cases from 1999 to 2009

Objective Examine prognostic factors that may indicate when surgical lens removal is indicated to prevent vision‐threatening complications in patients presented following traumatic perforating corneal laceration with associated lens capsule disruption. Procedures Seventy‐seven patients (10 cats and 67 dogs) were evaluated with this injury; of these, 47 were presented acutely and treated surgically and/or medically. Successful outcome was defined as functional vision in the treated eye. Results The 47 patients with acute injuries were divided into 3 treatment groups A‐C for comparison; A ‐ corneal repair/lens removal (n = 15), B ‐ corneal repair/no lens removal (n = 9), C – medical management (n = 23). Groups A and B showed a significantly greater rate of vision loss compared to Group C that was most obvious greater than 18 months post‐injury (P = 0.029 and 0.0097, respectively). Cox proportional hazards regression analysis found a significantly higher increased rate of vision loss in Group A (HR = 4.5; P = 0.023) and a higher but nonsignificant increased rate of vision loss in Group B (HR = 3.0; P = 0.23) compared to Group C after controlling for age and cause of injury. The length of the corneal laceration and time interval from injury to referral were also relevant prognostic factors. Conclusions Medical management is an appropriate therapy for patients of all ages suffering perforating corneal injuries with associated lens capsule disruption. Patients with corneal injuries requiring surgical repair or managed by lens removal following corneal repair suffered vision‐threatening complications approximately 3 to 4.5 times the rate of patients treated by medical management, respectively. Favorable prognostic signs for treatment by medical management include good corneal wound apposition and a formed anterior chamber without uveal prolapse or continued aqueous leakage.     

Spontaneous chronic corneal epithelial defects in dogs: a review

Spontaneous chronic corneal epithelial defects (SCCEDs) in dogs are typically found in middle-aged dogs of all breeds. These epithelial defects may be present for weeks to months, particularly if left untreated or if treated inappropriately. Typical histopathological findings include loss of the corneal epithelial basement membrane and formation of a superficial, acellular, hyalinized zone in the stroma. Together, these histological abnormalities lead to delayed wound healing and poor epithelial adhesion. Epithelial debridement, anterior stromal puncture, grid keratotomy, and superficial keratectomy are the most common treatment options applied to the defects. Procedures that address the stromal changes present generally have a higher success rate than epithelial debridement alone.     

Distichiasis causing recurrent corneal ulceration in two Friesian horses

Two cases of distichiasis with subsequent recurrent superficial corneal ulceration are described in Friesian horses. Case 1 was a 9‐year‐old Friesian stallion with distichiae on the superior and inferior eyelids of both eyes corresponding to areas of recurrent superficial corneal ulceration. Case 2 was a 5‐year‐old Friesian gelding with a single distichia on the inferior lid associated with recurrent superficial corneal ulceration in the right eye. Case 1 underwent cryotherapy and epilation twice under standing sedation without resolution of distichiasis. A partial tarsal plate excision was then performed on the inferior left lid, which was the most severely affected. Cryotherapy was repeated one and 4 months post operatively due to recurrence. Cryotherapy was associated with skin depigmentation and repigmentation several months following the procedure. No recurrence has been reported up to 3 years following the fourth cryotherapy procedure. Case 2 was treated with epilation. Distichiasis should be included as a differential diagnosis when presented with a horse experiencing recurrent superficial corneal ulcerations. There has been no established breed association for Friesian horses and distichiasis but, due to the inherited nature of this condition in some human patients and dogs, this possibility should be investigated.     

Entropion,Corneal Ulcer and Corneal Haemorrhages in a One‐Humped Camel (Camelus dromedarius)

An unusual case of entropion, corneal ulcer and corneal haemorrhages in a one‐humped camel (Camelus dromedaries) is described. The most prominent clinical findings were entropion of both eyelids, severe blephrospasm, epiphora, conjunctivitis, conjunctival oedema, mucopurulent conjunctival discharges, hyperaemia, lacrimation and photophobia. Corneal ulcers and corneal haemorrhages were also observed.     

Corneal ulceration in a dog following exposure to the defensive spray of a walkingstick insect (Anisomorpha spp.)

Objective – To describe a case of corneal ulceration in a dog resulting from ocular exposure to the defensive spray of a walkingstick insect (Anisomorpha spp.). Case Summary – A 4‐year‐old, male Chihuahua in southeastern Louisiana presented to an emergency veterinary hospital approximately 20 hours after it was witnessed to have come in close proximity to a walkingstick insect. Within seconds of approaching the insect, the dog yelped, jumped backwards and developed lacrimation, blepharospasm, and periocular swelling of the left eye. Upon presentation, the dog was found to have blepharospasms and miosis of the left eye. Fluorescein stain was applied to the affected eye and diffuse corneal uptake of stain was noted. A diffuse superficial corneal ulceration was diagnosed and treated supportively with ocular flushing, topical antibiotics, ocular lubrication, and a 1% solution of ocular atropine, as well as systemic nonsteroidal anti‐inflammatory agents. Clinical signs resolved 10 days after injury. New or Unique Information Provided – While most species of walkingstick insects are considered harmless, certain species in the southeastern United States have the ability to spray defensive venom at their predators. Upon ocular exposure to the venom, the victim may experience intense pain followed by blurred vision, conjunctivitis, keratitis, and corneal ulceration. To date, there is only 1 previous reported case of ocular exposure to walkingstick venom in a dog although both children and animals may be at higher risk for ocular exposure due to their curious nature and proximity in size to the insect. Superficial corneal and conjunctival damage can occur following direct exposure to the defensive chemical spray of the Northern and Southern Twostriped walkingstick insects found in the southeastern United States and may be considered a differential diagnosis in cases involving diffuse corneal ulceration.     

Experimental reactivation of latent canine herpesvirus-1 and induction of recurrent ocular disease in adult dogs

Latent canine herpesvirus-1 (CHV-1) infection is common in domestic dogs, but recrudescent CHV-1 diseases are poorly characterized. To determine if administration of an immunosuppressive dosage of prednisolone to adult dogs latently infected with CHV-1 results in recurrent ocular disease, adult beagles with and without experimentally induced CHV-1 latent infection were divided into groups: group 1 latently infected and administered prednisolone, group 2 latently infected and administered placebo, and group 3 not latently infected and administered prednisolone. Prednisolone (3.0 mg/kg/day) was administered to dogs in groups 1 and 3 for seven consecutive days beginning on study day 1. Samples for CHV-1 polymerase chain reaction and serum neutralization (SN) assays were collected, and physical, ophthalmologic, and in vivo ocular confocal microscopic examinations were performed at intervals for 42 days. Bilateral ocular disease (i.e., conjunctivitis or keratitis) was detected in 83% of group 1 dogs between study days 3 and 18. In vivo confocal microscopic abnormalities included conjunctival leukocyte infiltration and corneal leukocyte infiltration, abnormal epithelial cell morphology, and Langerhans cell infiltration. Ocular viral shedding was detected in 50% of group 1 dogs on study days 10 and 13. Fourfold elevations in CHV-1 SN titers were detected in 100% of group 1 dogs by study day 14. Dogs in control groups did not develop clinical ocular disease (P < 0.05), CHV-1 titer elevations (P < 0.005), or viral shedding. Administration of an immunosuppressive dosage of systemic prednisolone to adult dogs latently infected with CHV-1 may result in viral reactivation and ocular disease recrudescence.     

Keratitis and periocular lesions associated with equine herpesvirus‐3 in a 3‐month‐old filly

A 3‐month‐old Quarter Horse filly presented with corneal ulceration in the right eye with extensive coalescing periocular ulcerations, erosions, and cutaneous crusts. Similar periocular lesions were present around the left eye, on the gingival mucosa, and on the cutaneous and mucosal surfaces of the lips. Based on the severity of the filly's corneal lesions, expense and duration of treatment, euthanasia was elected. Histological post mortem examination revealed numerous hyperplastic and/or dysplastic epithelial cells adjacent to areas of ulceration and erosion with intranuclear viral inclusion bodies. Equine herpesvirus‐3 (EHV‐3) was identified by polymerase chain reaction from the right cornea and lip. The virus was isolated from the right cornea, right eyelid and lip. The dam presented with multifocal to coalescing perineal vesicles. EHV‐3 was confirmed by polymerase chain reaction from the vulvar lesions and the mare recovered spontaneously. This is the first case of EHV‐3 corneal infection reported in horses and emphasises that EHV‐3 should be included as a differential diagnosis for vesicular lesions involving the equine periocular and oronasal epithelium.     

Evaluation of cytologic findings in feline conjunctivitis

Background

Cytologic examination of smears prepared from ocular swabs of conjunctiva from cats with conjunctivitis permits identification of the type of inflammation and possibly specific microorganisms. Results of studies of the diagnostic utility of cytology for detection of infectious causes of feline conjunctivitis have been inconsistent.

Objectives

The objectives of this study were to describe cytologic findings in cats with conjunctivitis and to compare those findings with results of PCR analysis for feline herpesvirus (FHV‐1), Chlamydophila felis (C felis), and Mycoplasma felis (M felis).

Methods

Conjunctival smears from 88 cats with conjunctivitis and 10 healthy control cats were stained with a Romanowsky stain and evaluated for the type of inflammation and evidence of an infectious agent. PCR analysis for FHV‐1, C felis, and M felis was performed.

Results

Infectious agents identified by PCR analysis were FHV‐1 in 9 cats (10%), C felis in 8 cats (9%), and M felis in 6 cats (7%). Inclusions interpreted as chlamydial inclusions were found in all cytologic smears from cats positive for C felis by PCR analysis and in 3 PCR‐negative cats. Inclusions interpreted as Mycoplasma organisms were found in 3 of 6 cats that were PCR‐positive for M felis and in 1 PCR‐negative cat. FHV‐1 inclusion bodies were not detected on cytologic examination.

Conclusions

Cytologic examination can be diagnostic for C felis infection when many typical inclusions are present. Cytologic examination was unreliable in diagnosing M felis infection, and viral inclusions of FHV‐1 were not found in specimens stained with Romanowsky stains.     

Keratoconjunctivitis associated with Toxoplasma gondii in a dog

A 12-year-old Pug presented with a 3-mm corneal mass OD. The dog was currently being treated for keratoconjunctivitis sicca (KCS) and pigmentary keratitis OU. A superficial keratectomy followed by cryotherapy was performed OD. A histopathologic diagnosis of epithelial dysplasia and suppurative keratitis was made and the lesion resolved. Two months later, a yellow/tan conjunctival mass, diffuse chemosis and conjunctival thickening was discovered OD. Necrotizing conjunctivitis with protozoal parasites was diagnosed with histopathology. Complete blood count and a serum biochemistry panel were normal. Neospora caninum and Toxoplasma gondii titers were negative. The conjunctivitis resolved after a 6-week course of oral clindamycin. Two months later, the patient presented with a similar conjunctival mass OS. Toxoplasma gondii was confirmed as the etiologic agent with immunohistochemical staining. Repeat T. gondii titers were negative. Oral clindamycin was re-instituted. The corneal biopsy was re-reviewed and protozoal organisms were discovered. Three months later, a recurrence was suspected and oral ponazuril was initiated for 28 days. There has been no evidence of recurrence since this treatment. Ocular toxoplasmosis is rare in the dog but reports have included episcleritis, scleritis, retinitis, anterior uveitis, ciliary epithelium hyperplasia, optic neuritis and polymyositis. To our knowledge, this is the first confirmed report of toxoplasmosis causing only corneal and conjunctival disease in the dog. We hypothesize that these localized lesions may be associated with topical immunomodulating therapy for KCS. Toxoplasmosis should be considered as a differential for canine conjunctivitis and corneal disease and has the potential to manifest in one or both eyes.     

Allergic conjunctivitis and conjunctival provocation tests in atopic dogs

Introduction Canine atopic dermatitis (cAD) is a very common disease, but little is known about eye involvement. The conjunctival provocation test (CPT) is used in human to study the ocular response to allergenic stimuli and to evaluate anti‐allergic therapy. To our knowledge it has not been used in dogs. Objectives To evaluate the prevalence of ocular signs in a population of atopic dogs and relate these with clinical cAD scores; and the usefulness of CPT for dust mites in atopic dogs with itchy eyes. Procedures Sixty cAD patients were evaluated for (i) ocular signs of allergic conjunctivitis including conjunctival hyperemia, chemosis, epiphora, ocular discharge, pruritus and corneal involvement, graded 0 to 3 according to severity, and (2) cAD Extent and Severity Index (CADESI‐03). Additionally, CPTs for Dermatophagoides farinae (n = 12) and Dermatophagoides pteronyssinus (n = 12) were performed in sensitized atopic dogs and 24 control dogs. Results Periocular and ocular signs of allergy were present in 60% (36/60) of cases. Conjunctival hyperemia (90%) was the most common sign. Severity of ocular signs was significantly correlated with eye pruritus (r_s = 0.690, P = <0.001) and skin lesions score for head region (r_s = 0.261, P = 0.04). A highly significant difference (P < 0.001, Fisher test) was found in CPTs between the test and the control groups. Conclusion Allergic conjunctivitis signs associated with cAD seem under valuated so these patients would benefit from an ophthalmologic evaluation. Furthermore, we found CPT to be a reliable, easy to perform and safe test for the etiologic diagnosis of allergic conjunctivitis in the dog.     

Nonulcerative bullous keratitis associated with Pseudomonas alcaligenes infection in a Thoroughbred mare

A 5‐year‐old Thoroughbred mare presented with an intermittently mildly painful right eye with a nonulcerative corneal opacity of several weeks' duration that had improved with topical steroids but recurred when steroids were withdrawn. Ophthalmic examination demonstrated a focal region of moderate corneal oedema and midstromal corneal infiltrate centrally but no other significant ocular abnormalities, and suggested a diagnosis of immune‐mediated keratitis. Empirical courses of both topical and systemic anti‐inflammatory drugs, both nonsteroidal and steroidal, led to initial improvement but bullous keratopathy developed when corneal oedema became profound. Due to the rapidly progressive nature of the bullous keratopathy combined with poor response to medical therapy, a keratectomy and conjunctival graft were performed under general anaesthesia. Intraoperative corneal culture of the keratectomy site grew Pseudomonas alcaligenes, a common soil and water contaminant. Histopathology of the keratectomy specimen revealed neutrophilic inflammation. Keratectomy and conjunctival graft led to resolution of ocular pain and inflammation, with an acceptable cosmetic and visual outcome. This report describes an unusual case of a nonulcerative Pseudomonas keratitis that responded well to surgical therapy, and underscores the complicated nature of nonulcerative keratitis in horses.     

Feline eosinophilic conjunctivitis

Objective To review 12 cases of histologically confirmed feline eosinophilic conjunctivitis, their clinical, cytologic, histologic and electronmicroscopic findings, results on PCR for FeHV‐1, treatment and outcome. Animals studied Twelve naturally occurring cases presented during a period of 26 months. Procedures Thorough ophthalmologic examination, conjunctival scrapings performed with the cytobrush method; histologic samples from the palpebral conjunctiva; PCR for FeHV‐1 on Schirmer Tear Test (STT) strips; saliva and nasal swabs, and retrospective evaluation of all results. Results The breed most commonly affected was the Domestic Shorthair (n = 8), followed by Persians (n = 2), Somali (n = 1) and Siamese (n = 1). Age at presentation was 1–15 years with a mean age of 7.2 years. Nine cats were castrated males; three cats were females: two of them were spayed. Unilateral (n = 7) or bilateral (n = 5) involvement with depigmentation and erosions of lid margin, blepharospasm, swelling and redness of conjunctiva and third eyelid were the most common clinical findings. Frequency of eosinophils in cytologic samples was more than 10% in every patient. PCR for FeHV‐1 on STT was negative in all cases. Histologically, eosinophils, lymphocytes, plasma cells, mast cells and macrophages were involved. On electronmicroscopy, viral particles were not detected. Ten cases needed long‐term anti‐inflammatory treatment. Conclusions The 12 reviewed cases suggest that feline eosinophilic conjunctivitis is a chronic inflammatory uni‐ or bilateral disease of the adult cat. Typically the lid margin was also involved, and was thickened, depigmented and erosive. Cytological examination of conjunctival scrapings was a valuable tool for detecting eosinophilic conjunctivitis. The cytological findings correlated well with the histopathological findings in our patients. Topical or systemic anti‐inflammatory drugs resolved the clinical symptoms in our cases within a short period of time. Neither electronmicroscopy nor PCR were able to detect involvement of FHV1 in the represented cases. The etiopathogenic role of FeHV‐1 remains undetermined.