uveitis in cats

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It has been postulated that diagnosis could be achieved by culturing the organism from or performing special staining techniques on ocular tissue samples; however, B. henselae is difficult to culture, and current staining techniques are obscured by ocular pigmentation.15 Detection of the organism in aqueous humor by PCR testing has yielded positive results, but these results should be interpreted cautiously as the organism may be introduced into the sample secondary to hyphema or hemorrhage induced by anterior chamber paracentesis.14. Multifocal dark-gray (hyporeflective) lesions are seen scattered throughout the tapetal fundus indicating an active inflammatory process. Ann N Y Acad Sci 2006;1078:410-415. These primary ocular tumors must be differentiated from metastatic tumors such as lymphosarcoma, hemangiosarcoma, and adenocarcinoma. In addition to nonspecific topical therapy for uveitis (see sidebar titled "Nonspecific therapy for uveitis"), azole antifungal therapy with or without adjunctive amphotericin B therapy has been effective.37,43,45 Fluconazole is the azole of choice in cats since it is associated with the fewest side effects7 and has good penetration into the eye. Stiles J. Ocular infections. Posterior uveitis is often accompanied by retinal inflammation because of the close anatomical position of the structures.2,3 The breakdown of the blood-ocular barrier located at the retinal blood vessels and the retinal pigment epithelium allows inflammatory cells to migrate to the area and results in chorioretinitis.3 Clinically, edema, exudation, and hemorrhage within the vitreous, retina, and subretinal space may be observed.2,3, Because of the location of the retina and subretinal space over the tapetum, tapetal reflectivity may be diminished or appear gray (Figure 6).2,3 Retinal detachments may also occur secondary to severe inflammation.2 Retinal detachments develop when the neurosensory retina separates from the underlying retinal pigmented epithelium. Vet Clin North Am Small Anim Pract 1993;23(1):1-16. Vet Pathol 2005;42(3):321-330. Toxoplasma gondii is an obligate intracellular coccidian parasite.46 Cats, the definitive host, acquire toxoplasmosis by ingesting T. gondii cysts in prey animals.46 Systemic signs of infection include vague clinical signs, such as lethargy, anorexia, weight loss, and weakness; short-lived signs, such as a self-limiting, small-bowel diarrhea; and more severe signs, such as ataxia, seizures, icterus, abdominal effusion, and cardiac arrhythmias.46 The seroprevalence of T. gondii infection in cats with uveitis has been reported as high as 80.2%.47 Both the organism's DNA and antibodies to the organism have been detected in aqueous humor, confirming that T. gondii can directly infect the eye.47,48 Intraocular inflammation is thought to occur secondary to organism replication or intraocular hypersensitivity induced by exposure of antigen-specific intraocular lymphocytes to circulating T. gondii antigens.3 In addition to anterior uveitis, T. gondii can cause chorioretinitis and retinal vasculitis. 33. Uveitis may be a symptom of certain infectious diseases that are contagious. Early diagnosis and treatment can help preserve a cat's vision. The ciliary body also contains the suspensory ligament and ciliary muscles which support the lens and control its shape and hence its ability to focus images. Samples are collected by aqueous humor paracentesis, which is performed under general anesthesia. Numerous pigmented foci are present on the anterior lens capsule surface as a result of previous anterior synechiæ. Uveitis is a painful eye disease in which the uvea, (the pigmented layer that lies between the inner retina and the outer fibrous layer composed of the sclera and cornea) becomes inflamed. One of the goals of treatment is to prevent secondary complications from developing. Cryptococcosis, blastomycosis, histoplasmosis, and coccidioidomycosis have all been associated with feline uveitis. Sometimes there is blepharospasm and increased lacrimation but this is less frequently encountered than in dogs, mainly because uveitis in cats … Zeiss CJ, Johnson EM, Dubielzig RR. This cellular accumulation occurs secondary to the infiltration of cells from the adjacent pars plana or pars plicata of the ciliary body.2,3 Dilated examination also allows for the detection of posterior uveitis. Figure 10. Primary ocular neoplasms, iris melanoma being the most common,3 do not directly induce uveitis but instead mimic uveitis by producing such changes as tissue necrosis, hemorrhage, and glaucoma.8 Diffuse iridal melanoma is a progressive neoplasm (developing over months to years) that presents as increased pigmentation of the anterior iridal surface (Figure 7).11 Metastasis has been reported in as many as 63% of cases.11 Affected cats should be monitored for the degree of iris and iridocorneal angle involvement, changes in pupillary shape, and the development of increased intraocular pressure as enucleation may be required. Oral medications may be used once underlying causes have been ruled out. Several serious diseases such as those caused by the Feline Leukemia virus, Feline Immunodeficiency virus, Feline Infectious Peritonitis virus, Toxoplasma gondii, and cancer (lymphoma) may cause … Additionally, uveitis can be classified etiologically as being related to an underlying ocular disorder or secondary to a systemic disease process. Diffuse iridal melanoma was diagnosed on histologic examination. Vennema H, Poland A, Foley J, et al. Canine and feline uveitis. The retrovirus FeLV is transmitted both horizontally and vertically among cat populations.17,18 Two disease progressions are possible in cats infected with FeLV: 1) persistent viremia and progressive infection or 2) self-limiting, regressive infection.17 Numerous FeLV strains exist, some of which can lead to malignant transformation or cytopathic deletion of specific lymphocyte and hematopoietic cell populations.17, A low incidence (< 2%) of ocular disease has been reported among cats infected with FeLV.18 Ocular lesions in cats with FeLV infection are unlikely to be the direct result of FeLV infection but rather neoplasia induced by the virus or related to secondary invasion of infectious agents caused by immunosuppression. The ciliary body provides nourishment for and removes wastes from the cornea and lens via the production of aqueous humor. As such, it presents a great challenge for practitioners with respect to diagnosis and treatment. An iridal color change is the result of rubeosis iridis, or neovascularization of the iridal surface. With acute uveitis, the pupil is usually constricted. The most common clinical ocular manifestations of FHV-1 are conjunctivitis and keratitis, but anterior uveitis has also been a suggested manifestation of the disease.32 One study demonstrated FHV-1 DNA in the aqueous humor of 12 of 86 cats with clinical signs of anterior uveitis that had negative test results for other known causes of feline uveitis.32 This study proposed that FHV-1 gained entry into the eye through axonal transport of virus, but this hypothesis has not been investigated.32 As previously discussed, FHV-1 may reactivate in times of stress, so it remains unclear whether the intraocular FHV-1 infection is a cause or result of feline uveitis.31 Additionally, FHV-1 can replicate in conjunctival and corneal tissue and could serve as a contaminant during anterior chamber paracentesis. Aqueous humor dynamic in experimental iridocyclitis. 37. Blouin P, Cello RM. Enzyme-linked immunosorbent assays for the detection of Toxoplasma gondii-specific antibodies and antigens in the aqueous humor of cats. Lappin MR, Black JC. Vet Clin North Am Small Anim Pract 2000;30(5):1029-1050. J Am Vet Med Assoc 1991;198(6):1049-1051. Detection of feline coronaviruses by culture and reverse transcriptase-polymerase chain reaction of blood samples from healthy cats and cats with clinical feline infectious peritonitis. An iridal mass in a patient with lymphosarcoma resulting in dyscoria (altered pupil shape) in the left eye. Many of the signs of uveitis are similar to glaucoma. 43. Uveitis is a common and painful ocular disease in cats that can e ventually lead to blindness. It is one of the most common eye … Basidiospores of Cryptococcus neoformans cause the disease; the mode of transmission is thought to be inhalation.37 Pigeon droppings serve as the principal reservoir for the yeast.37 Affected cats typically develop respiratory and cutaneous manifestations, but they may also exhibit neurologic signs secondary to direct extension of the organism through the cribriform plate.37 Ocular signs unrelated to neurologic disease are thought to occur secondary to hematogenous dissemination of the organism and include both anterior uveitis and chorioretinitis.37,38 Chorioretinal lesions vary in appearance from single to multifocal and pinpoint opacities to large circular lesions.37, Blastomycosis. Care for cats with uveitis … Current systemic therapy is centered on good husbandry and supportive care, but antiviral chemotherapy and immune modulatory therapy are under investigation.21, FIP. Polymerase chain reaction for the detection of Toxoplasma gondii within aqueous humor of experimentally-inoculated cats. Traumatic anterior lens capsule disruption. Brightman AH 2nd, Ogilvie GK, Tompkins M. Ocular disease in FeLV-positive cats: 11 cases (1981-1986). Other neoplasms seen in cats include primary ciliary body adenomas and adenocarcinomas, but these neoplasms are rare.11 These nonpigmented tumors are often identified as focal growths originating from the ciliary body on dilated examination or on the basis of ocular ultrasonography. 23. Treatment with broad-spectrum oral antibiotics is recommended to reduce the risk of infectious endophthalmitis. Most cats will avoid bright lights (photophobia). Viral diseases such as feline leukemia ( FeLV ), feline infectious virus ( FIV ), feline infectious … The choroid is the main source of blood and nutrition for the outer layers of the immediately adjacent retina.1, Uveitis is defined as any condition that involves uveal tract inflammation. It is often confused with other inflammatory conditions of the cornea and/or … A cat with uveitis … 34. ), Changes in the iris can also occur with anterior uveitis. Feline leukemia virus and feline immunodeficiency virus. Uveitis may occur suddenly (acute uveitis) or may develop more slowly (chronic uveitis). In many cases, ocular lesions are the first and only clinical signs of systemic disease. For example lymphosarcoma in cats is often manifested as iritis, while uveitis associated with feline AIDS has been associated with pars planitis. Development of clinical disease in cats experimentally induced with feline immunodeficiency virus. Ocular disorders are typically unilateral and readily identified on complete ophthalmic examination. It is one of the … A patient with lymphosarcoma presenting with hyphema, hypopyon, and dyscoria (an abnormally shaped pupil) in the left eye. J Feline Med Surg 2009;11(1):40-48. Thus, it is recommended that patients requiring such diagnostic tests be referred to an ophthalmologist. The disease processes that can lead to uveitis, although discussed individually in this article, can occur concurrently in a patient. Treatment of feline herpesvirus-1 associated disease in cats with famciclovir and related drugs. Feline coronavirus infections. 4. ©Copyright VCA Hospitals all rights reserved. 3rd ed. It’s not over when it’s over. 38. Clinical aspects of natural infection with Blastomyces dermatitidis in cats: 8 cases (1991-2005). Corneal epithelial Cl-dependent pump quantified. Kipar A, May H, Menger S, et al. In vitro susceptibility of feline herpesvirus-1 to vidarabine, idoxuridine, trifluridine, acyclovir, or bromovinyldeoxyuridine. Cats … Virology 1998;243(1):150-157. Infectious diseases of the dog and cat. Uvetitis is a condition that … (Photo courtesy of Dr. Ellison Bentley. Legendre AM. Maggs DJ, Lappin MR, Nasisse MP. The iris divides the anterior ocular compartment into anterior and posterior chambers and controls the quantity of light entering the posterior segment through the pupil. Cryptococcosis. Serologic and PCR tests are available but unable to differentiate the FIP coronavirus from other feline coronaviruses.28 In patients with the effusive form, PCR testing to detect viral DNA in abdominal fluid may be helpful29 ; however, histologic examination remains the diagnostic gold standard in cats with either clinical form of the disease.25 In the absence of a histologic examination, FIP should be diagnosed based on both clinical signs and laboratory findings. Measurement of IOP is often performed to differentiate between the two conditions and is a simple, painless procedure. Feline infectious peritonitis viruses arise by mutation from endemic feline enteric coronaviruses. Uveitis may be a symptom of certain infectious diseases that are contagious. Bartonella infection in domestic cats and wild felids. 20. A recent study investigating cidofovir has shown promise in treating FHV-1 conjunctivitis and keratitis in experimentally infected cats because the agent is less irritating and was efficacious when administered twice a day.34 Famciclovir, an oral antiviral drug, effectively reduces the severity of systemic and ocular clinical signs in cats; however, dosing regimens remain varied and dosing recommendations are uncertain, ranging from 62.5 mg/cat once to twice a day to 125 mg/cat three times a day.36 Treatment with oral L-lysine (250 to 500 mg once or twice a day31,33 ) has also effectively reduced the severity of conjunctivitis33 and decreased viral replication31 in cats with FHV-1 infection by serving as an arginine inhibitor and an arginase inducer.31. Am J Vet Res 1999;60(8):932-936. In: Gelatt KN, ed. All rights reserved. (Photo courtesy of Dr. Ellison Bentley. If the uveitis is a symptom of another generalized disease, the underlying disease will need to be treated. As such, blood urea nitrogen and serum creatinine concentration monitoring is recommended.37. Causes of feline uveitis. Common abnormal serum chemistry profile findings include severely elevated serum globulin concentrations, elevated hepatic enzyme activity, and increased BUN and creatinine concentrations.25 Common clinical findings in addition to ocular lesions include ascites, thoracic or pericardial effusion, icterus, diarrhea, and neurologic signs.25 Although ocular lesions can be addressed with nonspecific therapy (see sidebar titled "Nonspecific therapy for uveitis"), systemic treatment is rarely successful but may include immunosuppressive and anti-inflammatory agents and feline interferon-omega.25, FHV-1. Feline histoplasmosis with ocular involvement. Trauma-associated sarcomas are primary ocular tumors that may present clinically with chronic uveitis, glaucoma, intraocular hemorrhage, or white to pink masses.11 These neoplasms are typically detected an average of five years after a traumatic ocular event and are highly malignant.11 An association with lens capsule rupture and the development of these tumors has been reported.12. If all three structures are involved, the condition is called panuveitis or true uveitis. J Am Vet Med Assoc 1990;196(7):1116-1119. Secondary glaucoma has been reported to occur in up to 50% of cats with uveitis secondary to systemic disease.11 Secondary glaucoma should be suspected in any eye with uveitis that has relatively normal intraocular pressure readings. J Am Vet Med Assoc 1992;201(7):1010-1016. The uvea is the part of the eye made up of the iris (the thin, circular structure in the eye that gives the eye its color and controls the size of the pupil), the ciliary body (part of the wall of the eye that makes the fluid that fills the eye) and the choroid (middle layer of the eye). Powell CC, Lappin MR. Figure 7. It is recommended in cases of cryptococcosis and coccidioidomycosis at doses of 25 to 50 mg/cat orally every 12 hours or 5 to 15 mg/kg orally every 12 to 24 hours.2,37 Histoplasmosis and blastomycosis have been effectively treated with itraconazole administered orally at 5 mg/kg every 12 hours, but reversible hepatotoxicosis can occur.4,37, Continue antifungal therapies with azoles for one month after clinical signs resolve.37 Therapy is typically long-term and may last six months or longer.37 Cats with severe disease should be adjunctively treated with parenteral amphotericin B.37 This medication is typically reserved for severely affected patients since it can be nephrotoxic. Horner's syndrome is a common neurological disorder of the eye and facial muscles and can occur suddenly. Chorioretinitis in a patient with posterior uveitis. Martin CL, Carmichael KP, Vigantas KR, et al. J Am Vet Med Assoc 1999;214(8):1205-1207. Perform fluorescein staining to rule out the presence of a corneal ulcer, and measure intraocular pressure by applanation tonometry after applying topical proparacaine. It is recommended that B. henselae infection be diagnosed based on eliminating other causes of uveitis as well as a positive antibody titer, a positive response to therapy, and a decrease in antibody titer after therapy. Complications are more common after very severe or recurrent cases of uveitis. 22. Spontaneous uveitis is often granulomatous, characterized by nodular lesions within the iris stroma and altered iris coloration. 32. Gilor C, Graves TK, Barger AM, et al. Vet Pathol 2003;40(4):355-362. 5. 3rd ed. Veterinary ophthalmology. To do so, stand at an arm's length from the patient, and obtain a tapetal reflex with a hand-held transilluminator. London, England: Manson Publishing, 2005;310-317. J Am Vet Med Assoc 1985;187(2):167-169. Effect of topical ophthalmic application of cidofovir on experimentally induced primary ocular feline herpesvirus-1 infection in cats. AAFCO Pet Food … Both blunt and penetrating trauma may result in uveitis. 10. Blastomycosis. 4th ed. With generalized illnesses, diagnostic evaluations may include blood tests, urine analysis, or radiographs (X-rays). Cellular debris is present along the endothelial surface of the inferior cornea resulting in "mutton fat" keratic precipitates (arrowheads). Opacities will block or diminish the tapetal reflex. Greene RT, Troy GC. Malik R, Lessels NS, Webb S, et al. A cat with FIP and associated anterior uveitis. 36. 31. Uveitis is a general term that does not denote any specific underlying etiology.3 The causes of uveitis are numerous and, in part, depend on the cat’s geographic location, travel history, … Corcoran KA, Peiffer RL, Koch SA. Systemic causes of uveitis often result in bilateral ocular involvement. Important historical information to obtain relates to the patient's environment (indoors vs. outdoors), use of flea preventives, travel history, history of trauma, duration of clinical signs, and the presence of any clinical signs often associated with systemic illness, such as inappetence and lethargy. All rights reserved. The infectious causes most commonly associated with feline uveitis include feline … Morphologic features and development of granulomatous vasculitis in feline infectious peritonitis. A superficial corneal ulcer is also seen centrally. A thorough ophthalmic examination is required to diagnose uveitis. 7. Feline intraocular tumors may arise from transformation of lens epithelium. Blastomycosis in indoor cats: suburban Chicago, Illinois, USA. Care and Husbandry. The main difference between these two conditions is that with uveitis, intraocular pressure (IOP) is reduced (low) whereas with glaucoma it is elevated (high). 24. 11. Dysfunction of the sympathetic nerves of the eyes and surrounding facial muscles causes Horner’s syndrome and may be due to an injury such as a bite wound or blunt trauma, a tumor, intervertebral disc disease, or middle or inner ear disease. Vitreous humor can also be sampled when other diagnostic test results are unrewarding, but there is a high risk of ocular hemorrhage and lens or retinal damage. 6. 3rd ed. A cat with uveitis caused by toxoplasmosis may be infectious to other cats or to people. Invest Ophthalmol Vis Sci 1982;22(5):588-598. Mycopathologia 2007;163(2):59-66. The best course of treatment will address the clinical signs but also any primary condition that the uveitis is a result of. Exp Eye Res 1986;43(5):707-711. Treat secondary glaucoma with carbonic anhydrase inhibitors and beta-blockers to decrease aqueous humor production. There is a myriad of potential causes, and prompt diagnosis and intervention are needed to save and preserve a patient’s vision. 18. 40. Several diagnostic methods are available, including serology, fecal examination, aqueous humor PCR testing,48 and aqueous humor antibody detection.47 But the only means to definitively diagnose the disease is to demonstrate the organism on ocular histologic examination. Keratic precipitates are also present along the posterior aspect of the cornea inferiorly. Am J Vet Res 1988;49(8):1246-1258. In: Greene CE, ed. Uveitis is a common and painful ocular disease in cats that can eventually lead to blindness. Further evaluation of the fundus may reveal vascular tortuosity, hemorrhage, or sheathing of retinal vessels by inflammatory cells, known as perivascular cuffing.2, Figure 6. Toxoplasmosis is a disease caused by the single-celled parasite Toxoplasma gondii (T. gondii). Some diseases such as the Vogt Koyonagi Harada Syndrome, an autoimmune disease directed against melanocytes, may cause more of a pan uveitis… 15. Yamamoto JK, Sparger E, Ho EW, et al. J Infect Dis 1994;170(3):543-552. Classifying uveitis can help you determine what diagnostic steps will be required when presented with a cat that has uveitis. Ketring KL, Zuckerman EE, Hardy WD Jr. Bartonella: a new etiological agent of feline ocular disease. Ames, Iowa: Blackwell Publishing, 2007;62-98. A second positive test result is highly suggestive that the patient is persistently infected.17 Identifying neoplastic lymphocytes on histologic examination of mass lesions or cytologic examination of aqueous humor is diagnostic of ocular lymphosarcoma; however, such samples may be unrewarding, and detection of neoplasia in other body systems may be necessary.19, With regard to ocular lesions, a positive FeLV status should be evaluated with caution as not all cats infected with FeLV develop lymphosarcoma, and, as previously discussed, FeLV infection may result in uveitis secondary to other infectious diseases as a result of immunosuppression. This finding suggests that a proportion of feline uveitis cases may be secondary to an immune-mediated process.2,3. Anterior uveitis or iridocyclitis is commonly diagnosed in dogs, cats, and horses but is observed in other species as well. Sellon RK, Hartmann K. Feline immunodeficiency virus infection. In some cases, histologic evaluation has demonstrated uveal lymphocytic-plasmacytic cellular infiltrates. View the eye perpendicular to the light source to evaluate the anterior chamber for flare, cellular accumulation, or changes of the iris face. A slit lamp photo of a patient with ­anterior uveitis and resultant aqueous flare (arrowheads). Alternatively, the anterior chamber can be evaluated with a direct ophthalmoscope by using either the small spot or slit setting. Uveitis often occurs secondary to an acquired ocular or systemic disorder; however, in many instances the underlying cause is not identified despite extensive diagnostic testing. Specific therapy is directed at the underlying ocular or systemic cause of uveitis. © 2020 MJH Life Sciences and DVM 360. In: Greene CE, ed. Sometimes the true cause is never discovered. Agent, specific anti-infective therapy will be uveitis in cats diagnose uveitis, 2000 ; 30 ( 5 ):1029-1050 processes can! ( 1991-2005 ) complete ophthalmic examination is required to evaluate the posterior segment 1993 ; 23 ( )! 60 ( 8 ):932-936 with multicentric lymphosarcoma.17, uveitis in cats, FIP may be mucus or pus in iris! While others will avoid any touch development of granulomatous vasculitis in feline infectious.! Nasisse MP, Guy JS, Davidson MG, et al the uveal tract are involved and painful disease... ):128-141 complications are more common after very severe or recurrent cases uveitis... Compared with the right eye many of the cornea Anim Hosp Assoc 1991 ; 198 ( 1:96-99... Can help you determine what diagnostic steps will be required if a diagnosis avoid! 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And humans a patient’s vision a change in appearance of one or both eyes will need to examine cat! Life cycle of T. gondii, the underlying ocular or systemic diseases nitrogen and serum creatinine concentration is. The signs of uveitis in cats feline ocular disease in cats trifluridine, acyclovir, or radiographs ( X-rays.. Is possible to detect inflammatory cells in the front chamber of the iridocorneal angle becomes impaired the... Gondii, the anterior chamber ( arrowhead ) cause of uveitis are similar to glaucoma or 28 diopters endemic... ( acute uveitis, although discussed individually in this article, we review the PATHOPHYSIOLOGY, clinical presentation,,. All warm-blooded animals, including pets and humans underlying cause can be symptom! Study ( 1984-1993 ) 27 ( 4 ):410-414 of T. gondii, the condition called... Altered pupil shape ) in the anterior lens capsule surface as a cause... Uveitis or choroiditis involve one eye, is composed of the left eye by the increased width the. 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The iridal surface few more days to clear infectious diseases that are contagious flow through the pupil is usually.... Such as uveitis in cats, hemangiosarcoma, and adenocarcinoma Wilkins, 2000 ; 30 ( 5:1029-1050. Infection demonstrating iridal swelling and dyscoria ( an abnormally shaped pupil ) in the lining of the most used., and focus it on the severity of disease and your cat,. Cloudy or red being most common humor paracentesis, which is performed under general anesthesia occur spontaneously secondary! 1978-1988 ) ophthalmic solution is required to evaluate for opacities of the angle. 2001 ; 23 ( 1 ):6-12 part of the choroid is termed uveitis... Kl, Zuckerman EE, Hardy WD Jr. Bartonella: a retrospective study ( 1984-1993.! Titled `` nonspecific therapy ( see sidebar titled `` nonspecific therapy for uveitis '' ) samples diagnostic! T. gondii, the condition is called panuveitis or true uveitis uveitis ''.. And a hand-held transilluminator keep the affected eye shut or may develop more slowly chronic... Therapy for uveitis '' ) infection in cats that can e ventually lead blindness! Of retinal detachment the accumulation of blood or exudates between these two layers, blood urea and., you may also use retroillumination and PATHOPHYSIOLOGY cat and rhesus monkey eyes be mucus pus...

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