DVOS VETS

DVOS VETS Online veterinary ophthalmology consulting service to practicing veterinarians as well online veteri

28/02/2025

Answer case 7
Most of you were correct it is a conjunctival hemangioma / hemangiosarcoma. In my opinion most of the 100 % conjunctival masses are hemangioma, if there is corneal involvement most likely hemangiosarcoma. They respond well to surgical excision.

What is your diagnosis ? Case 7Signalment: 7 year old male Cross breed dog. Very active outdoor dog.History: Small red ...
26/02/2025

What is your diagnosis ?
Case 7
Signalment: 7 year old male Cross breed dog. Very active outdoor dog.

History: Small red nodule on the eye became visible about 1 month previously. Slowly enlarging
Growth on eyelid has been there for months owner refusing treatment.

Clinical findings: Lesion as seen on photograph [OD]
Mild ocular discomfort.
Schirmer tear test 23 mm/min
Cornea fluorescein negative.
Intraocular pressure OS 14 mmHg OD 16 mmHg

24/02/2025

Answer Case 7
Subconjunctival hemorrhage
The most common cause for this is trauma, but clotting disorders can also cause lesions like this. This is normally a very dramatic presentation but resolve qu**ky.
Do thorough ocular and systemic examination to rule out any other ocular symptoms for example secondary uveitis as well systemic disease leading to a bleeding tendency.

If everything is normal I usually start a short course of topical corticosteroids Prednisolone acetate 1 % or Dexamethasone 0.1 % drops q6h for 5 – 7 days

What is your diagnosis ? Case 7Signalment: 5 year old active healthy non-descript breed dogHistory: Being barking outsid...
13/02/2025

What is your diagnosis ?
Case 7
Signalment: 5 year old active healthy non-descript breed dog

History:
Being barking outside the previous night
Owners found him like this in the morning.

Clinical findings:
Lesion as seen on photograph [OS]
Mild ocular discomfort.
Normal menace
Normal PLR
No aqueous flare
Schirmer tear test 21 mm/min
Cornea fluorescein negative.
Intraocular pressure OS 15 mmHg OD 18 mmHg

13/02/2025

Answer Case 6
Well done to you who got this one !!
Persistent Hyperplastic Tunica Vasculosa Lentis/Persistent Hyperplastic Primary Vitreous (PHTVL/PHPV) is characterized by fetal and postnatal hyperplasia of the hyaloid system, tunica vasculosa lentis, and primary vitreous, resulting in a variable but often significant opacity. This disorder has been observed in cats and numerous dog breeds, with hereditary transmission documented in Bouvier des Flandres, Staffordshire Bull Terriers, and Doberman Pinschers. Research on Doberman Pinschers in the Netherlands suggests an autosomal incompletely dominant mode of inheritance with variable expressivity. Clinically, PHTVL/PHPV manifests as a white or fibrovascular plaque on the posterior lens capsule and anterior vitreous. Additional potential findings include vascular ingrowth and hemorrhage within the vitreous and lens cortex, calcium deposits, posterior lenticonus, microphakia, lens coloboma, intralenticular melanosis or hemorrhage, progressive cataracts, and elongated ciliary processes.

What is your diagnosis ? Case 6Signalment: 2 year old DobermanHistory: Presented with a cataract. Clinical findings: Ca...
09/02/2025

What is your diagnosis ?
Case 6
Signalment:
2 year old Doberman

History:
Presented with a cataract.

Clinical findings:
Cataract visible
Due to the cataract the fundus is not visible Durgin ophthalmoscopy
As part of complete workup, an ultrasound is done
Lesion as seen on photograph [OU]
No ocular discomfort.
Intraocular pressure OS 18 mmHg OD 19 mmHg

07/02/2025

Another one of the Focus products that I think may have some ophthalmological impact is calmfocus. FHV is very much a stress driven condition when we think about recrudescent disease

26/01/2025

Case 5 Answer
Well done to all who got this one !!!
Lipid aqueous
This is not a specific condition, but rather one of the possible clinical signs of active uveitis. Lipid-laden aqueous is possible if the patient has concurrent hyperlipidemia in which the aqueous assumes a milky-white appearance.
The hyperlipideamia may be normal post prandial after eating a very fatty meal. True hyperlipidaemia can be either primary or secondary to other diseases. Secondary hyperlipidaemia is the most common form in dogs, and it can be a result of endocrine disorders, pancreatitis, cholestasis, protein-losing nephropathy and obesity. Primary hyperlipidaemia is less common in the general canine population but it can be very common within certain breeds. Hypertriglyceridaemia of Miniature Schnauzers is the most common form of primary hyperlipidaemia in dogs.
Lipid laded aqueous can occur very acutely, and the clinical appearance is dramatic with the entire anterior chamber appearing white. It is often misdiagnosed as corneal edema or a mature cataract in patient with mydriatic pupil.
Treatment is the same as the general treatment for uveitis combined with fasting for 12 hours or a low fat diet. If the lipemic aqueous is a recurrent event further investigation for an underlying cause resulting in recurrent lipemia is justified.

What is your diagnosis ? Case 5 Signalment: 5 year old SchnauzerHistory: Diabetic for the last 14 months under control ...
25/01/2025

What is your diagnosis ?
Case 5

Signalment: 5 year old Schnauzer

History: Diabetic for the last 14 months under control with insulin
Acute onset blindness. Dog was perfect the previous day. It was the owner's birthday and they had roast lamb. They “spoiled” the dog by giving him some leftovers after the meal.

Clinical findings:
Lesion as seen on photograph [OU]
Mild ocular discomfort.
Acute onset blindness
Schirmer tear test 17 mm/min
Cornea fluorescein negative.
Intraocular pressure OS 14 mmHg OD 11 mmHg

25/01/2025

Answer case 4
Feline geographic corneal ulcer
This is caused by Feline Herpes virus. It looks exactly like SCCED in dogs, but the treatment is completely different. Unlike dogs where a striate keratotomy is indicated in these cases striate keratotomies are contraindicated and in most may very often lead to secondary corneal sequestrum formation.
Treatment:
Debride the cornea using a dry cotton bud under topical anesthesia. It is very important to get rid of that very typical lip of unattached corneal epithelial cells. Without removing those cells these ulcers do not heal.
Topical antivirals. My product of choice is Cidofovir as this is only a q12h treatment compared to drugs like Idoxuridine that needs to be given q4h.
Chondroitin sulphate / High molecular hyaluronic acid. FHV affects the conjunctival goblet cells leading to qualitative KCS
Topical antibiotic as prophylactic.

What is your diagnosis ? Case 4Signalment: 6 year old Domestic shorthair catHistory: History of recurrent episodes of b...
24/01/2025

What is your diagnosis ?
Case 4
Signalment: 6 year old Domestic shorthair cat

History: History of recurrent episodes of bilateral conjunctivitis. Painful eye for the past 2 weeks

Clinical findings:
Lesion as seen on photograph [OD]
Ocular discomfort.
No visual deficits present.
Schirmer tear test 22 mm/min
Cornea fluorescein negative. Note the staining pattern.
Rest of ocular examination was normal.

Answer will be posted over the weekend

23/01/2025

Answer Case 3
Diagnosis: Limbal squamous cell carcinoma . Confirm diagnosis with cytology using a cytobrush under topical anesthesia.
Treatment
The ideal treatment for conjunctival / corneal SCC is surgical resection. However in very early cases like this topical mitomycin c may be curative.
0.04% MMC drops q 8 h) for a cycle of 7 days on followed by 7 days of. Repeat cycle three times.
Differential diagnosis
Corneal granulation

20/01/2025

Also a reminder that I have two complete online ophthalmology courses available. One small animal and one equine. For more info w app me 083 3089237 / email [email protected]
This is the Equine course breakdown. The small animal one more comprehensive I will forward exact breakdown to those interested.
Equine ophthalmology 2025
The course material include the following:
Complete set of notes [160 pages]
Narrated powerpoints on the following topics
Clinical Anatomy and Physiology [Part 1] 45 minutes
Clinical Anatomy and Physiology [Part 2] 44 minutes
Examination of the eye [Part 1] 37 minutes
Examination of the eye [Part 2] 40 minutes
Examination of the eye [Part 3] 48 minutes
Examination of the eye [Part 4] 26 minutes
Corneal disease [Part 1] 35 minutes
Corneal disease [Part 2] 30 minutes
Corneal disease [Part 3] 28 minutes
Corneal disease [Part 4] 44 minutes
Ocular neoplasia 44 minutes
Equine uveitis and recurrent uveitis [Part 1] 27 minutes
Equine uveitis and recurrent uveitis [Part 2] 43 minutes
Equine glaucoma 32 minutes
Equine ophthalmic surgery
Introduction to ocular surgery 16 minutes
Eyelid and third eyelid surgery 32 minutes
Corneal surgery 54 minutes
Anterior chamber and orbital surgery 15 minutes

Case 3Signalment: 6 Year Old WarmbloodHistory: “Weepy eye” Clinical findings: Lesion as seen on photograph [OD] Sl...
20/01/2025

Case 3
Signalment: 6 Year Old Warmblood

History: “Weepy eye”

Clinical findings: Lesion as seen on photograph [OD]
Slight ocular discomfort.
No visual deficits present.
Schirmer tear test 28 mm/min.

20/01/2025

Well done to to who got this one !!!!

Answer Case 2

Epithelial Inclusion Cyst

Epithelial inclusion cysts are a rare complication to corneal ulceration, erosion, or trauma. They are the result of epithelial cells becoming disorganized during healing. These cells form an epithelium-lined cyst.

Clinical signs: Fluid-filled, yellow corneal mass that protrude from the corneal surface. Keratitis surrounding the lesion is rare. No pain.
Treatment: In small cases not over the visual axis monitor the lesion. If enlarging, the only effective treatment is a superficial keratectomy.

What is your diagnosis? Case 2Signalment: 5-year-old Crossbreed dogHistory: History of previous corneal ulcer that heal...
19/01/2025

What is your diagnosis? Case 2

Signalment:
5-year-old Crossbreed dog

History: History of previous corneal ulcer that healed with topical treatment. Non painful slow growing growth on cornea.

Clinical findings:
Lesion as seen on photograph [OD]
No ocular discomfort.
No visual deficits present.
Schirmer tear test 20 mm/min
IOP 18 mmHg OU.
Cornea fluorescein negative.
Rest of ocular examination was normal.

19/01/2025

Case 1 Answer

Intracorneal hemorrhage

Etiology:
Corneal vascularization had to be present at some stage leaving so called ghost vessels.
Causes of corneal vascularization include keratoconjunctivitis sicca, corneal ulceration and superficial chronic keratitis.
Certain systemic diseases may play a role including: Diabetes mellitus and hyperadrenocorticism.

Diagnosis: Intracorneal haemorrhage is noted as light to dark red, focal, well-demarcated areas of free blood within the corneal stroma.
Intracorneal haemorrhage is associated corneal vascularization, including ghost vessels.
Lesion is not raised.
NB look for reasons for previous keratitis, Schirmer tear test is very important.

Treatment: Identification and treatment of other underlying ocular conditions.
Topical steroid [Prednisilone acetate / dexamethasone]
Tacrolimus / Cyclosporin if STT is reduced.

Prognosis:After resolution, long term effects include yellow-brown staining in the area of previous haemorrhage.
Corneal pigmentation may also occur in the area.

DD’s
Corneal neoplasia [hemangioma / hemangiosarcoma]
Corneal granulation
Hyphema

What is your diagnosis? Signalment: 9-year-old male Terrier cross.History: Few episodes of ocular discharge, dog had pr...
18/01/2025

What is your diagnosis?
Signalment: 9-year-old male Terrier cross.

History: Few episodes of ocular discharge, dog had previous “eye infections”. The eye became acutely red, as seen on the photograph.
No history of trauma.
Owner very certain this is not a slow growing lesion.

Clinical findings:
Lesion as seen on photograph [OD]
No ocular discomfort.
No visual deficits present.
Schirmer tear test 14 mm/min OU.
IOP 16 mmHg OU.
Cornea fluorescein negative.

Will post answer tomorrow

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Videos

Another one of the Focus products that I think may have some ophthalmological impact is calmfocus. FHV is very much a stress driven condition when we think about recrudescent disease

I have been absent for ages will start posting interesting ophthalmology related post again. Will start with a what is your diagnosis ? series over the weekend looking at some interesting clinical cases. I have also been involved at the development of some neutraceutical products am am very proud of the two ocular products. The fist one is LensFocus for the possible prevention of diabetic cataracts in DOGS. I have done some promotional material for owners and reception staff at veterrnarians I am attaching this video. If anybody want more technical info on the development of diabetic cataracts in dogs or why this product is not for cats contacxt me at [email protected] and I shall forward some interesting litterature.

It has been a very busy month with OP lectures etcetera but I am continuing with my diabetic cataract series. Here is part 4

Here is part three of the diabetic cataract series. This one is 7 minutes long. I am trying to keep these under 5 minutes but this one proved to be difficult in getting everything in 5 minutes !!. Please like these if you find them helpful.

As promised part 2 of diabetic cataracts looking at normal glucose metabolism in the lens and the pathophysiology of diabetic cataracts in both dogs and cats.

Part 1 of 4 of a look at diabetic cataracts. Each video is less than 5 minutes long

Lissamine Green. As requested I have prepared a short 3-minute slide show on the use of lissamine green in veterinary ophthalmology. Please feel free to contact me for more info or to leave a comment. I am also open for any suggestions for topics forfuture very short less than 5 minute presentations

Here is a short presentation 4 minutes 54 seconds on the use of fluorescein. If you like these very short presentations with tips and tricks let me know and I shall continue uploading them form time to time

Cyclosporin Episcleral Implant I have received several requests from vets asking how to implant these. I have prepared a very short 3-minute presentation on this topic.

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