Contributors: Dennis E Brooks, David L Williams

 Species: Canine   |   Classification: Diseases

Introduction Pathogenesis Diagnosis Treatment Outcomes Further Reading

Introduction

  • Cause: corneal ulcers induce varying degrees of uveitis.
  • Signs: transient usually mild uveitis, but can be prolonged and severe.
  • Treatment: none in most cases.
  • Prognosis: poor to good depending on the inciting cause.

Presenting Signs

  • Miotic pupil.
  • Red eye.
  • Wet eye (excessive lacrimation).
  • Corneal edema.
  • Hypopyon.
  • Ocular pain.

Cost Considerations

  • Treatment is required, but the degree depends on the extent of the inflammation.

Pathogenesis

Etiology

Pathophysiology

  • Uveal inflammation is incited through an axon reflex mediated by the trigeminal nerve. The sensory nerve endings release substances which induce the uveitic response.

Diagnosis

Presenting Problems

  • Red eye.
  • Wet eye.

Client History

  • Red eye.
  • Wet eye.
  • Ocular surface insult.
  • Ocular pain.

Clinical Signs

  • Miosis.
  • Corneal ulcer.
  • Ocular pain.
  • Aqueous flare.
  • Photophobia.
  • Red eye (ciliary injection).

Definitive diagnostic features

  • Fluorescein stain to detect ulcer.
  • Miotic pupil and failure to achieve mydriasis with atropine are diagnostic.

Histopathology Findings

  • Protein and/or white blood cells in anterior chamber and iris, but rarely this severe.

Differential Diagnosis


Warning: Reflex uveitis may accompany any of these conditionsWarning

Treatment

Initial Symptomatic Treatment

  • Treat ulcer.
  • Topical non-steroidals can suppress the uveitis found with an ulcer.
    Do NOT use topical steroids, since these will reduce ulcer healing
  • Topical mydriatics/cycloplegia to stabilize the blood aqueous barrier, dilate the pupil and relieve spasm of the ciliary muscle.

Monitoring

  • Note pupil size following mydriatic administration. Frequent mydriatic administration is necessary to cause pupil dilation when uveitis is active.
  • Healing of the corneal ulcer causes less stimulus for the uveitis which allows a decreased administration of the mydriatic to cause pupil dilation.

Subsequent Management

Monitoring

  • Monitor pupil size when treating keratitis.

Outcomes

Prognosis

  • Good if ulcer therapy causes resolution of the ulcer.
  • Poor if the stimulus for the uveitis cannot be cured.

Expected Response to Treatment

Reasons for Treatment Failure

  • Severe synechiation, glaucoma and/or cataract formation can result from reflex uveitis if it is not properly treated.

Further Reading

Publications

Refereed papers

Other Sources of Information