The precorneal tear film in horses: its importance and disorders

Preliminary observations on tear film interferometry performed in horses

This retrospective study evaluated tear film (TF) interferometry on horses examined in Northern Italy in 2019-2021. The objectives were to evaluate horses affected by keratitis, and to describe TF values in horses with no evidence of ocular disease. All horses received a complete ophthalmic examination and were examined with the Ocular Surface Analyser, Veterinary-setting, prior to eye manipulation, staining and sample collection. Eighteen horses with no evidence of ocular disease were included in the comparison group. Additionally, 46 horses displaying signs of keratitis (neovascularization, corneal opacities, ulceration, epithelial and subepithelial infiltrates) were evaluated. These horses were divided into presumed non-infectious and infectious or presumed infectious keratitis groups (one with proven bacterial origin, and the others with diagnosed or presumptive keratomycosis) with the former including immune-mediated keratitis. From the observations of TF interferometry in the comparison population the authors concluded that for non-invasive break-up time (NIBUT), the estimated preliminary reference interval was 10.4-31.2s, and for tear meniscus height (TMH), it was 0.215-0.457mm. Moreover, within the keratitis population, from an interferometric point of view punctate lesions of the ocular surface were present in all cases of active diagnosed or presumptive subepithelial keratomycosis but not in any of the non-infectious cases, either non-ulcerative or ulcerative. Limitations of the study include a relatively low number of horses examined and the fact that the diagnosis of infectious keratitis was presumptive and based on clinical improvement after treatment in some cases. To the authors' knowledge, this is the first report of TF interferometry performed in horses.

Anatomical, Histological and Histochemical Observations of the Eyelids and Orbital Glands in the Lowland Tapir (Tapirus terrestris Linnaeus, 1785) (Perissodactyla: Ceratomorpha)

The lowland tapir is one of four species belonging to the Tapiridae family of the Ceratomorpha suborder, similar to Rhinocerotidae. This study describes anatomy with morphometry, histology (hematoxylin and eosin, Masson-Goldner trichrome, Movat pentachrome, mucicarmine, picro-Mallory trichrome) and histochemistry (PAS, AB pH 1.0, AB pH 2.5; AB pH2.5/PAS and HDI) of the upper and lower eyelids, and superficial gland of the third eyelid with the third eyelid, deep gland of the third eyelid, and lacrimal gland. The aim of the work is to show the features of the above-mentioned structures typical only for Tapiridae, as well as to show the presence of similarities and differences between the families forming the order Perissodactyla. The eyelashes on the upper eyelid were long, while those of the lower eyelid were short and much less prominent. In the upper and lower eyelid sebaceous glands, a characteristic simple alveolar gland producing a mucus-like secretion and poorly developed tarsal glands were observed. The marginal zone of the posterior surface of the eyelids was covered by stratified columnar epithelium with 18-21 layers of nucleated cells, while the bulbar zone of these surfaces was covered by cubic multilayer epithelium with 6-11 non-keratinized layers of cells and with sparse goblet cells. In only lower eyelids, numerous lymphoid nodules, diffuse lymphocytes and high endothelial venules were observed. The superficial gland was an acinar complex which secreted mucous and contained plasma cells within the interlobular and interlobular connective tissue. The upper and lower branches of the third eyelid were the shape of a bent "caudal fin" and were composed of hyaline cartilage, and they contained conjunctiva associated lymphoid tissue (CALT). The deep gland was also an acinar complex producing a serous character and having numerous diffuse lymphocytes. The lacrimal gland was an acinar complex producing seromucous secretions and had numerous plasma cells located in the glandular interstitium. The results of our research indicate that the features of the anatomy of the eyelids and orbital region in the lowland tapir are also typical of the family Tapiridae, but also have features common to the families Equidae and Rhinocerotidae. We confirm the presence of poorly developed tarsal glands in both eyelids as well as presence of a palpebral part of the lacrimal gland in the upper eyelid, which is typical only to Tapirus terrestris.

Ultrasound, Dacryocystorhinography and Morphological Examination of Normal Eye and Lacrimal Apparatus of the Donkey (Equus asinus)

The study investigated normal macromorphological and ultrasonographic features of the eye and lacrimal gland, as well as normal dacryocystorhinography of the donkey (Equus asinus) in Egypt. A total of 36 donkeys of different ages, weights, and sexes were included in the study: 21 live animals for ultrasonography and dacryocystorhinography, and 15 cadaver skulls for morphological anatomy of the lacrimal apparatus. The ultrasound biometric values of the eye were 33.7 ± 1.7 mm for axial globe length (AGL), 39.8 ± 2.1 mm for globe diameter (GD), 10.8 ± 0.7 mm for lens thickness (LT), 3.2 ± 0.7 mm for anterior chamber depth (ACD), and 19.3 ± 1.6 mm for vitreous chamber depth (VCD). The lacrimal gland was recognized as a hypoechogenic structure with an anechoic core, located at the dorsolateral aspect of the orbit, and ovoid in shape. The mean NLD length was 193.0 ± 9.8 mm by radiography and 206.0 ± 20.4 mm by gross assessment. One NL orifice (NLO) was noticed on each side, with a diameter of 3.0 ± 0.1 mm and located 12.1 ± 2.1 mm from the dorsal commissure of the nostril. These results may act as the baseline for proper management of conditions of the eye and lacrimal apparatus in the donkey in the future.

The Impact of Surgical Excision of the Orbital Lacrimal Gland on the Aqueous Tear Production and Ocular Surface Health in Donkeys (Equus asinus)

The exact contribution of the orbital lacrimal gland (OLG) is unknown and is still a subject of debate and inconsistency in literature. Currently, there are no detailed studies addressing the influence of the OLG removal on tear production in equines. This study aimed to address the influence of surgical excision of the OLG on aqueous tear production and ocular surface health in donkeys. The study was conducted on six clinically healthy donkeys with no ophthalmic abnormalities. In each donkey, the OLG of the left eye was surgically excised, whereas the right eye was served as a control. External ophthalmic examination, Schirmer tear test (STT) I and II, tear pH, fluorescein staining test were conducted on both eyes, preoperatively and at one-week intervals for 60 days, postoperatively. There were significant decreases in STT I and II values (P = .0001 and .0001, respectively), whereas tear pH values showed a significant increase (P = .0001) in the operated eyes compared with the control ones. There were no overt clinical signs characteristics of keratoconjunctivitis sicca (KCS) in the operated eyes. However, there was evidence of microinjury of the keratoconjunctival epithelium evidenced by positive fluorescein uptake, postoperatively. Surgical excision of the OLG significantly diminished the aqueous tear production and threatened the corneal epithelium as a result of corneal dehydration. On the contrary to the recommendations of other studies, eyes subjected to this procedure should receive treatment of dry eye to prevent development of KCS, postoperatively.

Aquaporin 1 (AQP1) Expression in Healthy Dog Tears

Simple Summary

The characterisation of tear proteins is very important for scientists and clinicians, as it enhances their understanding of ocular physiological phenomena that sometimes evolve into diseases. Recently, ophthalmic research has been focused on aquaporins (AQPs), a family of water channel proteins that are largely ubiquitous in body tissues and are known for their role in water and small solute transport across cell membranes. Based on AQPs’ presumable role in the eye, the aim of the present study was to investigate the expression of aquaporin-1 (AQP1) by Western blot analysis in canine eye tears. To this end, we collected tears from both eyes of 15 healthy dogs by employing two tear collection methods: Schirmer tear strips (STS) and ophthalmic sponges (OS). Moreover, ocular parameters such as Schirmer tear test 1 (STT 1), intraocular pressure (IOP), and tear film break up time (BUT) were measured, and fluorescein and lissamine green staining were performed to uncover possible correlations among the aforementioned parameters. Our results showed that the expression of AQP1 in tears collected by both methods and expressed as multiple bands (measured by densitometry) was higher for the tears collected by OS than for those collected by STS. This work forms the basis of future studies aiming to understand and establish the involvement of AQPs in the production and secretion of tears.

Abstract

Aquaporins (AQPs) are a family of thirteen membrane proteins that play an essential role in the transport of fluids across the cell plasma membrane. Recently, the expression of AQPs in different ocular tissues and their involvement in the pathophysiology of eye diseases, have garnered attention. Considering that literature on AQP expression in the lacrimal glands and their secretion is scarce, we aimed to characterise AQP1 expression in the tears of healthy dogs using two tear collection methods (Schirmer tear strips (STS) and ophthalmic sponges (OS)). Fifteen healthy dogs, free of ophthalmic diseases, were included in the study. Tear collection was performed by using STS in one eye and OS in the other. After the extraction of proteins from the tears, the expression of AQP1 was analysed by Western blotting. AQP1 was expressed as a band of 28 kDa. In addition, differences were observed in the expression of AQP1 and in the correlation between tear volume and protein concentration, in tears collected by the two different methods. Our results suggest that AQP1 has a specific role in tear secretion; further research is required to assess its particular role in the function of the ocular surface in eye physiology and pathology.

Impression cytology as diagnostic tool in horses with and without ocular surface disease

BACKGROUND

Cytology plays a major role in the diagnosis of ocular surface diseases.

OBJECTIVE

To compare 2 cytological sampling methods for obtaining corneal and conjunctival cell samples regarding irritation for the patient, invasiveness, sample quality and diagnostic equivalence.

STUDY DESIGN

Observational prospective study.

METHODS

In 5 healthy horses, conjunctival and corneal samples were taken bilaterally by impression cytology sampling (ICS) and cytobrush sampling (CBS). Irritation and invasiveness were assessed with an eye irritation and an epithelial damaging score system, respectively. Sample quality was evaluated via morphometric analysis and graded by a board certified clinical pathologist. For the assessment of diagnostic equivalence, 15 eyes of 14 client owned horses with ocular surface anomalies were sampled by ICS and CBS. The methods were compared regarding the types of inflammatory cells and/or infectious agents detected and if the correct diagnosis could be achieved. Histopathology served as gold standard when available.

RESULTS

ICS was significantly less invasive and less irritating for the horses. Both methods retrieved cells of overall high quality; the cell quantity was significantly higher in IC samples. ICS preserved the natural cellular layout. There was a fair, but no statistically significant agreement between the diagnostic outcomes between sampling methods although CBS resulted in a slightly greater variability of inflammatory cell types compared to ICS.

MAIN LIMITATIONS

None.

CONCLUSIONS

Because of its low irritability and invasiveness ICS can be recommended for cell sampling in fragile corneas and for experimental studies. ICS is especially useful in cases where preservation of cellular layout is advantageous. CBS samples are easier to obtain because of the small equine palpebral fissure. Additionally, the identification of inflammatory cells within conjunctival cell samples is easier. Overall, CBS is still an appropriate method in clinical settings.

Baseline assessment of ophthalmic parameters in the greater one-horned rhinoceros (Rhinoceros unicornis)

Five healthy captive greater one-horned rhinoceroses (Rhinoceros unicornis) were evaluated with standing sedation (detomidine hydrochloride 20-30 mg and butorphanol tartrate 50-60 mg per animal) to determine baseline values for tear production, intraocular pressure (IOP), conjunctival flora, and ocular anatomy using brightness mode transpalpebral ultrasonography with a 4- to 7-MHz broadband curvilinear transducer. The mean Schirmer tear test I value was 18.2 ± 3.49 mm/min. The mean IOP measured using applantation tonometry was 31.2 ± 6.62 mm Hg. Ocular biometry measurements were the following: axial length 2.61 ± 0.11 cm; corneal thickness 0.13 ± 0.01 cm; anterior segment depth 0.28 ± 0.06 cm; lens depth 0.70 ± 0.11 cm; and posterior segment depth 1.46 ± 0.13 cm. These values indicate that the globe is smaller than that of the domestic horse. All eight conjunctival swabs cultured bacterial and fungal microorganisms, with the most common being Staphylococcus spp. (57%). All bacterial isolates were considered to be commensal organisms due to the presence of mixed bacterial populations and lack of clinical signs of ocular disease. The data collected in this study should provide veterinarians with baseline information to assist in the diagnosis of ophthalmic conditions in the greater one-horned rhinoceros.

Keratoconjunctivitis sicca attributable to parasympathetic facial nerve dysfunction associated with hypothyroidism in a horse

CASE DESCRIPTION

A 6-year-old 680-kg (1,496-lb) German Warmblood gelding was evaluated because of bilateral blepharospasm and head shaking.

CLINICAL FINDINGS

Moderate blepharospasm was evident bilaterally, and both eyes had hyperemic and edematous conjunctivas and lusterless corneas. For each eye, the Schirmer tear test value was only 7 mm/min. The horse's nasal mucosa was dry. Abnormal behaviors included mild repetitive vertical movement of the head, snorting, and flehmen response (classic signs of head shaking). Touching the horse's nostrils and face revealed paresthesia and dysesthesia with slight nasolabial muscle hypertrophy bilaterally. Cranial nerve examination revealed no other abnormalities. Serum thyroxine concentration was low, and results of thyrotropin-releasing hormone and thyroid-stimulating hormone stimulation tests were negative, indicating that the horse had hypothyroidism. The diagnoses included keratoconjunctivitis sicca and dry nares attributable to parasympathetic facial nerve dysfunction, head-shaking syndrome with paresthesia and dysesthesia of the face attributable to sensory trigeminal nerve disorder, and hypothyroidism. The 2 nerve dysfunctions were considered peripheral neuropathies that were most likely caused by hypothyroidism.

TREATMENT AND OUTCOME

Treatment of both eyes was initiated with topical applications of cyclosporine, 0.5% sodium hyaluronate, and vitamin A ointment. Levothyroxine (20 microg/kg [9.1 microg/lb], PO, q 24 h) was administered. Within 3 weeks to 4 months, serum thyroxine concentration was within reference range, and clinical signs and Schirmer tear test values improved.

CLINICAL RELEVANCE

Hypothyroidism should be considered as a differential diagnosis in horses with peripheral neuropathy or keratoconjunctivitis sicca. In affected horses, administration of levothyroxine may lead to resolution of neurologic signs.

Proteinases of the cornea and preocular tear film

Maintenance and repair of corneal stromal extracellular matrix (ECM) requires a tightly coordinated balance of ECM synthesis, degradation and remodeling in which proteolytic enzymes (proteinases) perform important functions. There are natural proteinase inhibitors present in preocular tear film (PTF) and cornea simultaneously with proteinases that prevent excessive degradation of normal healthy tissue. Disorders occur when there is an imbalance between proteinases and proteinase inhibitors in favor of the proteinases, causing pathologic degradation of stromal collagen and proteoglycans in the cornea. Two matrix metalloproteinases (MMPs), MMP-2 and MMP-9, are of major importance in terms of remodeling and degradation of the corneal stromal collagen. Immunohistochemical studies have shown different origins of MMP-2 and -9. MMP-2 is synthesized by corneal keratocytes and performs a surveillance function in the normal cornea, becoming locally activated to degrade collagen molecules that occasionally become damaged. Alternatively, MMP-9 may be produced by epithelial cells and polymorphonuclear neutrophils following corneal wounding. Because the cornea is in close contact with the preocular tear film (PTF), proteinases have been evaluated in the PTF. In damaged corneas, total proteolytic activity in the tear fluid was found to be significantly increased compared to normal eyes and contralateral eyes. Studies analyzing the proteolytic activity in serial PTF samples during corneal healing led to the following conclusions: ulcerative keratitis in animals is associated with initially high levels of tear film proteolytic activity, which decrease as ulcers heal; proteinase levels in melting ulcers remain elevated leading to rapid progression of the ulcers. The success of medical and surgical treatment of the corneal ulcers is reflected by the proteolytic activity in tears. In animals, successful treatment leads to a rapid reduction in tear film proteolytic activity that corresponds with the improvement in the clinical signs of corneal ulceration. The in vitro effects of various compounds on proteolytic activity in the tear fluid of animals with ulcerative keratitis have been evaluated and their important inhibitory effects have been confirmed. Because these various compounds utilize different mechanisms to inhibit various families of proteinases, a combination of these proteinase inhibitors may be beneficial.

Constant rate infusion for topical ocular delivery in horses: a pilot study

OBJECTIVE

To assess the efficacy and kinetics of a continuous infusion modality for topical ophthalmic drug delivery via subpalpebral lavage in horses.

ANIMALS STUDIED

Five ophthalmically normal horses

PROCEDURES

A constant-rate continuous delivery pump was used to apply 0.01% fluorescein solution to the eyes of five ophthalmically normal horses via subpalpebral lavage. Fluorescein was applied at a rate of 0.14 mL/h for 72 h. Tear samples were collected from the ventral conjunctival fornix at regular intervals via capillary tube and tear fluorescein concentrations were determined via spectral assay. Laboratory studies to evaluate the procedures used in the study also were performed.

RESULTS

Overall mean tear film fluorescein concentration was approximately 20% of the applied concentration of fluorescein. However, tear film fluorescein concentrations varied considerably between horses and over time. Dilution varied from 0.62% to 60% of the applied concentration. Air pockets sporadically appeared in subpalpebral lavage tubing lines, resulting in discontinuous topical application of fluorescein.

CONCLUSIONS

Constant-rate delivery of ophthalmic medications using a continuous infusion pump may provide a valuable method of topical drug delivery if tear film dilution of drugs is taken into account.

Tear urea nitrogen and creatinine levels in horse and their correlation with serum values

The objective of this paper was to determine the physiological values of urea nitrogen and creatinine in tears, and to compare the results with those obtained from serum. Thirty healthy thoroughbred horses were included in the study. Tear fluid samples were obtained using a glass capillary tube placed in lower conjunctival cul-de-sac. Blood samples were taken from the jugular vein. Tear and serum urea nitrogen and creatinine levels were quantitatively analyzed by an enzymatic colorimetric method. Urea nitrogen values were 4.22+/-1.84 mmol/l in tears and 4.44+/-1.78 mmol/l in serum, whereas creatinine values in tears were 14.14+/-7.74 micromol/l and in serum 147.63+/-12.17 micromol/l. Statistical analysis confirmed a significant correlation between serum and tear urea levels (P<0001). However, there was no significant correlation between blood and tear creatinine values. Mean value of creatinine obtained from tears was 9.6% of the mean value from serum. Urea nitrogen and creatinine levels can be measured in tears. A significant correlation was found between serum and tears urea levels. This finding may permit development of a new alternative laboratory diagnosis of uremia based on the content of urea in tears.