Oral doxycycline, niacinamide and prednisolone used to treat bilateral nodular granulomatous conjunctivitis of the third eyelid in an Australian Kelpie dog

A 5-year-old, female neutered, Australian Kelpie presented with a 2-month history of dramatic bilateral erythematous thickening of the third eyelids. Ophthalmic examination demonstrated raised, pink to red, irregular thickening of the entire palpebral surface of both third eyelids. There were no other ocular abnormalities. A surgical biopsy was taken from each third eyelid. Histopathologic examination revealed sheets of macrophages, plasma cells, lymphocytes, and occasional fibroblasts and neutrophils infiltrating the third eyelid stroma. A diagnosis of chronic granulomatous conjunctivitis was made. Grossly and histopathologically this case closely resembles previously described cases of nodular granulomatous conjunctivitis involving the third eyelids of Collie dogs. This report describes an unusual case of nodular granulomatous conjunctivitis isolated to the third eyelids in an Australian Kelpie. Resolution of the condition was achieved with a combination of oral doxycycline, niacinamide and prednisolone.     

Extranodal conjunctival Hodgkin's-like lymphoma in a cat

A seven-year-old female spayed Domestic Short-haired cat was brought for examination following a four-month history of conjunctivitis in the right eye. The superior palpebral conjunctiva was diffusely swollen and firm, displacing the right globe ventrally and preventing full closure of the eyelids. The right popliteal lymph node was enlarged as were several other peripheral lymph nodes. An incisional biopsy of the conjunctival swelling revealed a lymphoid neoplasm, the cellular make up of which suggested features of feline Hodgkin's-like lymphoma. Although the neoplasm was poorly responsive to standard chemotherapeutic protocols for lymphoma, radiation therapy rapidly reduced its size. Three years following the initial diagnosis, there has been no recurrence of the conjunctival neoplasm. To the authors' knowledge, there are no previous reports of extranodal or adnexal (conjunctiva, eyelid, orbit) Hodgkin's-like lymphoma in the veterinary literature.     

Standard and modified glabellar flap for medial canthus reconstruction following mass removal in three dogs and two cats

Purpose

To describe the surgical technique and clinical outcomes of the glabellar flap and its modification for the reconstruction of the medial canthus following resection of tumors in three dogs and two cats.

Methods

Three dogs (7-, 7-, and 12.5-year-old mixed breeds) and two cats (10- and 14-year-old Domestic shorthair) presented with a 7–13 mm tumor affecting the eyelid and/or conjunctiva in the medial canthal region. Following en bloc mass excision, an inverted V-shaped skin incision was made in the glabellar region (i.e., the area between the eyebrows in humans). The apex of the inverted V-shaped flap was rotated in three cases, whereas a horizontal sliding movement was performed in the other two cases to better cover the surgical wound. The surgical flap was then trimmed to fit the surgical wound and sutured in place in two layers (subcutaneous and cutaneous).

Results

Tumors were diagnosed as mast cell tumors (n = 3), amelanotic conjunctival melanoma (n = 1), and apocrine ductal adenoma (n = 1). No recurrence was noted in a follow-up time of 146 ± 84 days. Satisfactory cosmetic outcome with normal eyelids closure was achieved in all cases. Mild trichiasis was present in all patients and mild epiphora was noted in 2/5 patients, but there were no associated clinical signs such as discomfort or keratitis.

Conclusions

The glabellar flap was easy to perform and provided a good outcome in terms of cosmetic, eyelid function, and corneal health. Postoperative complications from trichiasis appear to be minimized by the presence of the third eyelid in this region.     

Use of chemical ablation with trichloroacetic acid to treat eyelid apocrine hidrocystomas in a cat

CASE DESCRIPTION: A 7-year-old Persian cat was evaluated for recurrence of multiple cystic periocular masses. A number of cyst-like lesions had been resected from the left eyelids 18 months earlier, with lesions recurring within 6 months after surgery. The cat had blepharospasm and signs of discomfort following rupture of the largest cyst the day prior to examination. Previous histologic examination of the cysts had revealed apocrine hidrocystomas. CLINICAL FINDINGS: Multiple pigmented nodules were seen around the skin of the upper and lower left eyelids. The nodules were brownish to black, round, soft, and fluid-filled. Signs of pain were not evident during palpation of the nodules. TREATMENT AND OUTCOME: The largest cyst on the upper eyelid was removed by means of a V-shaped full-thickness excision. Histologic and immunohistochemical examination of the excised tissue confirmed the diagnosis of apocrine hidrocystoma. The remaining periocular cysts were surgically debrided and then treated topically with 20% trichloroacetic acid. All lesions healed rapidly without any signs of discomfort. During a recheck examination 12 months later, the upper and lower left eyelids appeared morphologically normal, and there was no evidence of recurrence. CLINICAL RELEVANCE: Findings suggested that chemical ablation with trichloroacetic acid may be a useful treatment for apocrine hidrocystomas in cats.     

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.     

Treatment of a recurrent ocular squamous cell carcinoma in a horse with Iridium-192 implantation

A 7-year-old Selle français gelding was presented for a recurrent conjunctival tumour on the left eye. A previous histologic analysis revealed a conjunctival squamous cell carcinoma. As it was the third recurrence after surgical excision in a 1½-year period, we decided to perform interstitial radiotherapy combined with the surgical excision. Two Iridium-192 pins were implanted in the subcutaneous fascia of the lower eyelid over the tumor site and were removed 3 days later. No postoperative adverse reactions were observed. Twelve months postoperatively, there were no signs of local recurrence. Surgical excision combined with Iridium-192 therapy appeared to be an effective treatment in this case.     

Surgical management of bilateral,upper and lower eyelid entropion in 27 Shar Pei dogs,using the Stades forced granulation procedure of the upper eyelid only

ABSTRACT

Aims: To evaluate the outcome of surgical management of entropion of the upper and lower eyelids in Shar Pei dogs which had previously undergone temporary palpebral tacking, using the Stades forced granulation procedure of the upper eyelid only.

Methods: Medical records were retrospectively searched to identify Shar Pei dogs referred for bilateral entropion of both the lower and upper eyelids, and that were treated with the forced granulation procedure of the upper eyelid only. Dogs were included if they had previously undergone unsuccessful temporary palpebral tacking and had at least three follow-up examinations in the 30 days following surgery.

Results: Twenty-seven Shar Pei dogs with a median age of 7.9 (min 4, max 24) months were included in the study. Before surgery, all dogs showed signs of severe ocular discomfort with bilateral keratitis and visual deficit due to blepharospasm, enophthalmos and protrusion of the third eyelid. In 13/54 eyes, keratitis was associated with a corneal ulcer. When re-examined 4 weeks after surgery, correction of the upper eyelid entropion and associated trichiasis resolved ocular signs in 50/54 eyes. Mild bilateral lower entropion remained in two dogs postoperatively, which underwent revision surgery with the Hotz-Celsus technique. There were no cases of long-term recurrence of entropion or ocular irritation in the 38 eyes (19 dogs) which were re-examined 1 year after surgery.

Conclusion and clinical relevance: The forced granulation procedure performed on the upper eyelid only was effective for correction of entropion in the Shar Pei dogs included in this study. In our experience, it is preferable to operate on the upper eyelid alone, rather than attempting to correct upper and lower entropion during the same surgical operation. The dog can then be reassessed a few weeks later to determine whether the lower entropion is anatomical or secondary to the severe blepharospasm resulting from the painful ocular irritation.     

Hemangiosarcoma of the third eyelid in a cat

A case of hemangiosarcoma of the third eyelid in a 15-year-old Domestic Short-haired cat is reported. A small red mass protruding from the anterior surface of the third eyelid in the left eye was present. Only mild bilateral conjunctivitis and nuclear sclerosis were revealed on initial ophthalmic examination. After anti-inflammatory treatment, surgery and cryotherapy were performed. On histopathologic examination the mass was located just beneath the conjunctival epithelium, suggesting that the conjunctiva was the tissue of origin. The tumor showed high cellularity and was composed of pleomorphic spindle and polygonal cells arranged in interlacing bundles and solid sheets. The presence of slit-like spaces between tumor cells containing erythrocytes demonstrated the vascular differentiation. Mitotic activity was moderate, but atypical mitoses were detected. The surgical area healed uneventfully and after 7 months there was no recurrence. To the authors' knowledge, this is the first report of conjunctival hemangiosarcoma of the third eyelid in a cat.     

Bilateral nodular lymphocytic conjunctivitis in a horse

A Russian jumper horse presented because of an ocular perilimbal conjunctival mass and, on clinical examination, two bilateral conjunctival masses were found, of different size and conformation. Attempts at complete excision of the left eye mass and excisional biopsy of the right eye mass were performed. The left eye mass recurred rapidly, but resolved completely after topical corticosteroid therapy. The two lesions had similar histopathologic features, characterized by focal, chronic, primarily lymphocytic conjunctivitis with follicular lymphoid hyperplasia. Special histopathologic staining techniques (Gomori methenamine silver and acid fast stains) and immunohistochemistry (for CD3, BLA36 and lysozyme) failed to reveal any etiologic agents and indicated an inflammatory lesion composed of a heterogeneous population of lymphocytes and macrophages (nodular lymphocytic conjunctivitis). The lesions were indistinguishable, clinically and behaviorally, from what has been reported as 'conjunctival pseudotumor' in the horse. Equine conjunctival pseudotumor/nodular lymphocytic conjunctivitis has been reported to be unilateral and have a good prognosis after partial or complete surgical excision. This is the first reported case of bilateral nodular lymphocytic conjunctivitis in a horse and for which surgical excision alone was not curative.     

Ectopic cilium in seven horses

Ectopic cilium was diagnosed by slit-lamp biomicroscopy and treated surgically by transconjunctival excision in seven adult horses. All cases presented with a common history of blepharospasm, ocular discharge and keratitis. Ophthalmic examination revealed a single translucent cilium in the upper eyelid palpebral conjunctiva, emerging approximately 5 mm from the eyelid margin. Corneal ulceration was not observed in any horse. Most horses responded well to transconjunctival surgical excision. There was recurrence of ectopic cilium 6 weeks postoperatively in one horse. Histopathologic examination was performed in two cases and confirmed the diagnosis of ectopic cilium in one horse. This is the first publication of ectopic cilia in horses and emphasizes their importance as etiology for epiphora, blepharospasm and keratitis.     

Conjunctival changes in a Swiss Braunvieh heifer with malignant lymphoma

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.     

Osseous metaplasia in the conjunctiva of a horse presenting with recurrent ulcerative keratitis

A 13‐year‐old Thoroughbred gelding presented with a 6 month history of recurrent conjunctivitis, dacryocystitis and corneal ulceration affecting the left eye (OS). Treatment had included multiple topical antibiotic and anti‐inflammatory preparations, nasolacrimal system flushing and an injection of methylprednisolone acetate (MPA) (Depomedrone) ¹ administered subconjunctivally into the left lower eyelid. No mechanical cause for the ulcerative keratitis could be visualised but digital palpation revealed a firm linear structure in the central palpebral conjunctiva of the lower eyelid. An excisional biopsy was performed and histopathological examination revealed the lesion to be a region of osseous metaplasia. Following excision of the lesion, the corneal ulcer resolved and the eye remained disease free over a 4 year follow‐up period. A causal link between the osseous metaplasia and the recurrent ulcerative keratitis was therefore suspected. This report describes the management of this case and discusses the pathogenesis of osseous metaplasia and the use of subconjunctival corticosteroids.     

Focal Intestinal Lipogranulomatous Lymphangitis in 6 Dogs (2008–2011)

Background

Lipogranulomatous lymphangitis is inflammation of the intestinal lymphatic vessels and surrounding tissues caused by chronic leakage of lipid‐laden chyle. Grossly, lipogranulomas are typically disseminated small masses on the serosa and surrounding lymphatic vessels and consist of epithelioid macrophages, multinucleated giant cells, and cholesterol. Lipogranulomatous lymphangitis is occasionally seen in patients with lymphangiectasia and protein‐losing enteropathy (PLE).

Objectives

To characterize the historical features, clinical signs, treatment, histopathology, and outcome of dogs with focal lipogranulomatous lymphangitis.

Animals

Six dogs with ultrasonographic evidence of focal, regional small intestinal masses, often with involvement of the adjacent mesentery, and a diagnosis of focal lipogranulomatous lymphangitis based on histopathology of biopsied masses.

Results

The median age of dogs was 6.9 years (range 3–10 years). All dogs had total protein, globulin, and albumin concentrations within the reference range at initial presentation and had intestinal masses identified on abdominal ultrasound examination. Histopathologic evaluation of lesions identified severe mural and mesenteric lipogranulomatous lymphangitis. Lymphangiectasia was noted in 5 cases and only in sections within the mass‐like lesion; tissue without lipogranulomas had minimal lymphangiectasia, suggesting a localized phenomenon. Postoperative outcomes ranged from remission of clinical signs with no subsequent treatment for 10–12 months in 2 dogs, postoperative management with medical and nutritional management in 3 dogs, and no outcome for 1 case.

Conclusions and Clinical Importance

This case series describes a unique mass‐like manifestation of intestinal lipogranulomatous lymphangitis and should be considered as a possible differential diagnosis in dogs with an intestinal mass.     

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.     

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.     

Conjunctival mucinous adenocarcinoma in an ostrich (Struthio camelus)

A 2‐year‐old male ostrich (Struthio camelus) presented with a rapidly growing soft tissue mass protruding from the ventromedial aspect of the right eye (OD). The initial physical examination revealed a soft tissue mass attached to the medial inferior conjunctiva. The mass was excised with cryosurgery, and the conjunctival tissue margins were treated with cryoablation. Histopathological examination diagnosed granulomatous inflammation associated with scattered acid‐fast bacteria. The ostrich recovered uneventfully and appeared healthy until recurrence of a grossly similar mass 2 months later. Gross examination revealed a botryoid mass attached to the inferior palpebral conjunctiva and extending onto the palpebral aspect of the nictitating membrane. Euthanasia was selected, and the histological diagnosis of the second mass was a mixed mucinous adenocarcinoma; however, no acid‐fast bacteria were seen. Granulomatous conjunctival lesions have been previously described in the ostrich, while, to the authors' knowledge, neoplastic conjunctival lesions have not. Neoplasia should be considered as a differential diagnosis for a rapidly recurring, granulomatous conjunctival mass in this species.     

Mast cell tumour in the third eyelid of a mare

A 4‐year‐old Missouri Fox Trotter mare was referred to the Veterinary Teaching Hospital, Koret School of Veterinary Medicine with a reddish mass protruding from the third eyelid and adjacent palpebral conjunctiva of the left eye. On ophthalmic examination, the mare showed mild blepharospasm, mild mucopurulent discharge and mild corneal oedema in the left eye. Menace response, pupillary light reflexes and intraocular examination were normal. A rounded, fleshy red ulcerated mass, approximately 3 cm in diameter, expanded the edge of the outer surface of the medial third eyelid and conjunctiva of the ventromedial palpebral region. Physical examination was otherwise unremarkable. Based on history and clinical findings, surgical removal was elected. The tumour was excised and the conjunctiva in the area of tumour treated with cryotherapy. Histological evaluation revealed a mast cell tumour on the third eyelid. Nine months follow‐up revealed no recurrence.     

Mucosa-associated lymphoid tissue lymphoma of the third eyelid conjunctiva in a dog

A 4-year-old, neutered female Cocker Spaniel was presented to the veterinary clinic for protrusion of the left third eyelid. When the third eyelids from both eyes were everted, lobulated masses were present on the bulbar surface. The left third eyelid had a larger protrusion. There was no apparent associated ocular or systemic involvement. The tumor of left third eyelid was removed and referred for histological examination. Histologically, there were proliferations of lymphoid follicles surrounded by lymphoid cells forming a marginal zone. Those lymphoid cells occasionally infiltrated into conjunctival epithelium. A few apoptotic bodies with karyopyknotic and karyorrhexic nuclei were observed in the germinal center of lymphoid follicles. Mitotic figures were rare. On immunohistochemistry, tumor cells expressed CD79a but not CD3. A diagnosis of extranodal marginal zone B-cell lymphoma of mucosa-associated lymphoid tissue (MALT) of the third eyelid was established based on the histological and immunophenotypical features. At the 1-year follow-up, there was no evidence of recurrence of the mass at the area of excision of the left third eyelid and the remaining tumor of the right third eyelid was still a similar size. The dog still showed no significant findings, except those of the tumor, and no evidence of systemic involvement. To the authors' knowledge, this is the first reported case of MALT lymphoma of the third eyelid in a dog.     

Surgical correction of facial droop in the English cocker spaniel

Hooding of the globe with exposure of both membrana and everted lower palpebral conjunctival surfaces is part of a required facial conformation for several breeds of dog. Compliance with the associated Kennel Club breed standards may bring reward in the show ring, but poor apposition between eyelid and globe is clinically unsound. There may be an associated physical impairment of sight, chronic conjunctivitis or keratoconjunctivitis, and epiphora. Treatment can be difficult, but in the English cocker spaniel considerable improvement may be achieved by simple face lift surgery. The technique restores the palpebral fissure to its normal position, and long term results suggest that the correction is maintained permanently.     

Bilateral palpebral reduction and concurrent mycoplasmosis in a wild Agassiz's desert tortoise (Gopherus agassizii)

A wild Agassiz's desert tortoise, Gopherus agassizii, with bilateral eyelid reduction and plaques of tissue covering the superior surface of both corneas was examined in the field and subsequently submitted to the University of Florida for diagnostics. Polymerase chain reaction (PCR), from a swab of both corneas, was positive for Mycoplasma agassizii. Two months later, the tortoise was euthanatized and necropsied. There was increased bulbar exposure associated with dermal excoriation of periocular scales in both superior and inferior palpebra resulting in an increased palpebral fissure opening. Concurrently, there was bilateral conjunctivitis of the nictitating membranes and squamous metaplasia of the bulbar conjunctiva. Using PCR, Mycoplasma testudineum, another pathogen of tortoises, was identified in both nasal cavities, and the upper respiratory tract histopathological findings were consistent with those described for M. testudineum in Agassiz's desert tortoises. Although eye disease has been reported in desert and gopher (Gopherus polyphemus) tortoises with mycoplasmosis, widespread loss of palpebral tissue, conjunctivitis of the nictitans, and squamous metaplasia of the bulbar conjunctiva have not been reported in tortoises.