1 Physiologic Changes Due to Aging

1-2 Eyelids

Senile ectropion

• Signs: Eyelid margins very lax, exposure of the globes and the conjunctiva
• Treatment: None or artificial tears or surgery (V to Y technique) if too pronounced and exposure keratitis

1-2 Lacrymal film

Quantitative or qualitative deficit

• Decrease in tear production with age (-0.4 mm/year)
• Signs: Discharge, ± conjunctivitis/keratitis
• Diagnosis: Rose Bengal, Schirmer tear test, TBUT)
• Treatment: Artificial tears, cyclosporine, …according to signs

1-3 Iris

Iris atrophy

• Signs: Rough edge of the pupil, thin iris (even with holes) ± photophobia
• Differential: Iris hypoplasia, coloboma, glaucoma, retina or neurologic conditions
• Treatment: None or Doggles if photophobia

1-4 Lens

Nuclear sclerosis

• Signs: Normal change of the lens, in dogs and cats older than 6 years, no/slight effect on vision (presbyopia in humans)
• Differential: Cataract (disorganisation of the lens fibres=opacity) with ± effect on the vision to be differentiated by indirect ophthalmoscopy and presence of fundus reflex
• Treatment: None

1-5 Vitreous

Vitreal degeneration

• Asteroid hyalosis, liquefaction
• Signs: Punctiform multifocal opacities in the vitreous, liquified vitreous, “floating bands”
• Differential: Inflammation (vitritis)
• Treatment: None or prophylactic retinopexy in breeds predisposed to retinal detachment

2 Physiologic Changes Due to Aging

2-1 Exophthalmia

• Causes
• Cellulitis/abscess
• Myositis (eosinophilic m./extra-ocular m.)
• Neoplasm (primary/secondary)
• Traumatism of the orbit (hematoma/fracture)
• Clinical signs:
• Exophthalmia, strabism, discharge, NM protrusion, conjunctival chemosis ± hyperhemia, ± corneal lesion
• Diagnosis approach:
• Physical and eye exam (fluorescein test), retropulsion
• Exam of the oral cavity
• Imaging: radiography, ultrasound
• Therapeutic approach
• Temporary treatment until the cause is known:
• Pain control
• Globe protection (lubrification, tarsorraphy) ± treatment of the corneal lesions
• If obvious cause → start an eatiologic treatment:
• Abscess: Systemic AB ± drainage, syst. NSAI
• Neoplasia

2-2 Eyelids

Eyelid tumors (meibomian gland)

• Signs: Mass(es) at the eyelid margin ±keratitis/conjunctivitis, benign
• Treatment: None or artificial tears or excision surgery if mass too big/ulcerated or if keratitis/conjunctivitis
• Surgical excision:

Principle

• “a minima” incision
• Start suturing at the edge of the eyelid’s margin
• Figure 8 stitch
• One suture layer, 3-0 or 4-0, nylon or silk (simple or cross pattern)

2-3 Cornea

2-3-1 Calcic Degeneration

• Signs: White deposits on/in the cornea, rough aspect of the cornea ± oedema, ulcer, inflammation
• Treatment:
• Artificial tears ± AB
• Corneal contact lens
• (Lamellar superficial keratectomy)

2-3-2 Endothelial Decompensation

• Endothelium ± epithelium = water pumps
• Endothelial cell density: 2500 c/mm² in dogs
• Decrease of density with age: 1900–2100 in 9 y.o. dogs and decompensation at 500–800
• Predisposed breeds: Dachshund, Boston terrier, chihuahua
• Signs: Corneal oedema ± severe
• Treatment:
• Non if focal and light si monitoring)
• Hyperosmotic ointment (Muro 128, NaCl 5%, BID to TID)
• Thermokeratoplasty if severe

2-3-3 Indolent Ulcer (Boxer Ulcer)

• Predisposed breeds: Boxer, Pekingese, Corgi, Lhasa Apso and others...
• Middle and old age, female
• Hemidesmosomes deficit, basal membrane defect, presence of an hyaline membrane.
• Signs: Epithelial loss of substance with « lips » avec des “lèvres”, local corneal oedema, conjunctivitis, blepharospasm, discharge, photophobia, usually unilateral
• Improvement, then relapse
• Diagnosis: From history but mainly by exclusion of other causes of non-healing
• Confirmation: Fluorescein stain (that will pass underneath the epithelial lips)
• Initial treatment:
• Antibiotics: Drops (tobramycin 0.3%) TID–QID
• Cycloplegic: Atropine 1% (not too frequent SID)
• Hyperosmotic ointment (Muro 128, NaCl 5%, BID)
• Serum (frequent)
• E-collar 24h/24 7d/7
• If no progress, following treatment:
• Contact corneal lens, collagen auto-dissolving lens (72hrs)
• Debridement with Q-tip
• Same medication
• Nictitating flap (tarsorrhaphy): No
• Partial eyelid suture (blepharorrhaphy) possible
•  If no progress, then:
• Topical anesthesia
• ± Sedation
• Debridement with Q-tip: scrapping of the non-attached epithelium
• If no progress, then:
• Superficial linear scarification (superficial linear keratotomy)

2-3-4 “Indolent” Ulcer in Cats

• Do not exist in cats
• Often associated with feline herpes virus type 1
• Avoid debridments
• Keratotomy not indicated

Important risk of corneal sequestrum

• Treat as a superficial ulcer

2-4 Glaucoma

• Main disease causing blindness in humans in the world
• Frequent condition in dogs (as in humans); prevalence of 1.7 to 2%
• Disease often diagnosed too late in our pets
• Age = important risk factor
• At any age, but onset around 6–7 years old
• Clinical suspicion: Decrease in vision
• Pain
• Mydriasis
• Scleral redness
• Increase of globe’s size
• Opacity of the cornea

Differential diagnosis:

• Red eye syndrome: conjunctivitis, keratitis, uveitis, episcleritis
• Exophthalmia
• Oedema of cornea: keratitis with or without ulcer uveitis, endothelial dystrophy
• Mydriasis: retinal atrophy, iris sphincter atrophy, optic nerve disease
• Tonometry: Confirmation of the clinical diagnosis
• Follow-up of treatment installed
• “Screening” for predisposed breeds
• This test should be part of a geriatric exam

Treatment objectives

As of today, there is no curative treatment for glaucoma.

Objectives of the therapy:

• Maintain vision and control the pain by reducing the IOP:
• Increase of the drainage of the AH
• Decrease the production of the AH
• Prevent and delay the onset of glaucoma in the contro-lateral eye

2-5 Lens

Cataract

• Disorganisation of the lens fibers = opacity
• With ± effect on vision
• At any age (congenital, juvenile...) by increase in frequency with age
• C50 at 9.4±3.3 years old
• C100 at 13.5 years old
• Differential: Nuclear sclerosis, vitreous degeneration differentiated by indirect ophthalmoscopy and positive fundus reflex

Refer as soon as possible in order to:

• Follow the progression of the cataract
• Avoid complications from cataract
• Choose the right time to perform

2-6 Retina

Hereditary diseases of the retina

• Various types: Progressive atrophy, rod/cones dysplasia
• Many breeds affected
• Often early signs but not diagnosed
• Diagnosis made in terminal phase, when animal is older
• Fundic exam ± electroretinogram for earlier diagnosis
• Treatment: Anti-oxidants: Ocu-glo

Degenerative diseases of the retina

• Sudden acquired retinal degeneration syndrome (SARDs)
• Female, 6 y.o. and older, Cushing
• Fundic exam: Normal
• Electroretinogram: Flat
• Treatment: None

Hypertensive retinopathy of cats

• Aged cats
• Ocular signs:
• Sudden blindness
• Dilated pupils barely or no reactive to light
• Tortuous retinal vessels
• Serous retinal detachment
• Vitreal and retinal hemorrhages
• Systemic signs:
• Systolic arterial blood pressure >160 mm Hg
• Cardiomegaly
• Chronic renal failure
• Hyperthyroidism
• Hyperglycemia
• Treatment
• Treat underlying cause
• Calcium channel blocker agents: Amlodipine 0.625 mg/animal/day

Conclusions

• Ocular diseases are frequent in aged dogs and cats.
• Importance of a complete eye exam to detect as soon as possible an ocular disease in order to put a prophylactic or a therapeutic treatment.
• Importance to take into consideration age, breed and health status of the animal in order to propose the adequate treatment for the diagnosed eye disease.