Basics
Anterior uveitis is the inflammation of the uveal tract, particularly affecting the iris and ciliary body of the eye. When inflammation disrupts the eye's normal fluid drainage, it can lead to secondary glaucoma. Glaucoma causes dangerously high intraocular pressure (IOP), potentially leading to irreversible damage to the optic nerve and blindness if untreated. Both conditions are medical emergencies and require prompt diagnosis and treatment.
Clinical Symptoms
Dogs with anterior uveitis and secondary glaucoma may show several signs of eye discomfort and vision issues, including:
Redness of the eye (conjunctival hyperemia)
Squinting or excessive blinking (blepharospasm)
Cloudiness in the eye (corneal edema)
Pain or discomfort (rubbing or pawing at the eye)
Dilated or uneven pupil size (mydriasis)
Visible blood vessels on the white of the eye
Vision loss or blindness in severe cases
Potential Causes
The causes of anterior uveitis and secondary glaucoma can be wide-ranging. Common causes include:
Ocular trauma or injury
Infections (bacterial, viral, fungal, or parasitic)
Autoimmune diseases (e.g., immune-mediated uveitis)
Intraocular tumors or neoplasms
Systemic diseases (e.g., Ehrlichiosis, Lyme disease, Toxoplasmosis)
Lens-induced uveitis from lens luxation or cataracts
Differential Diagnoses
Other eye conditions that may present with similar symptoms include:
Primary glaucoma
Corneal ulcers or abrasions
Lens luxation (displacement of the lens)
Conjunctivitis or "pink eye"
Ocular tumors
Diagnostic Approach
Diagnosing anterior uveitis with secondary glaucoma involves thorough evaluation by a veterinarian, including:
Tonometry to measure intraocular pressure (IOP)
Slit-lamp examination to detect inflammation in the anterior chamber
Ophthalmoscopy to examine the retina and optic nerve
Blood tests and serological tests to identify infections or systemic diseases
Ultrasound or advanced imaging to assess the eye's internal structure
Treatment Options
Treatment is focused on reducing inflammation and controlling high IOP to prevent vision loss:
Topical corticosteroids (e.g., Prednisolone acetate) to control inflammation, unless there is an infection
Non-steroidal anti-inflammatory drugs (NSAIDs) if corticosteroids are contraindicated
Topical or systemic antibiotics/antivirals/antifungals in case of infection
Carbonic anhydrase inhibitors (e.g., Dorzolamide) to reduce aqueous humor production and lower IOP
Beta-blockers (e.g., Timolol) to reduce IOP by decreasing aqueous production
Mydriatics and cycloplegics (e.g., Atropine) to reduce pain from ciliary muscle spasm and prevent synechiae formation (adhesions between iris and lens)
Hyperosmotic agents (e.g., Mannitol) in emergencies to rapidly lower IOP
Monitoring Strategies
Frequent rechecks are essential in managing anterior uveitis with secondary glaucoma. Monitoring should include:
Regular tonometry to monitor intraocular pressure
Slit-lamp exams to evaluate the response to anti-inflammatory treatment
Ocular ultrasounds or imaging to check for any progression of intraocular changes
Prevention
Preventing anterior uveitis with secondary glaucoma involves managing the underlying cause, such as treating infections, managing autoimmune diseases, and monitoring for eye injuries. Routine eye examinations in predisposed breeds may help detect early signs.
Long-Term Management
Long-term management may include the following:
Continued use of anti-inflammatory and IOP-lowering medications
Frequent rechecks with tonometry and eye examinations
Possible surgical intervention if glaucoma becomes unmanageable with medications
Possible Complications
Untreated or poorly managed anterior uveitis with secondary glaucoma can lead to several complications, including:
Permanent damage to the optic nerve, resulting in blindness
Corneal degeneration or scarring
Formation of synechiae (adhesions within the eye)
Chronic pain that may require enucleation (surgical removal of the eye)
Prognosis
The prognosis for anterior uveitis with secondary glaucoma depends on early diagnosis and the underlying cause. With prompt treatment, many dogs can recover well, but if glaucoma remains uncontrolled, blindness and chronic pain can develop. Lifelong management may be necessary.
Need for Rechecks
Frequent rechecks with your veterinarian or veterinary ophthalmologist are essential for monitoring the condition and adjusting treatments. Regular IOP measurements, ocular exams, and visual assessments are crucial to avoid complications and manage the disease effectively.
© STITTSVILLE KANATA VETERINARY HOSPITAL
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