Ulcerative keratitis associated with qualitative tear film abnormalities in cats

Ocular surface physiology and aqueous tear secretion in cats of diverse cephalic conformations

OBJECTIVE

To describe normative ocular surface and aqueous tear testing data for cats of various cephalic conformation.

ANIMALS STUDIED

Fifty-three healthy adult cats (11 British Shorthair, 11 Burmese, 10 Devon Rex, 10 Scottish Fold, and 11 Sphynx).

PROCEDURES

Blink rate, corneal tactile sensation (CTS), and Schirmer tear test with or without topical anesthesia (STT-1, STT-2) and with nasolacrimal stimulation (NL-STT1, NL-STT2) were assessed. Palpebral fissure length (PFL) and skull morphology were measured, and cephalic index (CI) and craniofacial ratio (CFR) calculated.

RESULTS

Mean ± SD test results were as follows: blink rate (5.0 ± 2.3 blinks/min), CTS (3.2 ± 0.7 cm), STT-1 (11.2 ± 4.3 mm/min), STT-2 (6.7 ± 3.6 mm/min), NL-STT1 (13.4 ± 5.7 mm/min), NL-STT2 (13.5 ± 5.2 mm/min), and PFL (2.0 ± 0.2 cm). Corneal sensitivity did not differ significantly among breeds (p = .152) but was negatively correlated with body weight (r = -.32, p = .019). STT-1 significantly differed among breeds (p < .001) and was lowest in Sphynx cats (8.7 ± 4.3 mm/min). A positive correlation was detected between STT-1 values at 30 and 60 s (r = .98; p < .001). The nasolacrimal reflex significantly increased STT in anesthetized and unanesthetized eyes (approximately +100% and +20%, respectively; p ≤ .002). STT-1 tended to be higher in intact versus neutered cats (p = .062). Age did not impact any test result (p ≥ .085).

CONCLUSIONS

Normative data described here serve as a baseline for future studies assessing ocular surface disease in multiple feline breeds. Unlike dogs, brachycephalic cats did not have lower CTS or STT-1 than non-brachycephalic cats.

Tear film breakup time and Schirmer tear test in normal dogs: Effects of age, sex, reproductive status, skull type, and nasolacrimal duct patency

OBJECTIVE

The present study aimed to determine the effects of age, sex, reproductive status, skull type, and nasolacrimal duct (NLD) patency on tear production and tear film breakup time (TBUT) in normal dogs.

ANIMALS STUDIED

The ophthalmic data of 82 healthy adult dogs were evaluated in this study.

PROCEDURES

Age, sex, breed, and reproductive status were recorded. Schirmer tear test (STT) and TBUT were assessed in all dogs, and interferometry was available for the selected dogs. The Jones test was used to evaluate NLD patency. The cephalic index (CI) was calculated for each dog (skull width/skull length ×100).

RESULTS

Mean (SD) values for the STT results for the right (OD) and left (OS) eyes were 20.6 (2.7) and 20.2 (2.7) mm/min, respectively. Mean (SD) TBUT values for OD and OS were 6.5 (2.5) and 6.1 (2.3) mm/min in all dogs, respectively. Sex and reproductive status had no significant effect on STT and TBUT (P_[OU]  > 0.05). Skull type significantly affected TBUT in both eyes (P_(OD)  = 0.01, P_(OS)  = 0.003), but had no effect on STT (P_[OU]  > 0.3). Age had no correlation with STT and TBUT in either eye (P_[OU]  > 0.05). STT and TBUT had no correlation in either eye (P_[OU]  > 0.2). NLD patency had no significant effect on STT or TBUT (P_[OU]  > 0.1).

CONCLUSIONS

The results of this study showed lower TBUT values in brachycephalic breeds than in non-brachycephalic breeds. A compensatory increase in STT values was observed in dogs with low TBUT values.

Autologous lamellar keratoplasty for the treatment of feline corneal sequestrum: A retrospective study of 35 eyes (2012-2020)

OBJECTIVE

To evaluate the use of autologous lamellar keratoplasty for the treatment of feline corneal sequestrum (FCS).

PROCEDURE

The medical records of cats diagnosed with FCS that underwent autologous lamellar keratoplasty between 2012 and 2020 with a minimum of 2 months of follow-up were reviewed. After keratectomy of FCS, a button adjacent to the corneal limbus was harvested on the same eye and sutured to the recipient bed. A nictitating membrane flap was left in place until the first recheck except for one patient. Postoperative treatment with topical and systemic antibiotics and systemic nonsteroidal anti-inflammatory medications was prescribed. Follow-up examinations were carried out 2 weeks, 1 month and 2 months post-operatively and consisted of a complete ophthalmic examination.

RESULTS

A total of 35 cats (35 eyes) were included. The median follow-up time was 3.2 months (range, 2-59 months). Brachycephalic cats were overrepresented (85.7%). The mean graft size was 6.5 mm (range, 6-9 mm). Minor complications consisting of melting and partial integration of the graft occurred in 2/35 eyes (5.7%). Recurrence was observed in 1/35 eyes (2.9%) and was managed by a superficial keratectomy. A good visual outcome was achieved in all eyes, and a faint or mild corneal opacification occurred in 15/35 (42.9%).

CONCLUSIONS

Autologous lamellar keratoplasty is an effective treatment for FCS, providing good tectonic support to the affected cornea and resulting in good visual and cosmetic outcomes. These results should be verified in future prospective studies that include a larger number of cases and longer-term follow-up.

The distribution of conjunctival goblet cells in mice

PURPOSE

To evaluate the density and distribution of conjunctival goblet cells in mice without clinical evidence of ocular surface diseases.

METHODS

Immediately after euthanasia of C57BL/6 wild-type mice, the eyes including eyelids were removed and fixed in paraformaldehyde. Entire eyeballs and eyelids were cut in series along the sagittal axis from nasal to temporal on a microtome and then stained with Periodic Acid-Schiff acid to visualize the goblet cells. At each section stained in this way, the conjunctival goblet cells of the entire upper and lower lid conjunctiva were counted by light microscopy. Additional (transmission electron microscopy) (TEM)-Analysis on ultrathin sections was performed to evaluate morphological differences.

RESULTS

The total number of conjunctival goblet cells differs markedly between individual animals. Categorisation into upper eyelid (UL) and lower eyelid (LL) and into regions (nasal, middle, temporal) revealed a significant increase of goblet cells from nasal to temporal in the UL and a significant decrease in the LL.

CONCLUSION

The distribution of conjunctival goblet cells in mice differs considerably from humans and between individual animals. Therefore, precise selection of sampling and methods are needed to obtain comparable data. We recommend to use the middle region of the conjunctiva of UL/LL for goblet cell studies in mice. These findings are of particular interest for dry eye mouse models as well as pharmacological studies on mice with influence on their goblet cells.

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.

Clinical features of cats with aqueous tear deficiency: a retrospective case series of 10 patients (17 eyes)

OBJECTIVES

The aim of this study was to describe the clinical findings, diagnostic test results and response to therapy of cats with Schirmer tear test 1 (STT-1) values below the reference interval.

METHODS

The medical records of three institutions were searched for cats with ocular surface disease and STT-1 values <9 mm/min, confirmed at two or more separate visits.

RESULTS

Ten cats (17 eyes) were included. The mean ± SD (range) age and STT-1 values in affected eye(s) were 6.1 ± 5.7 (0.2-16) years and 2.4 ± 3.1 (0-8) mm/min, respectively. Concurrent ocular surface disease was bilateral in 5/10 cats. Clinical signs included conjunctivitis (14/17 eyes), corneal ulceration (6/17 eyes), non-ulcerative keratitis (4/17 eyes), symblepharon (4/17 eyes), eosinophilic keratitis (3/17 eyes), corneal sequestrum (3/17 eyes), corneal fibrosis (2/17 eyes) and meibomitis (2/17 eyes). Management included: topically applied lacrimomimetics, antiviral drugs, corticosteroids or immunomodulatory drugs; orally administered famciclovir; or surgical procedures, in various combinations. Response to therapy (defined as an increase in STT-1 value of ⩾5 mm/min) was transient (seen at a single reassessment) in 65% of eyes and sustained (seen at ⩾2 consecutive reassessments) in 18% of eyes.

CONCLUSIONS AND RELEVANCE

Clinical features seen in cats with low STT-1 values are described, although the association between aqueous deficiency and the reported ocular changes is unknown at this time. We encourage clinicians to assess the tear film in cats with ocular surface disease, and initiate therapy with lacrimomimetics if STT-1 values are repeatedly below normal. Such information will further define aqueous tear deficiency in cats, providing a better understanding of disease prevalence, pathogenesis and treatment.

Evaluation of tear production using the Schirmer tear test I in healthy cats; effect of age, life stage, sex, breed and neuter status

BACKGROUND

The purpose of this study was to evaluate the values of Schirmer tear test (STT) and determine effects of age, life stage, sex, breed and neuter status on tear production in healthy cats.

METHODS

Three hundred and forty-three domestic shorthair (DSH) and Persian cats, 50 days through 18 years old, were examined in this study. STT I was used to measure tear production in both eyes of each cat.

RESULTS

A mean STT 14.9±4.8 mm/min was calculated for the eyes of all cats. There was a significant difference between STT values in kittens (≤6 months old) and cats of other age groups (P<0.001). A substantial number of cats with clinically normal eyes had STT values less than 10 mm/min. No significant difference was found between males (14.7±5.0 mm/min) and females (15.1±4.5 mm/min) in STT values (P=0.46). Significant differences were found between entire (14.4±4.2 mm/min) and neutered (16.2±4.1 mm/min) cats (P=0.001), and between STT values of DSH (14.6±5.0 mm/min) and Persian (16.5±3.1 mm/min) cats in the study population (P=0.001).

CONCLUSIONS

This study documents the average STT values for a sizeable feline population demonstrating that, in contradistinction to the situation in dogs, a number of cats with clinically normal eyes have STT values below 10 mm/min.

Density and distribution of feline conjunctival goblet cells

Objectives The objective of this study was to examine the density and distribution of goblet cells (GCs) in the feline conjunctiva and to investigate a potential effect of age and sex on GC density (GCD). Methods Thirty-nine eyes of 21 cats euthanased for reasons unrelated to this study were used. Fixed upper and lower eyelid and bulbar conjunctiva were divided into nasal and temporal regions. The third eyelid was excised and investigated separately. Samples were embedded in paraffin wax; sections were stained with periodic acid-Schiff reaction and analysed with light microscopy. To determine the topographic distribution of GCs, each region was subdivided into the marginal, palpebral and bulbar zone. In each zone 200 epithelial cells, including GCs, were counted. Goblet cell index was defined as a percentage of the epithelial cells. Results The palpebral zone of both eyelids contained significantly ( P <0.001) more GCs (27.5-32.0%) than the marginal or bulbar areas. The highest GCD was found in the nasal palpebral zone of the upper eyelid (32.0%). Marginal and bulbar sites contained fewer numbers of GCs (2.6-10.0%). The lowest GCD was detected in the nasal bulbar zone of the lower eyelid (2.6%). Overall the nasal region contained significantly ( P = 0.036) more GCs than the temporal region, but there was no significant difference in GCD between the upper and lower eyelids. Correlation analysis did not show any effect of age or sex on GC counts. Conclusions and relevance GCD in the palpebral zones and on the anterior surface of the third eyelid was highest; the lowest density was found in the bulbar zones of the lower eyelid and in the marginal zones of both eyelids. Overall, higher GCD was found in the cat than in other species. Age and sex have no effect on GCD.

A review of antiviral drugs and other compounds with activity against feline herpesvirus type 1

Feline herpesvirus type 1 (FHV-1) is a common and important cause of ocular surface disease, dermatitis, respiratory disease, and potentially intraocular disease in cats. Many antiviral drugs developed for the treatment of humans infected with herpesviruses have been used to treat cats infected with FHV-1. Translational use of drugs in this manner ideally requires methodical investigation of their in vitro efficacy against FHV-1 followed by pharmacokinetic and safety trials in normal cats. Subsequently, placebo-controlled efficacy studies in experimentally inoculated animals should be performed followed, finally, by carefully designed and monitored clinical trials in client-owned animals. This review is intended to provide a concise overview of the available literature regarding the efficacy of antiviral drugs and other compounds with proven or putative activity against FHV-1, as well as a discussion of their safety in cats.

Goblet cell density and distribution in cats with clinically and histologically normal conjunctiva

OBJECTIVE

The aim of this study was to evaluate goblet cell density (GCD) and distribution in cats without clinical evidence of ocular surface disease and without histologic evidence of conjunctival disease.

ANIMALS STUDIED

Fourteen Domestic Shorthair cats euthanized for reasons unrelated to this study.

PROCEDURES

Before euthanasia, cats were verified using slit-lamp biomicroscopy and fluorescein staining to be free of eyelid or ocular surface abnormalities. Immediately after euthanasia, bilateral conjunctival specimens including third eyelid (TEL) were collected, routinely processed, and stained with periodic acid-Schiff and hematoxylin and eosin. Thirteen conjunctival regions were identified. For each region, GCD was expressed as the percentage of goblet cells/200 basal epithelial cells.

RESULTS

Mean GCD ranged widely by region: anterior surface of the TEL = 48.8%, fornicial regions = 47.0%, palpebral regions = 38.5%, bulbar regions = 19.6%, and posterior surface of the TEL = 12.6%. The anterior surface of the TEL had significantly higher GCD than did the bulbar and the palpebral regions, but not the fornicial regions. Bulbar conjunctiva had significantly lower GCD than did all other conjunctival regions except the posterior surface of the TEL. No significant difference was noted between GCD of male versus female cats, dorsal versus ventral regions, or lateral versus medial regions.

CONCLUSIONS

Although conjunctival GCD ranged widely by region, the anterior surface of the TEL appears to be an excellent location for assessing conjunctival goblet cells in cats because this area has high GCD and is more readily accessible than is the palpebral, fornicial, or bulbar conjunctiva.

Evaluation of tear production with modified Schirmer tear test-1 during the neonatal period in cats

The study aimed to evaluate tear production by means of modified Schirmer tear tes-1 (mSTT-1) in neonate cats. Likewise, correlation between mSTT-1 and STT-1 was assessed in vitro. Standard SST strips were cut in half and after eye lid opening, tear production of neonates (n=15) was daily measured in both eyes (mSTT-1), until the 7th day, and at day 14, 21, and 28. Animals were daily weighted until 28 days of age. Results were compared statistically (P<0.05). During the first 7 days, the overall mSTT-1 mean was 0.76 wetting/minute. Significant differences between right and left eyes were not observed at any time point (P=1.00). Tear secretion increased significantly, from the 14th to 28th day, in comparison with 7 first days (P<0.05). Positive correlation between maturity parameters and tear secretion was observed (P<0.0001). Distance between slopes of each strip changed significantly (P<0.0001). It was concluded that tear secretion in the neonatal period of cats is very below the reference values described for young and adults of the same species. It is not possible to extrapolate results obtained with mSTT-1 to standard STT-1.

Use of phenol red thread tests to evaluate tear production in clinically normal Amazon parrots and comparison with Schirmer tear test findings

OBJECTIVE

To determine phenol red thread test (PRTT) values in eyes of clinically normal Hispaniolan Amazon parrots before and after topical application of an ophthalmic anesthetic agent and compare findings with Schirmer tear test (STT) values.

DESIGN

Evaluation study.

ANIMALS

24 Amazona ventralis parrots from a research colony.

PROCEDURES

On 4 occasions (1-week intervals), all birds underwent a thorough ophthalmic examination of both eyes, which included (in sequence) performance of a PRTT and an STT; topical ocular application of proparacaine hydrochloride; and performance of another PRTT and another STT. Correlations between PRTT and STT values recorded with and without topical anesthesia were assessed.

RESULTS

Without topical anesthesia, mean +/- SD PRTT value was 12.5 +/- 5.0 mm/15 s (range, 1 to 25 mm/15 s). With topical anesthesia, the PRTT value was 12.6 +/- 5.4 mm/15 s (range, 2 to 24 mm/15 s). Without topical anesthesia, mean STT value was 7.9 +/- 2.6 mm/min (range, 0 to 13 mm/min). With topical anesthesia, the STT value was 5.1 +/- 3.3 mm/min (range, 0 to 18 mm/min). The correlation of PRTT and STT values recorded with or without topical anesthesia was weak (r = 0.51 and r = 0.32, respectively).

CONCLUSIONS AND CLINICAL RELEVANCE

Results indicated that the PRTT and STT were both viable methods for measurement of tear production in Hispaniolan Amazon parrots. Topical application of an ophthalmic anesthetic agent did not have a significant effect on the PRTT values but significantly decreased the STT values.

Effects of feline herpesvirus type 1 on tear film break-up time, Schirmer tear test results, and conjunctival goblet cell density in experimentally infected cats

OBJECTIVE

To determine the effect of feline herpesvirus type 1 (FHV-1) on tear film breakup time (TFBUT) and Schirmer tear test (STT) values in cats with primary experimental infection and to determine the relationship between TFBUT and STT values and conjunctival goblet cell density (GCD).

SAMPLE POPULATION

9 specific-pathogen-free cats of approximately 6 months of age.

PROCEDURES

6 cats were inoculated with FHV-1; 3 control cats were sham inoculated. Clinical and histologic evidence of conjunctivitis and TFBUT, GCD, and STT values were assessed at multiple times until postinoculation day (PID) 29.

RESULTS

In infected cats, mean clinical and histologic conjunctivitis scores peaked at PID 7 and remained above baseline at PID 29. In control cats, these 2 variables did not change from baseline throughout the study. Mean TFBUT declined rapidly in infected cats up to PID 15 and at PID 29 remained less than baseline, less than for control cats, and below reference range values. Mean STT value for infected cats at PID 29 was increased from baseline but was within the reference range and not different from the value for control cats. Mean GCD in infected cats declined precipitously by PID 7 and remained below reference range values at PID 29. Mean GCD in control cats remained unchanged for the duration of the study period.

CONCLUSIONS AND CLINICAL RELEVANCE

FHV-1 induced qualitative tear film abnormalities in experimentally infected cats, as measured by TFBUT and GCD. Assessment of TFBUT provided a reasonable clinical estimate of GCD.

Schirmer tear test values and tear film break-up times in cats with conjunctivitis

OBJECTIVES

(1) To document tear film break-up time (TFBUT) in a group of cats with conjunctivitis; (2) to determine if TFBUTs from cats with conjunctivitis vary significantly from previously established normal values for TFBUT in young cats without ocular disease; (3) to determine if a correlation exists between Schirmer tear test (STT) values and TFBUTs in cats with conjunctivitis; (4) to determine if the TFBUTs in cats with conjunctivitis are influenced by the detection of DNA from feline herpes virus-type 1 (FHV-1), Chlamydophila felis, Mycoplasma spp., and feline calicivirus.

ANIMALS STUDIED

Fourteen cats between the ages of 0.8 years to 12 years with active, untreated conjunctivitis and without active keratitis or other ocular or systemic abnormalities were included in this study. Procedures Complete ophthalmic examinations, including TFBUT, were performed on all cats. Polymerase chain reaction (PCR) screening for FHV-1, Chlamydophila felis, Mycoplasma spp., and feline calicivirus was performed on conjunctival swabs from affected eyes and blood samples from all cats.

RESULTS

Mean TFBUT for cats in this study was 8.9 (+/- 4.8) s in the right eye (OD) and 8.1 (+/- 4.6) s in the left eye (OS). No correlation existed between mean TFBUTs and mean STT values OD or OS. Conjunctival swabs from seven cats (n = 9 eyes) tested positive via PCR for one of the above infectious agents. Blood samples from nine cats tested positive for FHV-1. Mean TFBUTs for cats from which the DNA from FHV-1 was isolated from the blood were significantly lower than mean TFBUTs for cats from which no such DNA was isolated from the blood.

CONCLUSIONS

In this study, the mean TFBUT in cats with conjunctivitis was significantly lower than previously established values for clinically healthy cats. This supports the theory that qualitative tear film deficiency, and thus tear film instability, may play a role in the pathogenesis of feline conjunctivitis. Qualitative tear film deficiency may predispose to the development of conjunctivitis or may occur secondarily to this condition.

Keratoconjunctival effects of diabetes mellitus in dogs

OBJECTIVES

To compare Schirmer tear test (STT) values, corneal sensitivity, tear film break up times (TFBUTs), and tear glucose concentrations in relation to conjunctival microflora, and conjunctival cytologic and histologic findings among diabetic cataractous, nondiabetic cataractous, and nondiabetic noncataractous dogs. Procedures Fifteen dogs in each category underwent neuro-ophthalmic examination; aerobic, anaerobic and fungal conjunctival cultures; assessment of corneal touch threshold (CTT), STT, tear glucose, TFBUT; and conjunctival cytology and histology (in certain cases only). Degree of cataract and uveitis were critically graded. Glycemic control was estimated using serum fructosamine and glycosylated hemoglobin.

RESULTS

STT values were significantly lower in diabetic cataractous than nondiabetic noncataractous dogs. CTT of diabetic cataractous dogs was significantly lower than that of nondiabetic noncataractous dogs. Mean TFBUTs were significantly less in diabetic cataractous dogs than nondiabetic cataractous and nondiabetic noncataractous dogs. Tear glucose concentrations were significantly higher in diabetic cataractous dogs than nondiabetic cataractous and nondiabetic noncataractous dogs. Conjunctival microbial isolates did not differ among groups. There were no significant differences in degree of cataract or uveitis between diabetic cataractous and nondiabetic cataractous groups. There was mild submucosal inflammatory infiltrate in conjunctival specimens from diabetic dogs. Conjunctival epithelial dysplasia and/or squamous metaplasia was/were detected in conjunctival biopsies of 5/7 diabetic dogs. Reductions in conjunctival goblet cell (GC) densities were noted in 4/7 diabetic dogs; there were no significant differences in mean GC densities among the three groups.

CONCLUSIONS

Diabetic cataractous dogs have significantly altered keratoconjunctival characteristics compared to nondiabetic cataractous and nondiabetic noncataractous dogs.

Ultrastructural findings in feline corneal sequestra

OBJECTIVES

(1) To describe the ultrastructural features of corneal sequestra in cats; and (2) to enhance our understanding regarding the pathogenesis of feline corneal sequestration.

METHODS

Nine corneal sequestra were harvested via keratectomy from globes of nine cats. The sequestra were routinely fixed then postfixed for high resolution light and transmission electron microscopy (HR-LM and TEM, respectively). The tissues were embedded in Epon/Araldite. Sections of 0.5-microm thickness were cut and stained with 1% toluidine blue in 1% sodium tetraborate solution for HR-LM. Ultrathin sections were collected on copper grids and stained with uranyl acetate and Sato's lead stain for TEM. Ultrathin sections were examined and the images were captured on an Advantage HR CCD camera using a Hitachi 7500 electron microscope operated at 80 kV. Two healthy corneas from two cats were harvested immediately following euthanasia. These corneal tissues (control samples) were processed in the same manner as the corneal sequestra for HR-LM and TEM. A portion of each sequestrum was also submitted for polymerase chain reaction (PCR) testing for infectious agents including feline herpesvirus-1 (FHV-1), Toxoplasma gondii, Chlamydophila felis and Mycoplasma spp.

RESULTS

Ultrastructure of healthy corneal tissues revealed basal corneal epithelial cells aligned adjacent to a thin acellular layer similar to Bowman's layer with underlying tightly packed, regularly arranged, collagen fibrils oriented in different planes. Keratocytes were elongated and had long and irregularly shaped nuclei, and cytoplasm contained rough endoplasmic reticulum and abundant membrane-bound vesicles. In contrast, corneal sequestra contained varying amounts of an amorphous, electron-dense substance, continuous with intact basal epithelial basement membranes peripherally, and overlying corneal ulceration and loosely packed collagen fibrils. Remnants of necrotic keratocytes were seen in spaces between disarranged collagen layers. In all samples, occasional keratocytes exhibited morphology indicative of apoptosis including clumping and margination of chromatin, and shrunken cytoplasm. Varying degrees of inflammation were noted on HR-LM and TEM of affected corneas including peri- and intralesional neutrophils, lymphocytes, plasma cells, and macrophages. Corneal sequestra were FHV-1-positive (n = 3), FHV-1- and T. gondii-positive (n = 1), T. gondii-positive (n = 3), or negative for DNA of these infectious agents (n = 2) using PCR. All corneal sequestra were negative for DNA of Chlamydophila felis and Mycoplasma spp. using PCR.

CONCLUSIONS

Apoptosis may play a role in the pathogenesis of feline corneal sequestration independent of the presence of DNA of these infectious organisms. Prospective clinical studies are warranted to further understand the significance of T. gondii in relation to feline corneal sequestration.

Qualitative tear film and conjunctival goblet cell assessment of cats with corneal sequestra

OBJECTIVES

To evaluate the tear film qualitatively and conjunctival goblet cell numbers in cats with and without corneal sequestra. ANIMALS STUDIED AND PROCEDURES: This was a prospective evaluation of 11 cats with corneal sequestra and 14 control eyes that were either the contralateral normal eye when the sequestrum was unilateral or from control cats of similar age with no ocular disease. All cats in this study were examined by a veterinary ophthalmologist. The ophthalmic examinations included a neuro-ophthalmic evaluation, Schirmer tear tests, fluorescein staining, tear film break-up times, applanation tonometry, biomicroscopy, and indirect ophthalmoscopy. The palpebral conjunctiva at the dorsal nasal, ventral nasal, dorsal temporal and ventral temporal fornices were biopsied after topical anesthetic was applied to the cornea and conjunctiva. The conjunctival biopsies were fixed in formalin and sectioned routinely and stained with hematoxylin and eosin, and periodic acid-Schiff. These slides were examined by light microscopy by a blinded examiner. Goblet cell numbers were compared to conjunctival basal epithelial cell numbers by region. The goblet cell numbers by region from the eyes with sequestra was statistically compared to those from eyes without sequestra, with a student's paired t-test. Conjunctival swabs were collected from the cats with corneal sequestra and submitted for polymerase chain reaction for Herpes felis, Chlamydia psiitticia, and Mycoplasma felis. The corneal sequestra were removed by surgical keratectomy and fixed and stained routinely, and examined by light microscopy.

RESULTS

No neurologic abnormalities were detected in any of the cats. The Schirmer tear tests (eyes with sequestra 14+/-5.1 mm/min; normal eyes 15+/-6.8 mm/min) and intraocular pressures (eyes with sequestra 21+/-6.6; normal eyes 22+/-5.8) were within normal reference ranges for cats. Biomicroscopic examinations revealed varied sizes and depths of brown- and amber-colored corneal sequestra. No abnormalities were noted on indirect ophthalmoscopic examinations. The tear film break-up time was 21 s (+/-12) for the normal eyes (n=14) and 14 s (+/-13) in eyes with corneal sequestra (n=11). The average goblet/epithelial cell ratios by region for the normal eyes and the eyes with sequestra respectively were 0.66, 0.56 for the dorsal nasal fornix, 0.68, 0.57 for the ventral nasal fornix, 0.63, 0.48 for the temporal dorsal fornix, and 0.55, 0.49 for the temporal ventral fornix. There were no significant differences in tear film break-up times and goblet cell numbers in eyes with corneal sequestra and those without sequestra. Three conjunctival swabs from two of 11 cats with sequestra were positive with PCR for Herpes felis virus. These included one cat with bilateral sequestra and one cat with unilateral corneal sequestrum.

CONCLUSIONS

The pathogenesis of feline corneal sequestra does not appear to be linked primarily to abnormal goblet cell numbers, qualitative tear film abnormalities, and accelerated tear film break-up time.

Feline Corneal Disease

The cornea is naturally transparent. Anything that interferes with the cornea's stromal architecture, contributes to blood vessel migration, increases corneal pigmentation, or predisposes to corneal edema, disrupts the corneas transparency and indicates corneal disease. The color, location, and shape and pattern of a corneal lesion can help in determining the underlying cause for the disease. Corneal disease is typically divided into congenital or acquired disorders. Congenital disorders, such as corneal dermoids are rare in cats, whereas acquired corneal disease associated with nonulcerative or ulcerative keratitis is common. Primary ocular disease, such as tear film instability, adenexal disease (medial canthal entropion, lagophthalmus, eyelid agenesis), and herpes keratitis are associated with the majority of acquired corneal disease in cats. Proliferative/eosinophilic keratitis, acute bullous keratopathy, and Florida keratopathy are common feline nonulcerative disorders. Nonprogressive ulcerative disease in cats, such as chronic corneal epithelial defects and corneal sequestration are more common than progressive corneal ulcerations.

Tear film breakup times in young healthy cats before and after anesthesia

The objectives of this study were: (i) to determine tear film breakup times (BUTs) in young healthy cats; (ii) to determine tear film BUTs in feline eyes within 8-20 h following general anesthesia; (iii) to determine if tear film BUTs vary significantly preoperatively when compared with values obtained 8-20 h postoperatively; (iv) to determine if Schirmer tear test (STT) values correlate with tear film BUTs in young healthy cats; and (v) to determine if the isolation of particular etiologic agents from conjunctival swabs of healthy cats affects tear film BUTs. We studied eighteen healthy Domestic Short-haired (n=14) and Domestic Long-haired (n=4) cats, with normal ocular examinations, ranging in age from 0.5 to 3 years. Complete ophthalmic examinations, including tear film BUTs, were performed on all cats. Conjunctival swabs from each eye of all cats and blood samples from all cats were collected and submitted for polymerase chain reaction screening for feline herpes virus, Chlamydophila felis, Mycoplasma spp., and calicivirus. In 10 of 18 cats, STT values and tear film BUTs were measured before general anesthesia was administered and again within 8-20 h following the end of anesthesia. Mean preanesthesia tear film BUTs for all 18 cats were 17.4+/-4.6 s OD and 16.0+/-4.5 s OS. Mean postanesthesia tear film BUT results were 12.5+/-4.3 and 13.1+/-4.0 s OD and OS, respectively. Postanesthesia tear film BUTs were significantly more rapid than those measured before anesthesia (OD only). There was also a positive correlation, both before and after anesthesia, between STT values in both eyes (OU) and tear film BUTs OU. The isolation or lack of isolation of conjunctival microorganisms using PCR did not significantly affect tear film BUTs. Mean tear film BUT in young healthy domestic cats is 16.7+/-4.5 s. Tear BUT is positively correlated with STT values. Although mean tear film BUTs OD at 8-20 h following anesthesia were more rapid than preanesthesia values, this difference did not appear clinically relevant.

Feline corneal sequestra: a review of 64 cases (80 eyes) from 1993 to 2000

Feline corneal sequestrum is a common condition of the feline cornea. The purpose of this study was to provide a detailed description of the clinical features of the condition including the response to different management options and to assess the rate of recurrence. The medical records of 64 cases (80 eyes) of feline corneal sequestra that presented to the Animal Health Trust from 1993 to 2000 were reviewed. Fifty-two cases were reviewed retrospectively; 12 cases were assessed prospectively between April and September 2000 as part of a separate study. The Persian was the most frequently encountered breed and the mean age of affected cats was 5.6 years. At initial presentation, sequestra were unilateral in 58 cats and bilateral in 6 cats, 5 of which were Persians. Ocular discomfort and ocular discharge were common presenting signs, occurring in 42 and 36 eyes, respectively. Seventy-four eyes were managed surgically with keratectomy only (n = 44) or keratectomy followed by a graft procedure (n = 30). Sequestra recurred in 16 eyes in the study. There was no significant difference in the rate of recurrence between eyes that received a graft procedure (n = 5) and eyes that did not (n = 11) (P = 0.56). Complications following transection of conjunctival pedicle grafts were observed. Brown to black discoloration of noncorneal tissue and therapeutic biomaterials was observed, including discoloration of both viable and apparently nonviable grafted conjunctival tissue, small intestinal submucosa graft material and bandage contact lenses.

Lacrimostimulants and lacrimomimetics

A thorough understanding of tear film physiology and the clinical manifestations of tear film abnormalities enables the veterinarian to diagnose and treat quantitative (decreased aqueous layer) and qualitative (decreased mucin or lipid layers) tear film abnormalities accurately and to monitor the responses to lacrimostimulatory and lacrimomimetic therapy. This article reviews the embryology,anatomy, and physiology of the lacrimal glands; glands of the nictitating membrane; goblet cells; and tarsal glands as well as the pathophysiology of tear film deficiencies. We also review lacrimo-stimulants, including cyclosporine, tacrolimus, sirolimus, pilocar-pine, and lacrimomimetics (tear film replacements).

Ophthalmic disease in exotic species

This article highlights factors that must be kept in mind when dealing with species other than cats, dogs, and horses. Diseases of the eye are similar regardless of whether they occur in humans or domestic or exotic species. There are unique conditions in exotic species that reflect differences in anatomy, physiology, pharmacology, and pathophysiology compared with domestic species.