August Pulse Article (PART 2 OF 12, EYELID ABNORMALITIES)
August 15, 2018
This second ophthalmic review article takes a brief look at the more commonly encountered eyelid-associated presentations.
Common presentations in young patients include;
Feline eyelid agenesis(a condition which is both hereditary & congenital) and which typically presents as a defect affecting both upper lateral eyelids. Associated pathology may include secondary keratitis. Surgical repair is curative.
Distichiasisdefines a condition in which multiple abnormal cilia arise from the lid margins in varying numbers resulting in discomfort & keratitis. Surgical removal is curative
Ectopic ciliarepresent one or more abnormal hairs arising from inside the eyelid(s) – typically resulting in severe pain & significant secondary pathology. Ectopic hairs can be small & challenging to identify without magnification. Surgical removal is curative.
Juvenile pyoderma(“puppy strangles”) describes a pyogranulomatous condition affecting young dogs, generally within the first 6 months of life. Clinical symptoms comprise variable combinations of symmetrical pustular dermatitis of the muzzle, face, periocular tissues and/or ears and/or regional lymphadenopathy. Treatment comprises the administration of systemic corticosteroids, with or without adjunctive systemic anti-microbial therapy, with most cases responding rapidly.
Entropiondescribes eyelid pathology such that the lid margin(s) are inverted towards the globe(s). Most typically, the lower eyelids are involved, however upper eyelid entropion may also occur. Similarly, the condition is most commonly bilateral, however unilateral entropion may occur. Primary entropion arises due to a conformational eyelid abnormality & may additionally involve excessive eyelid length and laxity and/or brow-fold redundancy (particularly the English Bulldog, Chow Chow & Shar Pei). Spastic entropion arises as a result of ocular discomfort (such as that arising from corneal ulceration) and subsequent chronic blepharospasm. Secondary or Cicatricial entropion may also occur. Either temporary eversion (in young patients) or definitive surgical correction (in mature patients) is indicated.
Mature patients may present with a variety of immune-mediated &/or inflammatory eyelid pathology, including;
Primary immune-mediated blepharoconjunctivitis– a severe, acute, bilateral inflammation of the eyelid tissues which occurs relatively frequently, particularly in small-breed dogs.
Auto-immune blepharitis– the classification of these diseases is complex, encompassing the pemphigus (auto-antibody-mediated acantholysis) diseases, lupus (immune-cellular dysfunction) diseases, vasculitis-related diseases and uveodermatological syndrome (“Vogt-Koyanagi-Harada-like” or “VKH-like” disease). Of the pemphigus diseases, pemphigus foliaceous (PF) may be more commonly encountered, notably affecting the Akita, Chow Chow & Labrador Retriver. Of the lupus-related diseases, discoid lupus erythematosis (DLE), also described as “cutaneous lupus erythematosis”, may be more commonly encountered, notably affecting the Akita, Chow Chow, Siberian Husky, German Shepherd, herding & Collie-breeds. Breeds commonly affected by uveodermatological syndrome the Akita, Chow Chow & Siberian Husky. In all cases, treatment comprises long-term immune-modulation, typically encompassing steroidal therapy with or without the adjunctive use of immunosuppressive agents including azathioprine, chlorambucil, mycofenylate and/or cyclosporine.
Eyelid pathology in conjunction with more generalized disease as a result of parasitic and/or fungal infection may also be occasionally encountered, the diagnosis being made based on scrapings, cytology & culture and defining the appropriate medical therapy.
Multipletumorsmay affect the eyelids, most commonly relatively benign epitheliomas/adenomas (with or without the formation of adjunctive chalazia due glandular obstruction). Pigmented lesions commonly represent either (benign) melanoctyomas or (malignant) melanomas (the diagnostic spectrum also encompassing amelanotic melanomas!). More erythemous, proliferative or hemorrhagic changes should prompt concern for more aggressive changes including those resulting from cutaneous epitheliotropic lymphoma (commonly affecting other regions including mucocutaneous junctions) & squamous cell carcinoma (commonly affecting white or poorly pigmented tissues). Focal eyelid neoplasms which are relatively frequently encountered include relatively benign histiocytomas and more aggressive mast cell tumors & fibrosarcomas. 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 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 clinicVeterinary Ophthalmic Consulting 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.