Mini Aussie Monday

December 17, 2018

Enjoyed the company of 8 beautiful Australian Shephard puppies today, who all received their CERF eye certification from Dr Esson!

 

Are you interested in a CERF examination for your pet? OFA Eye Certification exams (previously “CERF” exams) are screening examinations performed by board certified veterinary ophthalmologists in order to identify changes within the eye(s) suggesting the presence of one or more of these diseases. Genetic diseases are those that are passed on from parent to offspring through genes that carry the codes for each specific trait. Many of the diseases and disorders that affect the eyes are associated with specific genetic factors and multiple eye diseases which affect dogs  are known to exhibit evidence of a genetic or heritable cause. Certification is valid for 12 months from the date of the eye exam. Annual re-examination is recommended.

To schedule an OFA examination for one or more pets, please call the reception at 949-404-4100.

November Pulse Article Available (part 5 of 12, Common Small Animal Corneal Diseases)

November 26 , 2018

Corneal disease represents potentially the most common ophthalmic presentation in general practice.

Corneal dystrophy describes a group of disorders, likely hereditary in etiology, resulting from an accumulation of cholesterol, phospholipids & free fatty acids. Lesions appear as grey/white, crystalline, relucencies within the stroma. This disorder is typically bilateral in presentation and inflammatory changes are not usually present. Multiple patterns of corneal dystrophy have been described. Treatment is not typically necessary. Commonly affected breeds include the King Charles Cavalier Spaniel, Siberian Husky & Beagle.

Corneal degeneration represents corneal pathology secondary to ocular inflammation. Degenerative changes appear as irregular, asymmetric grey/white deposits within the cornea.  Lesions may be unilateral or bilateral and are typically associated with neovascularization. Mineralized tissue may spontaneously slough, particularly in geriatric patients. Deposits may be removed where indicated via keratectomy. Exposed mineral may also be partially chelated using topical EDTA solution until re-epithelialization is complete.

Corneal endothelial decompensation represents a progressive loss of corneal endothelial cell function & density and results in slowly progressive corneal edema, marked by blue/grey discoloration & thickening. The disease is bilateral though not always symmetrical. Commonly affected breeds include the Boston Terrier & the Dachshund. When indicated, definitive surgical treatment includes limited thermo or CO2 laser keratoplasty, the placement of a “Gunderson” conjunctival pedicle graft or penetrating keratoplasty.

Chronic superficial keratitis (“pannus”) describes a bilateral inflammatory condition, which predominantly affects the corneal tissues. Changes encompass vascular proliferation, inflammatory cell infiltration & secondary pigment deposition.  Adjacent eyelid margin, conjunctival and third eyelid inflammation are frequently associated with this process. Commonly affected breeds include the German Shepherd & Belgian Malinois. Inflammatory changes typically respond to topical anti-inflammatory therapy using corticosteroids (+/- topical immune-suppressive agents including cyclosporine &/or tacrolimus). CSK is easily controlled in most cases, however ongoing topical therapy is typically required in order to prevent a recurrence of symptoms. In unusually severe & chronic cases, surgical superficial keratectomy +/- the use of adjunctive B-radiation may be indicated.

Eosinophillic keratoconjunctivitis describes an infiltration of the feline corneal and/or conjunctival tissues with an eosinophil-rich inflammatory infiltrate. The relationship between herpesviral disease and this process remains unclear. Affected cats display variable cream to white-colored corneal infiltration & “plaque-like” deposition. Treatment comprises topical and/or systemic anti-inflammatory therapy.

The feline corneal sequestrum represents a localized region of corneal necrosis. Clinically, corneal sequestrums appear as tan to brown regions which may vary in both size & depth and may or may not be associated with concurrent ulceration. The condition may be unilateral or bilateral. Chronic pre-existing keratitis, corneal ulceration, the performing of inappropriate “grid keratotomies” and/or the presence of FHV-1 as well as breed predispositions are potential contributory factors. The treatment of choice for corneal sequsetrums is excision via surgical keratectomy, facilitated by operating microscopy.

Corneal ulceration may arise secondary to a multitude of etiologies including conformational abnormalities, tear-film deficiencies (quantitative and/or qualitative), neurological dysfunction, trauma and/or microbial contamination;

Spontaneous chronic corneal epithelial defects (SCCEDs or “Boxer” ulcers) likely arise as a result of corneal micro-trauma in association with pre-existing structural &/or physiological corneal abnormalities. Clinically, SCCEDs present as superficial lesions typically surrounded by a rim of poorly adherent epithelial tissue, which is easily under-run by fluorescein creating a “halo” effect following corneal staining. Commonly affected breeds include the Boxer, Boston Terrier & French Bulldog. SCCEDs are treated by physical debridement of both loose superficial epithelial tissue as well as the underlying stromal surface.

Tissue dissolution through the action of enzymatic proteases is a normal part of the healing and remodeling process, however, uncontrolled lysis or “melting” of corneal tissue may result in significant keratomalacia. Appropriate topical therapeutic agents include serum, EDTA and/or N-acetyl cysteine. Anti-collagenases should be applied frequently.

Bacterial keratitis should be treated using appropriate antimicrobials. Ideally, therapy should be based on cytological interpretation & gram’s staining as well as the subsequent culture & sensitivity testing of microbial samples. In severe cases, or those associated with existing or impending corneal rupture, surgical tectonic corneal grafting procedures may be indicated.

Multiple neoplastic processes may affect the corneal tissues including melanocytoma, lymphoma and squamous cell carcinoma. The management of each tumor type is beyond the scope of this brief clinical review however typically encompasses excision where possible in combination with adjunctive radio/chemo therapy where indicated &/or the involvement of a veterinary oncologist. 

Dr Esson is a board-certified veterinary ophthalmologist with more than twenty years of clinical experience and multiple areas of interest & expertise. His clinic Veterinary Ophthalmic Consulting (www.veterinaryophthalmicconsulting.com) is family owned & operated and he takes great pride & pleasure in working closely with his friends and colleagues in the greater Southern California veterinary community.

Check out the November article here: 101818 PULSE, November 2018_p1 27101818 PULSE, November 2018_p1 26

Canine Cataract Surgery

November 7, 2018

This patient had a mature cataract (lens opacity) removed from her right eye via state-of-the-art cataract phacoemulsification and synthetic IOL (new lens) placement.  Factors associated with successful cataract surgery include Dr Esson’s experience, careful anesthetic monitoring, recovery in the hands of our experienced technical team and of course a lot of post-operative TLC ❤️

 

Cataract before surgery

Just as in human surgery, an operating microscope allows the surgeon to see incredible detail while removing the cataract

Stage 1 – cataract phacoemulsification (the lens is broken up & removed)

Stage 2 – irrigation/aspiration (remnants are removed & the lens capsule polished)

Stage 3 – synthetic IOL (new lens) introduction (the new lens is seen here prior to removal from its cassette)

Finally introduction of the (folded) synthetic lens into the lens capsule to restore optimal vision

If your pet has developed cataracts, you or your veterinarian may want to schedule a consultation with VOC in order to discuss management and further treatment options.

Even if surgery is not an appropriate option for your pet, the management of lens-assoicated inflammation can help avoid unwanted longterm complications & outcomes.

October Pulse article available (part 4 of 12, Common Small Animal Third Eyelid Abnormalities)

October 25, 2018

Ophthalmic presentations are not uncommonly associated with the tissues of one or both third eyelids. These structures are contiguous with their overlying conjunctival surfaces and as a consequence may also be affected by inflammatory and immune-mediated surface conditions, including allergic & follicular conjunctivitis & (less typical) chronic superficial keratitis (“pannus”).

Symblepharon describes varying degrees of adhesion which may occur between adjacent conjunctival surfaces (including palpebral and/or third eyelid surfaces) and/or the cornea. Symblepharon results from loss of epithelial continuity, most commonly arising secondary to feline herpesviral disease in young animals but potentially arising secondary to any severe feline or canine conjunctival inflammation Surgical resection of conjunctival adhesions is relatively straightforward, however the tendency for the aggressive (potentially aggravated) reformation of these adhesions is extremely high and as a consequence surgical resection is rarely indicated.

The third eyelid is supported by a “T-shaped” cartilaginous structure, which may occasionally be malformed, resulting in bending or “scrolling” of the leading edge of the third eyelid. This condition is generally congenital and may be unilateral or bilateral.  Secondary conjunctivitis typically results, the Great Dane being relatively commonly affected.  When indicated, treatment comprises the surgical resection of malformed cartilage. In skilled hands the prognosis for repair is excellent.

Prolapse of the lacrimal gland of the third eyelid (“cherry eye”) is relatively common, particularly in young patients. Presentation may be unilateral or bilateral. This condition results from defective connective tissue development in predisposed breeds, notably the English Bulldog. The excision of prolapsed glandular tissue should always be avoided where possible, in order to avoid subsequent complications (particularly KCS). The ideal treatment represents careful & accurate surgical repositioning of prolapsed tissue.

Keratoconjunctivitis sicca (“dry eye”) may represent a qualitative deficiency resulting from insufficient lipid and/or mucous secretion and/or a quantitative deficiency arising secondary to insufficient lacrimal glandular secretions. Lacrimal glandular dysfunction may arise secondary immune-mediated, traumatic, inflammatory, toxic or neurological etiologies. Pharmacological agents with the potential to cause or exacerbate KCS include the sulpha-containing anti-microbial compounds, making them a poor choice in patients affected by KCS. Commonly affected breeds include the West Highland White Terrier & English Bulldog. Treatment typically comprises a combination of lacrimostimulant and/or anti-inflammatory agents and long-term therapy is typically necessary in order maintain patients in a comfortable & disease-free state.  The adjunctive administration of oral pilocarpine may additionally help to re-establish function in cases associated with neurologic dysfunction. Secondary eyelid and/or meibomian gland inflammation/infection should be addressed where present and & ruling out underlying endocrinopathies is also advocated.

Finally, the glandular tissues of the third eyelid may be affected by a variety of neoplastic processes. Relatively common tumors in this location include the vascular neoplasms (haemangioma/haemangiosarcoma), squamous cell carcinoma (particularly in white or minimally pigmented patients), lymphoma, melanoma, and glandular adenomas/adenocarcinomas. The management of each tumor type is beyond the scope of this brief clinical review however typically encompasses excision where possible in combination with adjunctive radio/chemo therapy where indicated &/or the involvement of a veterinary oncologist. The defined presence of malignant neoplasia represents an appropriate indication for third eyelid excision (partial or total) despite the potential for complications, which may ensue.

Dr Esson is a board-certified veterinary ophthalmologist with more than twenty years of clinical experience and multiple areas of interest & expertise. His clinic Veterinary Ophthalmic Consulting (www.veterinaryophthalmicconsulting.com) is family owned & operated and he takes great pride & pleasure in working closely with his friends and colleagues in the greater Southern California veterinary community.

 Read this article: 092018 PULSE, October 2018_p2 28092018 PULSE, October 2018_p2 29 

#SoCalVets

October 18, 2018

Dr. Singer, Chief of Staff with Banfield, joined Dr. Esson today at VOC to assist in the OR for a bilateral Conjunctival Island Graft of one of his favorite patients “Pebbles!” VOC provides the highest standards of medical and surgical expertise and works closely with referring veterinarians to provide complete patient care.

 

Miracle “Morty”

October 9, 2018

Everyone say hello to “Morty!” This cute Labrador mix was surrendered to Labradors and Friends Rescue, who brought him to VOC needing immediate attention (& possible eye removal) for a badly infected eyelid injury. After surgical reconstruction of his lower right eyelid, “Morty” is healing very well & things are looking great. 

**UPDATE: “Morty” found his forever home in February 2019!**

 

 

September Pulse article available (part 3 of 12, nasolacrimal & conjunctival abnormalities)

September 25, 2018

This month, we look at some common ophthalmic presentations associated with the conjunctival and nasolacrimal tissues.

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The conjunctival surfaces are richly supplied with the cellular components of the immune system and represent a first line of antigenic response. As a consequence, allergic conjunctivitis is not uncommon, particularly in those patients affected by generalized dermal allergic or atopic disease. Treatment comprises the avoidance of inciting allergens, systemic management of generalized atopy and the application of topical anti-inflammatory therapy, the type, frequency and duration of application being determined by the clinical picture.

 

Dacryocystitis describes inflammation of the nasolacrimal drainage structures, which comprise the eyelid puncta, lacrimal canaliculi, lacrimal caverns and the sinonasal ducts that exit to the external nares. Inflammation may be the result of infection, extension of inflammation from adjacent structures, neoplasia or entrapment foreign material. Primary aplasia or hypoplasia of any part of this system may also occur. Post-inflammatory scarring & fibrosis is a common cause of nasolacrimal non-patency, particularly in cats previously affected by herpesviral-associated disease. Medical therapy using topical and/or systemic antimicrobial and/or anti inflammatory agents as well as canulation, irrigation, stenting and/or surgical exploration may be indicated based on the severity of disease, diagnostic findings and response to therapy.

 

Herpesviral- associated conjunctivitis is highly prevalent, particularly among young cats, resulting predominantly from animal to animal contact. Affected animals may display a range of symptoms including sneezing, coughing, nasal discharge, pyrexia, inappetance, lethargy, conjunctivitis, chemosis and/or keratitis. Herpes viral disease should also be considered when investigating similar symptoms in canine patients. Accurate testing for the presence of FHV-1 and its correlation with ophthalmic disease is challenging, however, polymerase-chain-reaction assays, based on tissue samples, are currently considered most reliable. Topical and/or systemic antiviral agents may be administered where appropriate, including; (topical) trifluorothymidine, idoxuridine, cidofovir, & ganciclovir and/or (systemic) famciclovir.

 

Thelazia (“eye worms”), represent a genus of nematode parasites which may occasionally be found in the ocular and adnexal tissues of dogs and cats in southern California. The life cycle of these parasites comprises a definitive host (comprising a range of wild mammals including horses, ruminants & numerous wild carnivores) and an intermediate host (notably dipteran flies).

After mating, adult female parasites produce immature larvae, which are released into the pre-corneal tear film of the definitive host. Adult parasites may be found in the conjunctival fornix, nasolacrimal system, under the third eyelid or in rare cases, inside the globe. Resultant conjunctivitis is frequently aggravated by self-trauma. Adult worms are thin, linear, white to translucent in color and approximately 1-2cm in length. Treatment includes the removal of adult parasites, the topical administration of demeracrium bromide and/or systemic anthelminthic agents including the avermectins, praziquantal and/or mebendazole.

 

Neoplastic processes which may affect the conjunctival and nasolacrimal tissues include papillomas (notably viral papilomatosis in puppies), adenoma/adenocarcinoma, haemangioma/haemangiosarcoma, lymphoma and squamous cell carcinoma (notably in white or minimally pigmented animals). The management of each tumor type is beyond the scope of this brief clinical review however typically encompasses excision where possible in combination with adjunctive radio/chemo therapy where indicated &/or the involvement of a veterinary oncologist.

 

Dr Esson is a board-certified veterinary ophthalmologist with more than twenty years of clinical experience and multiple areas of interest & expertise. His clinic Veterinary Ophthalmic Consulting (www.veterinaryophthalmicconsulting.com) is family owned & operated and he takes great pride & pleasure in working closely with his friends and colleagues in the greater Southern California veterinary community.

 Read the article here; 082218 PULSE, September 2018_p2 30082218 PULSE, September 2018_p2 31