Compounding in veterinary ophthalmology.

Compounded medications provide treatment options that can improve the clinical outcome for patients, improve compliance, and increase the potential for cure. This article provides an overview of the types and uses of compounded ophthalmic products in veterinary practice as well as criteria for selecting a pharmacist skilled in sterile compounding.     

Nonsteroidal anti-inflammatory drugs in veterinary ophthalmology.

Uveitis is a common sequela to many ocular diseases. Primary treatment goals for uveitis should be to halt inflammation, prevent or control complications caused by inflammation, relieve pain, and preserve vision.Systemic and topical NSAIDs are essential components of the pharmaceutic armamentarium currently employed in the management of ocular inflammation by general practitioners and veterinary ophthalmologists worldwide. NSAIDs effectively prevent intraoperative miosis; control postoperative pain and inflammation after intraocular procedures, thus optimizing surgical outcome; control symptoms of allergic conjunctivitis;alleviate pain from various causes of uveitis; and circumvent some of the unwanted side effects that occur with corticosteroid treatment. Systemic NSAID therapy is necessary to treat posterior uveitis, because therapeutic concentrations cannot be attained in the retina and choroid with topical administration alone, and is warranted when diseases, such as diabetes mellitus or systemic infection, preclude the use of systemic corticosteroids.Risk factors have been identified with systemic and topical administration of NSAIDs. In general, ophthalmic NSAIDs may be used safely with other ophthalmic pharmaceutics; however, concurrent use of drugs known to affect the corneal epithelium adversely, such as gentamicin, may lead to increased corneal penetration of the NSAID. The concurrent use of NSAIDs with topical corticosteroids in the face of significant preexisting corneal inflammation has been identified as a risk factor in precipitating corneal erosions and melts in people and should be undertaken with caution[8]. Clinicians should remain vigilant in their screening of ophthalmic and systemic complications secondary to drug therapy and educate owners accordingly. If a sudden increase in patient ocular pain (as manifested by an increase in blepharospasm, photophobia, ocular discharge, or rubbing)is noted, owners should be instructed to contact their veterinarian promptly.     

Nonhypotensive autonomic agents in veterinary ophthalmology.

The parasympathetic and sympathetic divisions of the autonomic nervous system are involved in homeostatic control of a wide variety of ocular functions, including accommodation, pupillomotor control, lacrimation, eyelid position, and aqueous humor production. Familiarity with the functional anatomy of the autonomic nervous system is paramount to the understanding and application of the large number of autonomic drugs used in veterinary ophthalmology. The cholinergic and adrenergic agents discussed in this article are commonly employed to facilitate routine ophthalmic examination, in the diagnosis of autonomic dysfunction, and in the treatment of a variety of ocular diseases.     

Viscoelastic materials in veterinary ophthalmology

Viscoelastic materials have applications in both human and veterinary ophthalmology and orthopedics and for humans in otorhinolaryngology, urinary incontinence, cosmetic surgery and cosmetics. In ophthalmology, viscoelasties are most commonly used in facilitating cataract and other anterior segment surgeries, but also have applications in posterior segment surgery and in the topical management of keratoconjunctivitis sicca. Viscoelastics are routinely used during anterior segment surgery in filling and maintaining the anterior chamber, repositioning the iris, and to coat and protect the corneal endothelium, and expand the capsular bag prior to intraocular lens implantation. Viscoelastics can also be essential in the management of intraoperative complications such as miosis, hemorrhage, posterior capsular tears, and vitreous presentation. The most common products available for ophthalmic use include various concentrations of sodium hyaluronate, chondroitin sulfate, and hydroxypropylmethylcellulose. The physical properties of each viscoelastic material are dependent on chain length, and intra-and interchain interactions. The rheologic properties of viscosity, pseudoplasticity, viscoelasticity, and surface tension dictate the usefulness of each material for a specific purpose.     

Cross-sectional imaging techniques in veterinary ophthalmology

Ultrasonography (US), computed tomography (CT), and magnetic resonance imaging (MRI) are useful, complementary cross-sectional imaging modalities of the eye and orbit. High-resolution US provides excellent morphological information of ocular structures but offers limited information on the periocular tissues. CT and MRI provide valuable morphologic and topographic images of both ocular and periocular structures, thereby giving a more complete picture of the pathological process. US can be performed on awake patients, whereas CT and MRI require general anesthesia. In addition, US equipment is readily available and less costly than CT or MRI units. Fine-needle aspirations and biopsies under US or CT guidance can also be performed. This article reviews the technique and normal findings of ocular and orbital structures as displayed in each of these imaging modalities. Representative clinical cases are presented to illustrate the interpretation principles as well as to provide an illustrative reference for common ocular and orbital changes.     

Laser use in veterinary dentistry.

Lasers have been used in human dentistry since the 1960's. Lasers can provide a veterinary dentist access to difficult to reach areas with a relatively bloodless surgical field. Due to vaporization of nerve endings, human patients undergoing laser dental treatment reveal less pain compared to scalpel driven procedures. Dental applications for the commonly used lasers are discussed, as are special safety precautions. Many dental procedures enhanced by a carbon dioxide laser are covered. Future applications for the laser in veterinary dentistry are also discussed.