Reprint with permission

Valerie Bernard
Permissions EXecutive
SAGE Publications Ltd
The oryginal version of this paper has been published in Journal of Feline Medicine and Surgery , May 2011, 13, (5) pp. 333-345 by SAGE Publications LTD. All rights reserved. URL http://intl-jfm.sagepub.com, doi 10.1016/j.jfms 2011.0.010.
****

CHOROBY OCZU KOTÓW WYWOŁANE ZAKAŻENIAMI HERPESVIRUSEM -1: OBJAWY KLINICZNE, DIAGNOSTYKA I SPOSOBY LECZENIA

STRESZCZENIE:

W SWOJEJ PRACY AUTOR PRZEDSTAWIA KLUCZOWE ASPEKTY ZWIĄZANE Z CHOROBAMI OCZU WYSTĘPUJĄCYMI U KOTÓW, KTÓRE  POWODUJE  HERPESVIRUS  KOCI TYPU 1. PRACA  W OBSZERNY SPOSÓB OMAWIA WIELE CHORÓB IMPLIKOWANYCH TYM TYPEM WIRUSA. SZCZEGÓŁOWO OPISUJE OBJAWY KLINICZNE POSZCZEGÓLNYCH SCHORZEŃ, DIAGNOSTYKĘ ORAZ DORADZA W SPOSÓB PRAKTYCZNY DOBIERANIE ODPOWIEDNIEGO LECZENIA. MAMY PODANY SZEREG LEKÓW WRAZ Z DAWKAMI I SPOSOBAMI ICH PODANIA DLA POSZCZEGÓLNYCH SCHEMATÓW LECZENIA. PRACA JEST BOGATO ILUSTROWANA FOTOGRAFIAMI OBRAZUJĄCYMU KONKRETNE PRZYPADKI KLINICZNE. AUTOR WŁOŻYŁ WIELE WYSIŁKU, DZIĘKI CZEMU POWSTAŁA NAPRAWDĘ WSPANIAŁA PRACA NAUKOWA, KTÓRA PRAKTYKOM DAJE GOTOWY SCHEMAT ROZPOZNAWANIA I LECZENIA TYCH TRUDNYCH Z PUNKTU KLINICZNEGO CHORÓB.

Dr David congratulations !

PB

Author

David Gould BSc (Hons) BVM&S PhD DVOphthal DipECVO MRCVS
Davies Veterinary Specialists
Manor Farm Business Park
Higham Gobion
Hertfordshire
SG5 3HR
UK
Email: This e-mail address is being protected from spambots. You need JavaScript enabled to view it

Key points

• Following exposure to FHV-1, more than 80% of cats become persistently infected. Of these, 45% will subsequently shed virus spontaneously or as a result of natural stress situations, whilst around 70% will shed virus in response to corticosteroid administration

• Diagnostic testing results must be interpreted with caution since both false-negative and falsepositive testing is common. Because of this, it is important to consider the overall clinical picture when attempting to make a diagnosis of FHV-1 ocular disease

• Reducing environmental stress is a particularly important management strategy for recrudescent disease

• As one of only two antivirals with proven clinical efficacy against FHV-1 (the other being cidofovir), famciclovir should be considered one of the drugs of choice in the treatment of FHV-1 clinical disease

• There is no evidence for the benefit of dietary L-lysine supplementation, and its addition may paradoxically increase disease severity and viral shedding

• Topical and oral interferon appears to be ineffective in the treatment of FHV-1 ocular disease

Abstract

Practical relevance

Feline herpesvirus-1 (FHV-1) is a major cause of feline morbidity. Following exposure to the virus, virtually all cats become persistently infected and many of these will develop recrudescent disease on one or more occasions during their life. Ocular manifestations include conjunctivitis, corneal ulceration and keratitis. In severe cases the condition can be blinding.

Global importance

FHV-1 has a worldwide distribution, with reported exposure rates in some cat populations of up to 97%. As such it is a significant cause of clinical disease in the global cat population.

Patient Group

Young and adolescent cats are most at risk of acute primary disease, and the vast majority of these will then become persistently infected. Around half of all persistently infected cats will shed virus at some stage in their life and these may develop recrudescent ocular disease.

Clinical challenges

Acute ocular herpetic disease can be severe and painful. Repeated bouts of recrudescent ocular disease can lead to progressive corneal pathology that can be ultimately blinding in affected cats.

Treatment of FHV-1 ocular disease is challenging. Antiviral medications may be expensive and require good owner and patient compliance. Clinical responses in patients can be variable.

Selecting the appropriate therapeutic approach requires good clinical judgement and depends on a number of factors such as severity and stage of clinical disease, patient and owner compliance and financial considerations.

Evidence base

Although a wide range of antiviral treatments are available, very few of these have been tested in controlled clinical trials. Instead, therapeutic decisions are often made based on results of in vitro studies, case-based reports and anecdote. Large, masked, controlled clinical trials are required in order to determine the efficacy of the antiviral drugs currently available to treat FHV-1.

This article will summarise the viral characteristics, epidemiology and disease pathogenesis of FHV-1 and describe its ocular manifestations. Diagnostic testing for FHV-1 will be discussed and current treatment options for FHV-1 will be critically reviewed.

Dr hab. Rafał A. Sapierzyński
Zakład Patomorfologii Zwierząt Katedry Patologii i Diagnostyki Weterynaryjnej
Wydział Medycyny Weterynaryjnej SGGW
Warszawa 02-076, ul. Nowoursynowska 159 c e-mail: This e-mail address is being protected from spambots. You need JavaScript enabled to view it
Tel. (22) 5936153

EYELIDS NEOPLASIA IN DOGS AND CATS.

Summary:

Physical and functional abnormalities of the lids or adnexal ocular structures may result in abnormalities of the cornea and subsequently vision. Cancer begins when normal cells start to change and grow uncontrollably, forming a mass called a tumor. Eyelid tumors can be either benign or malignant. The most common  malignant eyelid tumors include basal cell carcinoma, sebaceous gland carcinoma, squamous cell carcinoma and malignant melanoma. Cytologic  examination of the fine needle aspiration and biopsy samples may reveal a specific type of neoplasm. All cancers from the eyelid and eye globe need to be removed. Histologic examinations of incised masses are recommended.

Key words : neoplasia, tumor, eyelids , cat, dogs, recognition, treatment

WYSTĘPOWANIE  I  CHARAKTERYSTYKA

Zmiany nowotworowe w obrębie narządu wzroku u psów i kotów będących pacjentami lecznic weterynaryjnych nie są stwierdzane zbyt często (0,87 % psów i 0,34 % kotów) (Miller i wsp. 2002). Z drugiej jednak strony guzy nowotworowe są przyczyną 25 % przypadków nieurazowego zapalenia błony naczyniowej u psów, a ponadto stanowią drugą co do częstości przyczynę wyłuszczenia gałki ocznej u tych gatunków zwierząt (Koestner i wsp. 2002, Massa i wsp. 2002). Rozrosty wywodzić się mogą ze skóry i tkanki podskórnej powiek, spojówki, przydatków, nerwu wzrokowego, samej gałki ocznej oraz innych struktur zlokalizowanych w obrębie oczodołu. Spośród wszystkich nowotworów zlokalizowanych w obrębie narządu wzroku jednymi z najczęściej rozpoznawanych są guzy, które obejmują powieki. Przyczyną tego stanu jest fakt, że zmiany te najłatwiej zauważyć (zarówno przez właściciela pacjenta, jak i lekarza weterynarii). Powieki utworzone są ze skóry pokrytej naskórkiem, mięśni powiek,  spojówki powiek (błona śluzowa wewnętrznej powierzchni powiek), trzeciej powieki oraz gruczołów powiek.

Dr David Gould

Reprint with written permission by SAGE Publications LTD.

The oryginal version of this paper has been published in Journal of Feline Medicine and Surgery.

May 2011, 13(5), 333-346 doi 10.1016/j.jfms2011.03.010 URL http//intl-jfm.sagepub.com

Case notes 1

A 3yo neutered female domestic shorthair cat is presented for evaluation of a left ocular abnormality (see Figure i). The cat is a confirmed FHV-1 carrier (by PCR from a previously taken conjunctival swab taken) but is otherwise healthy and has no active signs of upper respiratory tract disease. The owner reports that the eye condition was first noticed around 3 weeks previously and that it has gradually progressed since that time.

No signs of ocular discomfort have been noted and the other eye is unaffected.

a). Describe the lesions seen.

b). What is the most likely diagnosis in this case and how could it be confirmed?

c). What is the usual treatment for this condition, and what is the concern about instigating such therapy in this particular case?

Odpowiedź jest w dalszej części e-kwartalnika.

Case notes 2

A 6yo neutered female Persian cat is presented for assessment of a painful right eye of two week’s duration (see Figures ii, iii). The cat has a history of recurrent right corneal ulceration but has been previously tested negative for FHV-1 by PCR from corneal swabs. However, her sibling housemate is a known FHV-1 carrier (by PCR from a previously taken conjunctival swab.

a). Describe the ocular abnormalities shown in Figures ii and iii.

b). What is your diagnosis?

c). What treatment options should be considered in this case?

Odpowiedź jest w dalszej części e-kwartalnika.

Dr n. wet. Przemysław K. Bryła
Przychodnia weterynaryjna w Warszawie

TREATMENY OF DISTICHIASIS IN A DOG USING ELECTROLISIS

SUMMARY:

The eyelids represent a structure composed of skin and cutaneous appendages, including hair follicles and glandular structures. The eyelids and ocular adnexa comprise the primary surface defence for the globe, specifically the cornea. There are three main forms of ciliary disorders: distichiasis, trichiasis and ectopic cilia. The abnormally placed hairs irritate the cornea. The affected eye will become red, inflamed and may develop a discharge. In severe cases, the cornea may became ulcerated. Both upper and lower lids may be involved. Some breads are affected more, suggesting that it is an inherited trait. Ciliary abnormalities are extremely rare in the cat. The diagnosis is made by direct visualization, although head loupe or slit-lamp magnification is helpful. The abnormal eyelashes are best removed through the use of surgery, kryotherapy or electroepilation. This report documents bilateral distichiasis in west highland white terrier. The distichia were removed using electroepilation technique.

KEY WORDS :

dog eyelash, distichiasis, trichiasis, ectopic cilia, electroepilation

WPROWADZENIE

Powieki, są to ruchome fałdy skórno-mięśniowe, które pokrywają gałkę oczną. Gdy są zamknięte zakrywają oko, w czasie mrugania rozprowadzają łzy, dzięki czemu chronią je przed wysychaniem. Między powiekami znajduje się szpara powiekowa. Powieki łączą się ze sobą spoidłem bocznym i przyśrodkowym powiek, w ten sposób tworząc kąt oka boczny i przyśrodkowy (1). Na wolnych brzegach powiek wyróżniamy krawędzie (blaszki) przednie i tylne (1, 2). Krawędzie te oddzielone są od siebie linią szarą. Krawędź (blaszka) przednia, zbudowana jest ze skóry i mięśnia okrężnego oka, natomiast krawędź (blaszka) tylna składa się z tarczki oraz spojówki (3). Tarczka jest to płytka zbudowana z tkanki łącznej włóknistej, która nadaje powiece pewną sztywność (1, 3). W brzegu powieki znajdują się gruczoły: Meiboma, Molla i Zeisa (3, 4). Liczne gruczoły Meiboma zlokalizowane są w tarczce.

With written permission by SAGE Publications LTD.

The oryginal version of this paper has been published in Journal of Feline Medicine and Surgery May 2011, 13 (5), 333-346 , doi 10.1016/j.jfms2011.03.010, URL http:/intl-jfm.sagepub.com

Answers, case notes 1:

1a). A mild mucopurulent ocular discharge is associated with superficial corneal neovascularisation extending towards multiple areas of discrete white proliferative lesions that appear to be raised from the ocular surface.

1b). The clinical appearance is characteristic of eosinophilic keratitis. Diagnosis can be confirmed by corneal cytology, which should show a mixed inflammatory response including eosinophils.

1c). Eosinophilic keratitis is usually responsive to topical corticosteroids. However, use of corticosteroids in FHV-1 infected cats carries a high risk (70%) of viral reactivation.2 Treatment options in this case include topical corticosteroids in combination with topical antivirals, or systemic megoestrol acetate.

Answers, case notes 2:

2a). Figure ii shows a mucoid ocular discharge with green staining due to application of topical fluorescein. The reflection from the tear film reflex on the ocular surface is disrupted and a faint brown discolouration to the cornea is evident. Figure iii reveals a relatively large but apparently superficial corneal ulcer surrounded by diffuse corneal oedema, consistent with epithelial under-running. The central part of the ulcer is faintly brown in colour.

2b). The brown discolouration of the corneal stroma is diagnostic of early corneal sequestrum formation. This is associated with an under-run superficial corneal ulcer. It is likely that recurrent or chronic corneal ulceration has predisposed to the formation of a corneal sequestrum.

2c). The presence of a corneal sequestrum means that the overlying corneal ulcer is unlikely to heal without surgical intervention. Surgical treatment would involve gentle debridement of the underrun epithelium followed by superficial keratectomy to remove the corneal sequestrum. This procedure should be performed under an operating microscope, and additional grafting procedures (eg conjunctival pedicle grafting) may be required following superficial keratectomy.
Although the cat has previously been tested negative for FHV-1, the ophthalmic history and the environmental association with a known FHV-1 carrier raise the suspicion that this cat is chronically infected with and maybe currently affected by FHV-1. Repeat PCR testing may be indicated, or a therapeutic trial with antiviral medications could be considered