{"id":1308,"date":"2013-05-01T16:19:12","date_gmt":"2013-05-01T16:19:12","guid":{"rendered":"http:\/\/phosdev.com\/todaysveterinarypractice\/?p=1308"},"modified":"2022-02-17T19:09:22","modified_gmt":"2022-02-17T19:09:22","slug":"clinical-approach-to-the-canine-red-eye","status":"publish","type":"post","link":"https:\/\/navc.sitepreview.app\/todaysveterinarypractice.com\/ophthalmology\/clinical-approach-to-the-canine-red-eye\/","title":{"rendered":"Clinical Approach to the Canine Red Eye"},"content":{"rendered":"<p class=\"p1\"><a href=\"https:\/\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2016\/09\/T1305F01.pdf\"><img decoding=\"async\" class=\"alignnone size-full wp-image-9886\" src=\"https:\/\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2011\/07\/pdf_button.png\" alt=\"pdf_button\" width=\"110\" height=\"27\" \/><\/a><\/p>\n<hr \/>\n<p class=\"p1\"><span class=\"s1\"><em>Elizabeth Barfield Laminack, DVM; Kathern Myrna, DVM, MS; and Phillip Anthony Moore, DVM, Diplomate ACVO<\/em><\/span><\/p>\n<p class=\"p1\">The acute red eye is a common clinical challenge for general practitioners. Redness is the hallmark of ocular inflammation but a nonspecific sign related to a number of underlying diseases. Proper evaluation depends on effective and efficient diagnosis in order to save the eye&#8217;s vision and the eye itself.<\/p>\n<hr \/>\n<p class=\"p1\"><span class=\"s1\">The acute red eye is a common clinical challenge for general practitioners. Redness is the hallmark of ocular inflammation; it is a nonspecific sign related to a number of underlying diseases and degree of redness may not reflect the severity of the ocular problem.<\/span><\/p>\n<p class=\"p1\"><span class=\"s1\">Proper evaluation of the red eye depends on effective and efficient diagnosis of the underlying ocular disease in order to save the eye&#8217;s vision and the eye itself.<\/span><span class=\"s2\"><sup>1,2<\/sup><\/span><\/p>\n<h2 class=\"p3\"><span class=\"s1\"><b>SOURCE OF REDNESS<\/b><\/span><\/h2>\n<p class=\"p1\"><span class=\"s1\">The conjunctiva has small, fine, tortuous and movable vessels that help distinguish conjunctival inflammation from deeper inflammation (see <b>Ocular Redness<\/b> algorithm).<\/span><\/p>\n<ul class=\"ul1\">\n<li class=\"li1\"><b><\/b><span class=\"s1\"><b>Conjunctival hyperemia<\/b> presents with redness and congestion of the conjunctival blood vessels, making them appear more prominent, and is associated with extraocular disease, such as <em>conjunctivitis<\/em> (<b>Figure 1<\/b>). If severe intraocular inflammation is present, conjunctival hyperemia can also occur in conjunction with episcleral injection.<\/span><span class=\"s2\"><sup>1<\/sup><\/span><\/li>\n<li class=\"li1\"><b><\/b><span class=\"s1\"><b>Subconjunctival hemorrhage<\/b> appears as amorphous areas of deep red below the conjunctiva, obscuring the view of the individual vessels. Subconjunctival hemorrhage occurs in <em>over-restraint, traumatic injury, clotting disorders, and strangulation<\/em> (<b>Figure 2<\/b>).<\/span><span class=\"s2\"><sup>1<\/sup><\/span><\/li>\n<li class=\"li1\"><b><\/b><span class=\"s1\"><b>Episcleral injection<\/b> causes redness because of congestion of the deep episcleral vessels, and is characterized by straight and immobile episcleral vessels, which run 90\u00b0 to the limbus. Episcleral injection is an external sign of intraocular disease, such as anterior uveitis and glaucoma (<b>Figures 3 and 4<\/b>). Occasionally, episcleral injection may occur in diseases of the sclera, such as <em>episcleritis or scleritis<\/em>.<\/span><span class=\"s2\"><sup>1<\/sup><\/span><\/li>\n<\/ul>\n<p><a href=\"https:\/\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2013\/05\/050613-red-eye-fig-1.png\"><img fetchpriority=\"high\" decoding=\"async\" class=\"alignnone wp-image-9206 size-figure_img\" src=\"https:\/\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2013\/05\/050613-red-eye-fig-1-e1456502781108-397x300.png\" alt=\"050613 red eye fig 1\" width=\"397\" height=\"300\" \/><\/a><\/p>\n<div id=\"attachment_3179\" style=\"width: 310px\" class=\"wp-caption alignnone\"><a href=\"https:\/\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2013\/05\/Figure-2.jpg\"><img decoding=\"async\" aria-describedby=\"caption-attachment-3179\" class=\"wp-image-3179 size-medium\" src=\"https:\/\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2013\/05\/Figure-2-300x200.jpg\" alt=\"Figure 2\" width=\"300\" height=\"200\" srcset=\"https:\/\/navc.sitepreview.app\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2013\/05\/Figure-2-300x200.jpg 300w, https:\/\/navc.sitepreview.app\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2013\/05\/Figure-2.jpg 451w\" sizes=\"(max-width: 300px) 100vw, 300px\" \/><\/a><p id=\"caption-attachment-3179\" class=\"wp-caption-text\">Figure 2. Subconjunctival hemorrhage; note diffuse redness with no obvious congestion of bulbar vessels<\/p><\/div>\n<div id=\"attachment_3180\" style=\"width: 310px\" class=\"wp-caption alignnone\"><a href=\"https:\/\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2013\/05\/Figure-3.jpg\"><img loading=\"lazy\" decoding=\"async\" aria-describedby=\"caption-attachment-3180\" class=\"wp-image-3180 size-medium\" src=\"https:\/\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2013\/05\/Figure-3-300x199.jpg\" alt=\"Figure 3\" width=\"300\" height=\"199\" srcset=\"https:\/\/navc.sitepreview.app\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2013\/05\/Figure-3-300x199.jpg 300w, https:\/\/navc.sitepreview.app\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2013\/05\/Figure-3.jpg 452w\" sizes=\"(max-width: 300px) 100vw, 300px\" \/><\/a><p id=\"caption-attachment-3180\" class=\"wp-caption-text\">Figure 3. Episcleral injection associated with glaucoma secondary to an anterior luxated lens; note presence of episcleral vessels 90\u00b0 to the limbus.<\/p><\/div>\n<div id=\"attachment_3181\" style=\"width: 310px\" class=\"wp-caption alignnone\"><a href=\"https:\/\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2013\/05\/Figure-4.jpg\"><img loading=\"lazy\" decoding=\"async\" aria-describedby=\"caption-attachment-3181\" class=\"wp-image-3181 size-medium\" src=\"https:\/\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2013\/05\/Figure-4-300x200.jpg\" alt=\"Figure 4\" width=\"300\" height=\"200\" srcset=\"https:\/\/navc.sitepreview.app\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2013\/05\/Figure-4-300x200.jpg 300w, https:\/\/navc.sitepreview.app\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2013\/05\/Figure-4.jpg 449w\" sizes=\"(max-width: 300px) 100vw, 300px\" \/><\/a><p id=\"caption-attachment-3181\" class=\"wp-caption-text\">Figure 4. 360\u00b0 perilimbal deep corneal vascularization (arrow); note episcleral injection (straight, nonmoveable, perilimbal, episcleral vessels approximately 90\u00b0 to limbus).<\/p><\/div>\n<ul class=\"ul1\">\n<li class=\"li1\"><b><\/b><span class=\"s1\"><b>Corneal Neovascularization<\/b><\/span>\n<ul class=\"ul2\">\n<li class=\"li1\"><span class=\"s1\"><strong>Superficial<\/strong>: Long, branching corneal vessels; may be seen with <em>superficial ulcerative<\/em> (<b>Figure 5<\/b>) or <em>nonulcerative keratitis<\/em> (<b>Figure 6<\/b>)<\/span><\/li>\n<li class=\"li1\"><span class=\"s1\"><strong>Focal deep<\/strong>: Straight, nonbranching corneal vessels; indicates a <em>deep corneal keratitis<\/em> <\/span><\/li>\n<li class=\"li1\"><span class=\"s1\"><strong>360\u00b0 deep<\/strong>: Corneal vessels in a 360\u00b0 pattern around the limbus; should arouse concern that <em>glaucoma<\/em> or <em>uveitis<\/em> (<b>Figure 4<\/b>) is present<\/span><span class=\"s2\"><sup>1,2<\/sup><\/span><\/li>\n<\/ul>\n<\/li>\n<li class=\"li1\"><b><\/b><span class=\"s1\"><b>Hyphema or hemorrhage<\/b> within the eye appears as either a:<\/span>\n<ul class=\"ul2\">\n<li class=\"li1\"><span class=\"s1\">Settled line of dull to bright red in the anterior chamber <\/span><\/li>\n<li class=\"li1\"><span class=\"s1\">Diffuse redness filling the entire chamber (<b>Figure 7<\/b>)<\/span><\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<p class=\"p1\"><span class=\"s1\">Hyphema can result from <i>clotting disorders, severe blunt trauma, or uveitis<\/i>, and can be associated with <i>systemic hypertension<\/i>.<\/span><\/p>\n<div id=\"attachment_3182\" style=\"width: 310px\" class=\"wp-caption alignnone\"><a href=\"https:\/\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2013\/05\/Figure-5.jpg\"><img loading=\"lazy\" decoding=\"async\" aria-describedby=\"caption-attachment-3182\" class=\"wp-image-3182 size-medium\" src=\"https:\/\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2013\/05\/Figure-5-300x262.jpg\" alt=\"Figure 5\" width=\"300\" height=\"262\" srcset=\"https:\/\/navc.sitepreview.app\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2013\/05\/Figure-5-300x262.jpg 300w, https:\/\/navc.sitepreview.app\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2013\/05\/Figure-5.jpg 344w\" sizes=\"(max-width: 300px) 100vw, 300px\" \/><\/a><p id=\"caption-attachment-3182\" class=\"wp-caption-text\">Figure 5. Palpebral and bulbar conjunctival hyperemia and chemosis associated with superficial ulcer secondary to an ectopic cilium (arrow). Superficial corneal neovascularization is present in the dorsal cornea; note long and branching corneal blood vessels.<\/p><\/div>\n<div id=\"attachment_3183\" style=\"width: 310px\" class=\"wp-caption alignnone\"><a href=\"https:\/\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2013\/05\/Figure-6.jpg\"><img loading=\"lazy\" decoding=\"async\" aria-describedby=\"caption-attachment-3183\" class=\"wp-image-3183 size-medium\" src=\"https:\/\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2013\/05\/Figure-6-300x207.jpg\" alt=\"Figure 6\" width=\"300\" height=\"207\" srcset=\"https:\/\/navc.sitepreview.app\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2013\/05\/Figure-6-300x207.jpg 300w, https:\/\/navc.sitepreview.app\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2013\/05\/Figure-6.jpg 434w\" sizes=\"(max-width: 300px) 100vw, 300px\" \/><\/a><p id=\"caption-attachment-3183\" class=\"wp-caption-text\">Figure 6. Superficial corneal neovascularization and melanosis, in association with adherent and tenacious mucopurulent discharge secondary to KCS; note long, branching corneal blood vessels, which confirms their superficial location.<\/p><\/div>\n<div id=\"attachment_3190\" style=\"width: 215px\" class=\"wp-caption alignnone\"><a href=\"https:\/\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2013\/05\/NEW-Figure-6.jpg\"><img loading=\"lazy\" decoding=\"async\" aria-describedby=\"caption-attachment-3190\" class=\"wp-image-3190 size-medium\" src=\"https:\/\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2013\/05\/NEW-Figure-6-205x300.jpg\" alt=\"NEW Figure 6\" width=\"205\" height=\"300\" \/><\/a><p id=\"caption-attachment-3190\" class=\"wp-caption-text\">Figure 7. Hyphema secondary to anterior uveitis; note diffuse bright red color and clot obscuring the pupil.<\/p><\/div>\n<h2><b>DISEASES &amp; DIAGNOSTICS<\/b><\/h2>\n<p><span class=\"s1\">All red eyes must be evaluated for 3 key ocular diseases that may cause vision loss in an eye (<strong>Table 1<\/strong>):<\/span><\/p>\n<ol>\n<li><span class=\"s1\"><b>Corneal ulceration<\/b><\/span><\/li>\n<li><b style=\"line-height: 1.5\">Glaucoma<\/b><\/li>\n<li class=\"p1\"><span class=\"s1\"><b>Uveitis<\/b><\/span><\/li>\n<\/ol>\n<p><a href=\"https:\/\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2013\/05\/Screen-Shot-2015-06-04-at-3.11.10-PM.png\"><img loading=\"lazy\" decoding=\"async\" class=\"alignnone wp-image-4303 size-figure_img\" src=\"https:\/\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2013\/05\/Screen-Shot-2015-06-04-at-3.11.10-PM-419x300.png\" alt=\"Screen Shot 2015-06-04 at 3.11.10 PM\" width=\"419\" height=\"300\" \/><\/a><\/p>\n<p class=\"p1\"><span class=\"s1\">A few basic diagnostic procedures can quickly assess whether these diseases are present; they should be performed in the following order for all patients with ocular signs:<\/span><\/p>\n<ol class=\"ol1\">\n<li class=\"li1\"><b><\/b><span class=\"s1\"><b>Schirmer tear test (STT):<\/b> Aids in diagnosis of conditions associated with decreased tear production, such as keratoconjunctivitis sicca (KCS), and should be performed before any medications are administered to the ocular surface<\/span><\/li>\n<li class=\"li1\"><b><\/b><span class=\"s1\"><b>Fluorescein stain:<\/b> Is critical for diagnosis of corneal ulceration<\/span><span class=\"s2\"><sup>1,2<\/sup><\/span><\/li>\n<li class=\"li1\"><b><\/b><span class=\"s1\"><b>Tonometry:<\/b> Is critical for diagnosis of glaucoma and uveitis<\/span><span class=\"s2\"><sup>1,2<\/sup><\/span><\/li>\n<\/ol>\n<p><span class=\"s1\">Once an examination and these diagnostics are completed, the eye&#8217;s condition can be classified as:<\/span><\/p>\n<ul class=\"ul2\">\n<li class=\"li1\"><span class=\"s1\">Extraocular (conjunctival or corneal)<\/span><\/li>\n<li class=\"li1\"><span class=\"s1\">Intraocular (glaucoma or uveitis)<\/span><\/li>\n<li class=\"li1\"><span class=\"s1\">Ocular manifestation of systemic disease.<\/span><\/li>\n<\/ul>\n<h2 class=\"p3\"><span class=\"s1\"><b>CORNEAL ULCERS<\/b><\/span><\/h2>\n<h3 class=\"p4\"><span class=\"s1\"><b>Causes of Red Eye<\/b><\/span><\/h3>\n<p class=\"p1\"><span class=\"s1\">Corneal ulcers result in corneal vascularization, which appears as a &#8220;red eye.&#8221; <\/span><\/p>\n<p class=\"p1\"><span class=\"s1\">Corneal blood vessels are an indication of chronic disease and, generally, take 1 to 3 days to proliferate on the corneal surface. Uncomplicated corneal ulcers typically heal in 3 to 5 days; ulcers that do not heal in this time period must be closely evaluated for confounding factors. Underlying disease that can impede healing include:<\/span><\/p>\n<ul class=\"ul1\">\n<li class=\"li1\"><span class=\"s1\">KCS (low STT values, rapid tear breakup time)<\/span><\/li>\n<li class=\"li1\"><span class=\"s1\">Adenexal disease (entropion, distichia, ectopic cilia)<\/span><\/li>\n<li class=\"li1\"><span class=\"s1\">Chronic corneal exposure (lagophthalmos, exophthalmos).<\/span><\/li>\n<\/ul>\n<p class=\"p1\"><span class=\"s1\">They are often associated with other signs of corneal melanosis (or &#8220;pigmentation&#8221;). Corneal vascularization can occur with nonulcerative corneal disease, but this article strictly focuses on ulcerative disease.<\/span><\/p>\n<p class=\"p1\"><span class=\"s3\"><b><i>Clinical Note:<\/i><\/b><\/span><span class=\"s1\"><i> <\/i><b><i>Blepharospasm<\/i><\/b><i> is seen with most forms of corneal disease but is a common and nonspecific sign of pain associated with many ocular diseases.<\/i><\/span><\/p>\n<h3 class=\"p4\"><span class=\"s1\"><b>Diagnosis &amp; Classification<\/b><\/span><\/h3>\n<p class=\"p1\"><span class=\"s1\">Once an ulcer has been identified with positive fluorescein staining, further classification allows proper therapeutic interventions and prevents catastrophic complications related to lack of treatment.<\/span><\/p>\n<p class=\"p1\"><span class=\"s1\">Corneal ulcers are classified as superficial or deep:<\/span><span class=\"s2\"><sup>1<\/sup><\/span><\/p>\n<ul class=\"ul1\">\n<li class=\"li1\"><b><\/b><span class=\"s1\"><b>Superficial corneal ulcer:<\/b> Has even and superficial fluorescein stain uptake, with no visible loss of stroma,3 and presence of long, branching vessels over the cornea (<b>Figure 5<\/b>). <\/span><\/li>\n<li class=\"li1\"><b><\/b><span class=\"s1\"><b>Deep corneal ulcer:<\/b> Has an irregular surface, with loss of corneal stroma, and presence of focal, fine, nonbranching vessels (<b>Figure 8<\/b>).<\/span><\/li>\n<\/ul>\n<p class=\"p1\"><span class=\"s1\"><b>Superficial non-healing ulcers:<\/b><\/span><\/p>\n<ul class=\"ul1\">\n<li class=\"li1\"><span class=\"s1\">Indicated by superficial staining with diffuse borders due to stain under running a nonadherent epithelial lip that develops <em>secondary to abnormal wound healing<\/em>.<\/span><\/li>\n<li class=\"li1\"><span class=\"s1\">Can be associated with KCS (<b>Figure 6<\/b>), adnexal disease, chronic corneal exposure, or foreign bodies (<b>Figure 9<\/b>).<\/span><span class=\"s2\"><sup>3<\/sup><\/span><\/li>\n<li class=\"li1\"><span class=\"s1\">Others, however, are believed to occur without concurrent disease and are, therefore, associated with primary corneal disease and referred to as spontaneous chronic corneal epithelial defects (SCCEDs).<\/span><span class=\"s2\"><sup>3<\/sup><\/span><\/li>\n<\/ul>\n<p class=\"p1\"><span class=\"s1\"><b>Corneal malacia (melting ulcer):<\/b><\/span><\/p>\n<ul class=\"ul1\">\n<li class=\"li1\"><span class=\"s1\">Presents with visible defects in the corneal surface; corneal malacia<\/span><span class=\"s2\"><sup>4<\/sup><\/span><span class=\"s1\"> appears as soft, gelatinous cornea around the edges of the ulcer and in the ulcer bed (<b>Figure 8<\/b>) or stromal loss, both of which are due to activation of matrix metalloproteinases. <\/span><\/li>\n<li class=\"li1\"><span class=\"s1\">Infiltration of the corneal stroma with white blood cells (WBCs; visible as creamy or yellow corneal opacity) often occurs in conjunction with corneal melting or stromal loss; this infiltration is considered highly suggestive of bacterial or fungal infection.<\/span><\/li>\n<\/ul>\n<div id=\"attachment_3186\" style=\"width: 310px\" class=\"wp-caption alignnone\"><a href=\"https:\/\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2013\/05\/Figure-9.jpg\"><img loading=\"lazy\" decoding=\"async\" aria-describedby=\"caption-attachment-3186\" class=\"wp-image-3186 size-medium\" src=\"https:\/\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2013\/05\/Figure-9-300x288.jpg\" alt=\"Figure 9\" width=\"300\" height=\"288\" srcset=\"https:\/\/navc.sitepreview.app\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2013\/05\/Figure-9-300x288.jpg 300w, https:\/\/navc.sitepreview.app\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2013\/05\/Figure-9.jpg 313w\" sizes=\"(max-width: 300px) 100vw, 300px\" \/><\/a><p id=\"caption-attachment-3186\" class=\"wp-caption-text\">Figure 8. Deep stromal ulcer with a central descemetocele secondary to corneal malacia and stromal loss; 360\u00b0 superficial corneal neovascularization is also present.<\/p><\/div>\n<div id=\"attachment_9208\" style=\"width: 610px\" class=\"wp-caption alignnone\"><a href=\"https:\/\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2013\/05\/050613-red-eye-fig-9a.png\"><img loading=\"lazy\" decoding=\"async\" aria-describedby=\"caption-attachment-9208\" class=\"wp-image-9208\" src=\"https:\/\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2013\/05\/050613-red-eye-fig-9a-e1456504246801.png\" alt=\"050613 red eye fig 9a\" width=\"600\" height=\"184\" \/><\/a><p id=\"caption-attachment-9208\" class=\"wp-caption-text\">Figure 9. Foreign body posterior to the third eyelid (A); note hyperemia and chemosis of palpebral, bulbar, and third eyelid conjunctiva. Presence of superficial corneal ulcer following removal of foreign body and fluorescein staining (B).<\/p><\/div>\n<p class=\"p1\"><strong><span style=\"line-height: 1.5\">Deep corneal ulcer (descemetocele):<\/span><\/strong><\/p>\n<ul>\n<li class=\"p1\"><span style=\"line-height: 1.5\">Indicated by complete stromal loss and exposure of descemet&#8217;s membrane<\/span><\/li>\n<li class=\"li1\"><span class=\"s1\">Corneal stain uptake will occur in the walls but not the floor of the ulcer, producing a characteristic donut-shaped region of fluorescein stain retention. <\/span><\/li>\n<li class=\"li1\"><span class=\"s1\">Severe condition in which the eye is in grave danger of perforation<\/span><span class=\"s2\"><sup>4<\/sup><\/span><span class=\"s1\">; urgent referral to a specialist should be recommended to the client.<\/span><\/li>\n<\/ul>\n<p class=\"p1\"><span class=\"s3\"><b><i>Clinical Note:<\/i><\/b><\/span><span class=\"s1\"><b><i> Ulcers with greater than 50% stromal loss and malacia<\/i><\/b><i> require more aggressive medical management; sometimes surgical correction is necessary.<\/i><\/span><\/p>\n<h3 class=\"p4\"><span class=\"s1\"><b>Treatment<\/b><\/span><\/h3>\n<p class=\"p1\"><span class=\"s1\">Topical therapy for superficial ulceration is geared toward preventing infection and alleviating pain. Unless the ulcer is infected, topical drugs do not promote healing; therefore, patients should be evaluated for underlying ocular disease (eg, KCS) and treated accordingly and concurrently. Routine corneal cytology is indicated to rule out low-grade infection.<\/span><\/p>\n<p class=\"p1\"><span class=\"s3\"><b><i>Clinical Note:<\/i><\/b><\/span><span class=\"s1\"><b><i> Superficial and uncomplicated ulcers<\/i><\/b><i> should heal in 3 to 5 days.<\/i><\/span><\/p>\n<p class=\"p1\"><span class=\"s1\">Management of <b>superficial uncomplicated corneal ulcers<\/b> consists of:<\/span><span class=\"s2\"><sup>4<\/sup><\/span><\/p>\n<ul class=\"ul1\">\n<li class=\"li1\"><i><\/i><span class=\"s1\"><i>Topical atropine<\/i> once or twice daily until dilation is achieved to control ciliary muscle spasm and ocular discomfort. Atropine reduces tear production and should be decreased in frequency or discontinued after clinical effect. Most uncomplicated ulcers only require 2 to 3 days of treatment.<\/span><\/li>\n<li class=\"li1\"><i><\/i><span class=\"s1\"><i>Topical broad-spectrum bactericidal antibiotic<\/i>, such as neomycin and bacitracin in combination with polymyxin B (ointment) or gramicidin (solution), three times daily.<\/span><\/li>\n<li class=\"li1\"><i><\/i><span class=\"s1\"><i>Oral nonsteroidal anti-inflammatory drug<\/i> (NSAID) for additional comfort. <\/span><\/li>\n<li class=\"li1\"><span class=\"s1\">Simple ulcers should be rechecked within 5 days; therapy should be continued until resolution of the ulcer.<\/span><\/li>\n<\/ul>\n<p class=\"p1\"><span class=\"s1\">Management of <b>superficial non-healing ulcers<\/b> consists of:<\/span><span class=\"s2\"><sup>3<\/sup><\/span><\/p>\n<ul class=\"ul1\">\n<li class=\"li1\"><i><\/i><span class=\"s1\"><i>Treatment of concurrent disease <\/i><\/span><\/li>\n<li class=\"li1\"><i><\/i><span class=\"s1\"><i>Medical management <\/i><\/span>\n<ul class=\"ul2\">\n<li class=\"li1\"><span class=\"s1\">As outlined for uncomplicated ulcers <\/span><\/li>\n<li class=\"li1\"><span class=\"s1\">Do <strong>not<\/strong> use atropine in patients with KCS<\/span><\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<p class=\"p1\"><span class=\"s1\">Management of SCCEDs associated with primary corneal disease:<\/span><\/p>\n<ul class=\"ul1\">\n<li class=\"li1\"><span class=\"s1\"><em>Medical management<\/em> as outlined for uncomplicated ulcers <\/span><\/li>\n<li class=\"li1\"><span class=\"s1\"><em>Debridement of ulcer<\/em> with a cotton tip applicator <\/span><\/li>\n<li class=\"li1\"><span class=\"s1\"><em>Contact lenses<\/em> to provide comfort during the healing process, if needed <\/span><\/li>\n<li class=\"li1\"><span class=\"s1\"><em>Grid keratotomy or diamond burr debridement<\/em> if ulcer fails to heal (see <strong>Diamond Burr Debridement<\/strong>)<\/span><\/li>\n<\/ul>\n<p class=\"p1\"><span class=\"s1\">Treatment of <strong>deep and melting ulcers<\/strong> consists of:<\/span><\/p>\n<ul class=\"ul1\">\n<li class=\"li1\"><i><\/i><span class=\"s1\"><i>Topical atropine<\/i> 2 to 3 times daily until dilation; do not use atropine in patients with KCS <\/span><\/li>\n<li class=\"li1\"><i><\/i><span class=\"s1\"><i>Topical broad-spectrum antibiotic<\/i> Q 1 to 4 H; fluoroquinolones, such as ofloxacin, have good broad-spectrum efficacy <\/span>\n<ul class=\"ul2\">\n<li class=\"li1\"><span class=\"s1\">Corneal ulcers should be carefully evaluated with cytology to guide initial antibiotic therapy<\/span><\/li>\n<li class=\"li1\"><span class=\"s1\">Culture and sensitivity are indicated to confirm antibiotic choice<\/span><\/li>\n<\/ul>\n<\/li>\n<li class=\"li1\"><i><\/i><span class=\"s1\"><i>Compounded 50 mg\/mL cefazolin<\/i> is indicated if gram-positive organisms are present; only used in conjunction with other antibiotics<\/span>\n<ul class=\"ul2\">\n<li class=\"li1\"><span class=\"s1\">Cefazolin eye drops can be compounded by reconstituting a 1-g vial of injectable cefazolin with 2.5 mL of sterile water; shake the mixture until dissolved and add it to a 15-mL bottle of artificial tears.<\/span><\/li>\n<li class=\"li1\"><span class=\"s1\">Keep refrigerated and discard after 10 days<\/span><span class=\"s2\"><sup>5<\/sup><\/span><\/li>\n<\/ul>\n<\/li>\n<li class=\"li1\"><i><\/i><span class=\"s1\"><i>Topical protease inhibitors<\/i>, such as autologous serum, N-acetyl-cysteine, or EDTA, are applied Q 2 H until corneal malacia and stromal loss are controlled. Serum can be obtained in private practice via venipuncture and centrifugation, with sterile preparation and storage. Oral doxycycline (10 mg\/kg Q 24 H) also acts as a proteolytic inhibitor<\/span><span class=\"s2\"><sup>9-12<\/sup><\/span><\/li>\n<li class=\"li1\"><i><\/i><span class=\"s1\"><i>Oral NSAID<\/i> for additional comfort.<\/span><\/li>\n<\/ul>\n<p class=\"p1\"><span class=\"s1\">Patients should be re-evaluated within 24 hours for signs of improvement. <\/span><\/p>\n<p class=\"p1\"><span class=\"s1\">Signs of improvement include:<\/span><span class=\"s2\"><sup>4<\/sup><\/span><\/p>\n<ul class=\"ul1\">\n<li class=\"li1\"><span class=\"s1\">Increased pupil dilation<\/span><\/li>\n<li class=\"li1\"><span class=\"s1\">Smoothing of the epithelial margin<\/span><\/li>\n<li class=\"li1\"><span class=\"s1\">Reduction of:<\/span>\n<ul class=\"ul2\">\n<li class=\"li1\"><span class=\"s1\">Corneal and episcleral\/conjunctival blood vessel perfusion <\/span><\/li>\n<li class=\"li1\"><span class=\"s1\">Corneal edema <\/span><\/li>\n<li class=\"li1\"><span class=\"s1\">Mucopurulent discharge <\/span><\/li>\n<li class=\"li1\"><span class=\"s1\">Signs of pain (blepharospasm and epiphora)<\/span><\/li>\n<li class=\"li1\"><span class=\"s1\">Stromal loss, malacia, and WBC infiltration.<\/span><\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<div class=\"orange-box\">\n<p class=\"p1\"><span class=\"s4\"><b>DIAMOND BURR DEBRIDEMENT<\/b><\/span><span class=\"s1\"> (DBD) is a relatively new treatment modality that:<\/span><\/p>\n<ul class=\"ul1\">\n<li class=\"li1\"><span class=\"s1\">Provides safe and effective therapy for SCEDDs (no need for grid keratotomy)<\/span><span class=\"s2\"><sup>6,7<\/sup><\/span><\/li>\n<li class=\"li1\"><span class=\"s1\">Has a low risk of injury to the deeper corneal layers8 <\/span><\/li>\n<li class=\"li1\"><span class=\"s1\">Does not require extensive specialized training<\/span><\/li>\n<li class=\"li1\"><span class=\"s1\">Is an affordable treatment solution. <\/span><\/li>\n<\/ul>\n<p class=\"p1\"><span class=\"s1\">However, only use grid keratotomy and DBD for superficial ulcerations <i>without stromal loss<\/i> and make sure <i>no infectious<\/i> <i>process<\/i> is present prior to performing either procedure.<\/span><\/p>\n<\/div>\n<p class=\"p4\"><span class=\"s1\"><span class=\"s1\"><b>Referral &amp; Advanced Therapy<\/b><\/span><\/span><\/p>\n<p class=\"p4\"><span class=\"s1\"><span class=\"s1\">It is prudent to refer all patients with deep stromal ulcers, descemetoceles, and ruptured eyes to an ophthalmologist for surgical evaluation in order to save the globe and vision. Surgical interventions include conjunctival flap, corneal graft, or corneal-conjunctival transposition.<\/span><span class=\"s2\"><sup>4,5<\/sup><\/span><\/span><\/p>\n<p class=\"p4\"><span class=\"s1\">Recently, bioscaffold materials (ACell, acell.com) have shown promise for corneal ulcer treatment. These materials help promote healing of deep corneal ulcers and, when combined with a conjunctival flap, can be used for surgical repair of descemetoceles or penetrating corneal injuries.<\/span><span class=\"s2\"><sup>13<\/sup><\/span><\/p>\n<p class=\"p1\"><span class=\"s1\">Another recent study has shown that the use of amniotic membranes can decrease scarring, promote healing of corneal injuries, and provide anti-inflammatory properties.<\/span><span class=\"s2\"><sup>14<\/sup><\/span><\/p>\n<h2 class=\"p3\"><span class=\"s1\"><b>GLAUCOMA<\/b><\/span><\/h2>\n<h3 class=\"p4\"><span class=\"s1\"><b>Causes of Red Eye<\/b><\/span><\/h3>\n<p class=\"p1\"><span class=\"s1\">In a patient presenting with glaucoma, redness of the eye is due to episcleral injection, with deep corneal vessels that form a 360\u00b0 perilimbal pattern if the condition is chronic. <\/span><\/p>\n<p class=\"p1\"><span class=\"s3\"><b><i>Clinical Note:<\/i><\/b><\/span><span class=\"s1\"><b><i> Pain, corneal edema, and disturbance of vision<\/i><\/b><i> may be present with glaucoma.<\/i><\/span><\/p>\n<h3 class=\"p4\"><span class=\"s1\"><b>Diagnosis<\/b><\/span><\/h3>\n<p class=\"p1\"><span class=\"s1\">The only diagnostic sign of glaucoma is increased intraocular pressure (IOP). <\/span><\/p>\n<ul class=\"ul1\">\n<li class=\"li1\"><span class=\"s1\">IOP is measured by applanation (Tono-Pen, reichert.com; I-pen Vet, imedpharma.com) or rebound (TonoVet, icaretonometer.com) tonometry.<\/span><\/li>\n<li class=\"li1\"><span class=\"s1\">Normal IOP in the dog varies between 10 to 20 mm Hg<\/span>\n<ul class=\"ul2\">\n<li class=\"li1\"><b><\/b><span class=\"s1\"><b>Applanation tonometry:<\/b> Mean IOP \u00b1 standard deviation (SD) in the dog is reported as 17 \u00b1 4 mm Hg<\/span><span class=\"s2\"><sup>15<\/sup><\/span><\/li>\n<li class=\"li1\"><b><\/b><span class=\"s1\"><b>Rebound tonometry:<\/b> Mean IOP \u00b1 SD in the dog is reported as 10.8 \u00b1 3.1 mm Hg (range, 5\u201317 mm Hg)<\/span><span class=\"s2\"><sup>16<\/sup><\/span><\/li>\n<\/ul>\n<\/li>\n<li class=\"li1\"><span class=\"s1\">A recent study has shown that inexperienced personnel can obtain comparable intraocular values in dogs using either applanation or rebound tonometry.<\/span><span class=\"s2\"><sup>17<\/sup><\/span><\/li>\n<\/ul>\n<p class=\"p1\"><span class=\"s3\"><b><i>Clinical Note:<\/i><\/b><\/span><span class=\"s1\"><b><i> Minor variations in IOP<\/i><\/b><i> are noted secondary to diurnal variations, corneal scarring and pigmentation, and stress related to the white coat effect.<\/i><\/span><span class=\"s2\"><i><sup>18-20<\/sup><\/i><\/span><i> <\/i><\/p>\n<h3 class=\"p4\"><span class=\"s1\"><b>Classification<\/b><\/span><\/h3>\n<p class=\"p1\"><span class=\"s1\"><b>Primary glaucoma<\/b> (<b>Figure 10<\/b>) in dogs is almost always unilateral and often associated with a narrow or closed filtration angle.<\/span><\/p>\n<ul class=\"ul1\">\n<li class=\"li1\"><span class=\"s1\">Once glaucoma becomes severe, episcleral injection is the predominate cause of redness.<\/span><\/li>\n<li class=\"li1\"><span class=\"s1\">Increased IOP typically results in slow pupillary light responses and mydriasis in the affected eye.<\/span><\/li>\n<li class=\"li1\"><span class=\"s1\">Buphthalmia (enlargement of the globe) occurs in patients with chronic glaucoma, but not in those with acute glaucoma or ocular hypertension. <\/span><\/li>\n<\/ul>\n<p class=\"p1\"><span class=\"s1\"><strong>Secondary glaucoma<\/strong> is often seen with uveitis (<b>Figure 11<\/b>) or anterior lens luxation (<b>Figure 3<\/b>).<\/span><\/p>\n<p class=\"p1\"><span class=\"s1\">Referral for gonioscopic examination or advanced imaging is required to classify type of glaucoma based on the iridocorneal angle morphology. While only the most superficial parts of the iridocorneal angle can be visualized with a goniolens, the entire ciliary cleft can be visualized with advanced imaging techniques, such as high-resolution ultrasonography or ultrasound biomicroscopy.<\/span><span class=\"s2\"><sup>21,22<\/sup><\/span><\/p>\n<div id=\"attachment_3187\" style=\"width: 310px\" class=\"wp-caption alignnone\"><a href=\"https:\/\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2013\/05\/Figure-10-acute-glaucoma.jpg\"><img loading=\"lazy\" decoding=\"async\" aria-describedby=\"caption-attachment-3187\" class=\"wp-image-3187 size-medium\" src=\"https:\/\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2013\/05\/Figure-10-acute-glaucoma-300x200.jpg\" alt=\"Figure 10 acute glaucoma\" width=\"300\" height=\"200\" srcset=\"https:\/\/navc.sitepreview.app\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2013\/05\/Figure-10-acute-glaucoma-300x200.jpg 300w, https:\/\/navc.sitepreview.app\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2013\/05\/Figure-10-acute-glaucoma.jpg 451w\" sizes=\"(max-width: 300px) 100vw, 300px\" \/><\/a><p id=\"caption-attachment-3187\" class=\"wp-caption-text\">Figure 10. Episcleral injection and conjunctival hyperemia, chemosis, mydriasis, and diffuse corneal edema associated with primary glaucoma.<\/p><\/div>\n<div id=\"attachment_3188\" style=\"width: 310px\" class=\"wp-caption alignnone\"><a href=\"https:\/\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2013\/05\/Figure-11-secglauc.jpg\"><img loading=\"lazy\" decoding=\"async\" aria-describedby=\"caption-attachment-3188\" class=\"wp-image-3188 size-medium\" src=\"https:\/\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2013\/05\/Figure-11-secglauc-300x199.jpg\" alt=\"Figure 11 secglauc\" width=\"300\" height=\"199\" srcset=\"https:\/\/navc.sitepreview.app\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2013\/05\/Figure-11-secglauc-300x199.jpg 300w, https:\/\/navc.sitepreview.app\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2013\/05\/Figure-11-secglauc.jpg 452w\" sizes=\"(max-width: 300px) 100vw, 300px\" \/><\/a><p id=\"caption-attachment-3188\" class=\"wp-caption-text\">Figure 11. Anterior uveitis with diffuse corneal edema and secondary glaucoma; note 360\u00b0 deep perilimbal deep neovascularization, diffuse edema, and slight mydriasis<\/p><\/div>\n<div id=\"attachment_3189\" style=\"width: 310px\" class=\"wp-caption alignnone\"><a href=\"https:\/\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2013\/05\/Figure-12.jpg\"><img loading=\"lazy\" decoding=\"async\" aria-describedby=\"caption-attachment-3189\" class=\"wp-image-3189 size-medium\" src=\"https:\/\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2013\/05\/Figure-12-300x207.jpg\" alt=\"Figure 12\" width=\"300\" height=\"207\" srcset=\"https:\/\/navc.sitepreview.app\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2013\/05\/Figure-12-300x207.jpg 300w, https:\/\/navc.sitepreview.app\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2013\/05\/Figure-12.jpg 435w\" sizes=\"(max-width: 300px) 100vw, 300px\" \/><\/a><p id=\"caption-attachment-3189\" class=\"wp-caption-text\">Figure 12. Iris neovascularization (rubeosis iridis), episcleral injection, and miosis secondary to anterior uveitis.<\/p><\/div>\n<h3 class=\"p4\"><span class=\"s1\"><b>Treatment<\/b><\/span><\/h3>\n<p class=\"p4\"><span class=\"s1\"><strong>Initial medical therapy for acute primary glaucoma<\/strong> is aimed at rapidly reducing IOP.<\/span><\/p>\n<ul>\n<li class=\"p4\"><span class=\"s1\"><i>Ophthalmic solutions containing prostaglandin<\/i> analogues, such as latanoprost 0.005% or travoprost 0.004% (if available), should be used to rapidly decrease IOP; latanoprost 0.005% is administered Q 1 to 2 H until IOP decreases.<\/span><span class=\"s2\"><sup>23<\/sup><\/span><\/li>\n<li class=\"li1\"><i><\/i><span class=\"s1\"><i>Intravenous mannitol<\/i> (1\u20132 g\/kg, slowly administered over 15\u201320 min) is used as an alternative to topical prostaglandin analogues or in patients that do not respond to topical therapy within 2 hours. <\/span>\n<ul class=\"ul2\">\n<li class=\"li1\"><span class=\"s1\">Withhold water for 4 hours after administering mannitol.<\/span><span class=\"s2\"><sup>24<\/sup><\/span><\/li>\n<li class=\"li1\"><span class=\"s1\">Adverse effects may occur in dehydrated or systemically ill animals, especially those with cardiac or renal disease; therefore, patient monitoring is critical when administering any osmotic diuretic, such as mannitol. <\/span><\/li>\n<\/ul>\n<\/li>\n<li class=\"li1\"><i><\/i><span class=\"s1\"><i>Oral carbonic anhydrase inhibitors<\/i> (CAIs), such as methazolamide (2\u20135 mg\/kg Q 8\u201312 H), decrease aqueous humor formation in the ciliary body. <\/span><\/li>\n<\/ul>\n<p class=\"p1\"><span class=\"s1\"><b>If secondary glaucoma associated with uveitis, hyphema, or lens luxation is suspected<\/b>, latanoprost should <strong>not<\/strong> be used due to its miotic effects, especially if the lens is in the anterior chamber.<\/span><span class=\"s2\"><sup>17<\/sup><\/span><\/p>\n<p class=\"p1\"><span class=\"s1\"><strong>Combinations of medications to maintain lower IOP<\/strong> within the normal or acceptable range for dogs are often needed.<\/span><\/p>\n<ul class=\"ul1\">\n<li class=\"li1\"><i><\/i><span class=\"s1\"><i>Topical CAIs<\/i>, such as dorzolamide or brinzolamide, are recommended Q 8 H.<\/span><span class=\"s2\"><sup>26<\/sup><\/span><\/li>\n<li class=\"li1\"><i><\/i><span class=\"s1\"><i>Topical beta-blockers<\/i>, such as timolol maleate 0.5% or betaxolol 0.5% (Q 8\u201312 H) are insufficient to control IOP when used alone but have a mild additive effect in lowering IOP when used in conjunction with a topical CAI.<\/span><span class=\"s2\"><sup>27<\/sup><\/span><\/li>\n<li class=\"li1\"><span class=\"s1\">If needed, a <i>prostaglandin analogue<\/i> may be used Q 12 H to help normalize IOP.<\/span><span class=\"s2\"><sup>28<\/sup><\/span><\/li>\n<\/ul>\n<p class=\"p1\"><span class=\"s1\"><i>Oral CAIs<\/i>, such as methazolamide (2\u20135 mg\/kg Q 8\u201312 H) have been recommended to help maintain IOP.<\/span><span class=\"s2\"><sup>29<\/sup><\/span><span class=\"s1\"> However, a recent study demonstrated that, in dogs with glaucoma, addition of an oral CAI did not improve reduction of IOP over the decrease achieved with a topical CAI (dorzolamide) alone.30 In addition, when compared to a topical CAI alone, combination therapy with a topical and oral CAI was no more likely to provide long-term control in dogs with primary or secondary glaucoma.<\/span><span class=\"s2\"><sup>30-32<\/sup><\/span><\/p>\n<p class=\"p1\"><span class=\"s3\"><b><i>Clinical Note:<\/i><\/b><\/span><span class=\"s1\"><b><i> Referral should be considered<\/i><\/b><i> early in the disease process, especially if IOP fails to respond to medical management.<\/i><\/span><\/p>\n<p class=\"p1\"><span class=\"s1\"><b>Glaucoma is ultimately a surgical disease<\/b>. Medical therapy will typically become ineffective within a year. Surgical intervention may prolong vision but has a relatively poor long-term success rate.<\/span><\/p>\n<ul class=\"ul1\">\n<li class=\"li1\"><i><\/i><span class=\"s1\"><i>Laser ablation of the ciliary body (cyclophotocoagulation) or anterior chamber shunts<\/i>, such as gonioimplants, used alone or together, offer longer periods of IOP control than medical management alone.<\/span><span class=\"s2\"><sup>33<\/sup><\/span><\/li>\n<li class=\"li1\"><i><\/i><span class=\"s1\"><i>Endoscopic laser cyclophotocoagulation<\/i> provides a longer period of control when combined with a gonioimplant, medical therapy, and frequent examinations.<\/span><span class=\"s2\"><sup>34-36<\/sup><\/span><\/li>\n<li class=\"li1\"><i><\/i><span class=\"s1\"><i>Enucleation or evisceration<\/i> is a humane option in most cases of blindness since the goal of therapy\u2014if the eye is blind\u2014should be pain relief.<\/span><\/li>\n<\/ul>\n<h3 class=\"p4\"><span class=\"s1\"><b>Prevention<\/b><\/span><\/h3>\n<p class=\"p1\"><span class=\"s1\">Generally, primary glaucoma begins as a unilateral disease but, eventually, the other eye develops it as well. Treating the &#8220;second&#8221; eye with a prophylactic medication even if IOP is within the normal range is critical in order to delay onset of disease. <\/span><\/p>\n<ul class=\"ul1\">\n<li class=\"li1\"><span class=\"s1\">Topical dorzolamide; beta blockers, such as timolol or betaxolol; and demecarium bromide are common prophylactics.<\/span><span class=\"s2\"><sup>31,37<\/sup><\/span><\/li>\n<li class=\"li1\"><span class=\"s1\">When a topical CAI is applied prophylactically, glaucoma develops, on average, in 196 days.<\/span><span class=\"s2\"><sup>31<\/sup><\/span><span class=\"s1\"> Published time to onset of glaucoma for demecarium bromide and betaxolol when used prophylactically is 31 months and 30.7 months, respectively.<\/span><span class=\"s2\"><sup>37<\/sup><\/span><\/li>\n<\/ul>\n<h2 class=\"p3\"><span class=\"s1\"><b>ANTERIOR UVEITIS<\/b><\/span><\/h2>\n<h3 class=\"p4\"><span class=\"s1\"><b>Causes of Red Eye<\/b><\/span><\/h3>\n<p class=\"p1\"><span class=\"s1\">When anterior uveitis is present, redness of the eye is due to episcleral injection, with 360\u00b0 deep corneal vascularization if the disease is chronic (<b>Figure 4 and 11<\/b>). Other causes of redness related to anterior uveitis include hyphema (blood in the anterior chamber [<b>Figure 7<\/b>]) and rubeosis iridis (iris neovascularization; <b>Figure 12<\/b>).<\/span><\/p>\n<p class=\"p1\"><span class=\"s3\"><b><i>Clinical Note:<\/i><\/b><\/span><span class=\"s1\"><i> Subtle and early uveitis may cause only mild ocular redness; be careful not to misdiagnose it as conjunctivitis.<\/i><\/span><\/p>\n<h3 class=\"p4\"><span class=\"s1\"><b>Diagnosis<\/b><\/span><\/h3>\n<p class=\"p1\"><span class=\"s1\">Other <b>intraocular clinical signs<\/b> of anterior uveitis include:<\/span><\/p>\n<ul class=\"ul1\">\n<li class=\"li1\"><span class=\"s1\">Aqueous flare (cloudiness of the aqueous humor) <\/span>\n<ul class=\"ul2\">\n<li class=\"li1\"><span class=\"s1\">Identified with a small focal light or slit beam<\/span><\/li>\n<li class=\"li1\"><span class=\"s1\">The fluid in the anterior chamber should be crystal clear; when flare is present, the light is visualized as it passes through the aqueous (Tyndall effect)<\/span><\/li>\n<\/ul>\n<\/li>\n<li class=\"li1\"><span class=\"s1\">Fibrin within the anterior chamber<\/span><\/li>\n<li class=\"li1\"><span class=\"s1\">Hypopyon<\/span><\/li>\n<li class=\"li1\"><span class=\"s1\">Keratic precipitates <\/span><\/li>\n<li class=\"li1\"><span class=\"s1\">Synechiae. <\/span><\/li>\n<\/ul>\n<p class=\"p1\"><span class=\"s1\">Nonspecific <b>clinical signs<\/b> include:<\/span><\/p>\n<ul class=\"ul1\">\n<li class=\"li1\"><span class=\"s1\">Blepharospasm <\/span><\/li>\n<li class=\"li1\"><span class=\"s1\">Epiphora<\/span><\/li>\n<li class=\"li1\"><span class=\"s1\">Miosis <\/span><\/li>\n<li class=\"li1\"><span class=\"s1\">Ocular discharge.<\/span><\/li>\n<\/ul>\n<p class=\"p1\"><span class=\"s1\">With anterior uveitis, IOP is generally low, unless the animal has developed secondary glaucoma. As a rule, IOP less than 10 mm Hg, or a difference of 5 to 10 mm Hg between eyes, suggests uveitis.<\/span><span class=\"s2\"><sup>1,2<\/sup><\/span><\/p>\n<p class=\"p1\"><span class=\"s1\">All patients with anterior uveitis should have the following performed:<\/span><\/p>\n<ul class=\"ul1\">\n<li class=\"li1\"><span class=\"s1\">Complete blood count and serum biochemical profile<\/span><\/li>\n<li class=\"li1\"><span class=\"s1\">Urinalysis<\/span><\/li>\n<li class=\"li1\"><span class=\"s1\">Titers for tick-borne diseases<\/span><\/li>\n<li class=\"li1\"><span class=\"s1\">Thoracic (3 views) and abdominal radiographs<\/span><\/li>\n<li class=\"li1\"><span class=\"s1\">Abdominal ultrasound. <\/span><\/li>\n<\/ul>\n<p class=\"p1\"><span class=\"s3\"><b><i>Clinical Note:<\/i><\/b><\/span><span class=\"s1\"><b><i> Ocular ultrasound<\/i><\/b><i> can help determine extent of ocular disease if anterior segment changes are severe and the posterior segment cannot be visualized.<\/i><\/span><\/p>\n<h3 class=\"p4\"><span class=\"s1\"><b>Systemic Disease<\/b><\/span><\/h3>\n<p class=\"p1\"><span class=\"s1\">Uveitis, whether unilateral or bilateral, is most often due to a systemic cause. Systemic causes of uveitis include infectious, autoimmune, and neoplastic disorders (<b>Table 2<\/b>). Uveitis is considered nonsystemic if there is evidence of:<\/span><\/p>\n<ul class=\"ul1\">\n<li class=\"li1\"><span class=\"s1\">Cataracts (lens-induced uveitis)<\/span><\/li>\n<li class=\"li1\"><span class=\"s1\">Corneal ulceration<\/span><\/li>\n<li class=\"li1\"><span class=\"s1\">Intraocular neoplasia<\/span><\/li>\n<li class=\"li1\"><span class=\"s1\">Other external evidence of trauma.<\/span><\/li>\n<\/ul>\n<p><a href=\"https:\/\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2013\/05\/Screen-Shot-2015-06-04-at-3.12.56-PM.png\"><img loading=\"lazy\" decoding=\"async\" class=\"alignnone wp-image-4304 size-figure_img\" src=\"https:\/\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2013\/05\/Screen-Shot-2015-06-04-at-3.12.56-PM-e1456505142574-405x300.png\" alt=\"Screen Shot 2015-06-04 at 3.12.56 PM\" width=\"405\" height=\"300\" \/><\/a><\/p>\n<p class=\"p1\"><span class=\"s1\">As for any other inflammatory conditions, underlying etiology must be determined in order to institute proper therapy. However, this determination is often impossible even with thorough diagnostic investigation.<\/span><\/p>\n<h3 class=\"p4\"><span class=\"s1\"><b>Treatment<\/b><\/span><\/h3>\n<p class=\"p1\"><span class=\"s1\">Treatment should be directed at addressing the primary cause and decreasing pain and inflammation. <\/span><\/p>\n<ul class=\"ul1\">\n<li class=\"li1\"><i><\/i><span class=\"s1\"><i>Atropine 1%<\/i> Q 6\u20138 H may be used to relieve miosis and pain; it should not be used in patients with normal or elevated IOP in the face of uveitis as it will exacerbate glaucoma. <\/span><\/li>\n<li class=\"li1\"><i><\/i><span class=\"s1\"><i>Prednisolone acetate 1% ophthalmic suspension<\/i> (Q 4\u20136 H38) and\/or topical NSAIDs, such as diclofenac sodium 0.1% or flurbiprofen sodium 0.03%, can be used alone or in combination to reduce intraocular inflammation. <\/span><\/li>\n<li class=\"li1\"><i><\/i><span class=\"s1\"><i>Systemic NSAIDs<\/i>, such as IV meloxicam (0.2 mg\/kg)<\/span><span class=\"s2\"><sup>39<\/sup><\/span><span class=\"s1\"> and oral firocoxib (5 mg\/kg),<\/span><span class=\"s2\"><sup>40<\/sup><\/span><span class=\"s1\"> may be beneficial in controlling inflammation associated with uveitis; however, concurrent disease and hepatic and renal function should be considered before using systemic NSAIDs. <\/span><\/li>\n<li class=\"li1\"><i><\/i><span class=\"s1\"><i>Systemic glucocorticoids<\/i> should only be used to treat uveitis after infectious causes and neoplasms requiring chemotherapy, such as lymphoma, have been ruled out. <\/span><\/li>\n<\/ul>\n<p class=\"p1\"><span class=\"s3\"><b><i>Clinical Note:<\/i><\/b><\/span><span class=\"s1\"><b><i> Referral to an ophthalmic specialist<\/i><\/b><i> is appropriate for management of severe or resistant cases of uveitis.<\/i><\/span><\/p>\n<h2 class=\"p3\"><span class=\"s1\"><b>OTHER CAUSES OF RED EYE<\/b><\/span><\/h2>\n<p class=\"p1\"><span class=\"s1\">This article has focused on causes of red eye that are most likely to threaten vision. However, it is important to remember that there are other causes for the apparently &#8220;acute&#8221; red eye, including more insidious disorders that are perceived as acute by the owner. These include:<\/span><\/p>\n<ul class=\"ul1\">\n<li class=\"li1\"><b><\/b><span class=\"s1\"><b>Blepharitis associated with lid lacerations, pyogranulomatous blepharitis<\/b>, and <b>infectious blepharitis<\/b>, which often present as a cause of acute ocular redness <\/span><\/li>\n<li class=\"li1\"><b><\/b><span class=\"s1\"><b>Conjunctivitis<\/b> (KCS, allergic conjunctivitis) and <b>prolapsed gland of the third eyelid<\/b> (&#8220;cherry eye&#8221;)<\/span><\/li>\n<li class=\"li1\"><b><\/b><span class=\"s1\"><b>Nonulcerative keratitis<\/b>, such as chronic superficial keratitis (pannus), qualitative tear film abnormalities, and other keratopathies without ulceration<\/span><\/li>\n<li class=\"li1\"><b><\/b><span class=\"s1\"><b>Orbital diseases<\/b> (cellulitis, abscess, neoplasia), which routinely present with conjunctival hyperemia and chemosis.<\/span><\/li>\n<\/ul>\n<h2 class=\"p3\"><span class=\"s1\"><b>IN SUMMARY<\/b><\/span><\/h2>\n<p class=\"p1\"><span class=\"s1\">Correct diagnosis and treatment of the red eye are important to prevent loss of vision, the globe, or, in some cases, loss of life. Corneal ulcers, uveitis, and glaucoma must all be considered and can be diagnosed by performing a thorough ophthalmic examination, STT, fluorescein staining, and tonometry. Each of these diagnoses requires prompt and specific treatment in order to ensure a positive outcome.<\/span><\/p>\n<p class=\"p1\"><span class=\"s1\">CAI = carbonic anhydrase inhibitor; DBD = diamond burr debridement; IOP = intraocular pressure; KCS = keratoconjunctivitis sicca; NSAID = nonsteroidal anti-inflammatory drug; SCCED = spontaneous chronic corneal epithelial defects; SD = standard deviation; STT = schirmer tear test; WBC = white blood cell<\/span><\/p>\n<p class=\"p1\"><span class=\"s1\"><i>Figures courtesy of University of Georgia teaching collection<\/i><\/span><\/p>\n<p class=\"p1\"><span class=\"s1\"><i>Dr. Laminack wishes to thank Dr. Denise Weaver, Dr. Troy Pickerel, the practice team of Companion Animal Hospital, and the University of Georgia Veterinary Teaching Hospital Ophthalmology Service for their support. She also extends gratitude to her mentors and coauthors, Dr. Anthony Moore and Dr. Kate Myrna.<\/i><\/span><\/p>\n<p class=\"p1\"><span class=\"s1 author-bio\"><b><a href=\"https:\/\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2013\/05\/Elizabeth-Barfield-Laminack.png\"><img loading=\"lazy\" decoding=\"async\" class=\"alignleft size-full wp-image-9209\" src=\"https:\/\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2013\/05\/Elizabeth-Barfield-Laminack.png\" alt=\"Elizabeth Barfield Laminack\" width=\"100\" height=\"112\" \/><\/a>Elizabeth Barfield Laminack<\/b>, DVM, is a veterinarian at Companion Animal Hospital in Athens, Georgia. When not in the clinic, she studies small animal ophthalmology at the University of Georgia Veterinary Teaching Hospital. In 2012, she completed research abstracts for the Association for Research in Vision and Ophthalmology on canine primary glaucoma and for the American College of Veterinary Ophthalmology regarding canine secondary glaucoma. She received her DVM from University of Georgia.<\/span><\/p>\n<p class=\"p1\"><span class=\"s1 author-bio\"><b><a href=\"https:\/\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2013\/05\/Phillip-Anthony-Moore.png\"><img loading=\"lazy\" decoding=\"async\" class=\"alignleft size-full wp-image-9210\" src=\"https:\/\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2013\/05\/Phillip-Anthony-Moore.png\" alt=\"Phillip Anthony Moore\" width=\"100\" height=\"112\" \/><\/a>Phillip Anthony Moore<\/b>, DVM, Diplomate ACVO, is an associate professor in the Department of Small Animal Medicine and Surgery at University of Georgia College of Veterinary Medicine. His primary research interest is the anterior segment of the eye. Dr. Moore received his DVM from Auburn University; he completed both an internship and residency at University of Georgia.<\/span><\/p>\n<p class=\"p1\"><span class=\"s1 author-bio\"><b><a href=\"https:\/\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2013\/05\/Kathern-Myrna.png\"><img loading=\"lazy\" decoding=\"async\" class=\"alignleft size-full wp-image-9211\" src=\"https:\/\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2013\/05\/Kathern-Myrna.png\" alt=\"Kathern Myrna\" width=\"100\" height=\"112\" \/><\/a>Kathern Myrna<\/b>, DVM, MS, is an assistant professor of ophthalmology at the University of Georgia. Her interests are in comparative ophthalmology, corneal wound healing, and ocular analgesia. She completed a specialty internship in small animal ophthalmology at Angell Animal Medical Center in New England. She completed a residency in comparative ophthalmology and MS in comparative biomedical sciences at University of Wisconsin-Madison. She received her DVM from Virginia-Maryland Regional College of Veterinary Medicine.<\/span><\/p>\n<h3 class=\"p5\"><\/h3>\n","protected":false},"excerpt":{"rendered":"<p>Elizabeth Barfield Laminack, DVM; Kathern Myrna, DVM, MS; and Phillip Anthony Moore, DVM, Diplomate ACVO The acute red eye is a common clinical challenge for general practitioners.<\/p>\n","protected":false},"author":1,"featured_media":2745,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"iawp_total_views":21733,"footnotes":""},"categories":[374],"tags":[13],"class_list":["post-1308","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-may-june-2013","tag-peer-reviewed","column-features","clinical_topics-ophthalmology"],"acf":{"hide_sidebar":false,"hide_sidebar_ad":false,"hide_all_ads":false},"yoast_head":"<!-- This site is optimized with the Yoast SEO Premium plugin v24.7 (Yoast SEO v27.3) - 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