Chronic superficial keratitis

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Sections available in full article Introduction, Presenting signs, Age predisposition, Breed predisposition, Cost considerations, Pathogenesis, Etiology, Pathophysiology, Timecourse (incubation, duration), Diagnosis, Presenting problems, Client history, Clinical signs, Diagnostic investigation, Confirmation of diagnosis, Histopathology findings, Differential diagnosis, Treatment, Standard treatment, Monitoring, Subsequent management, Sequelae, Prognosis, Expected response to treatment, Reasons for treatment failure, Sources, Publications, Vetstream contributor(s),
Contributors Dr Dennis E Brooks DVM PhD DipACVO
Dr David L Williams MA VetMB PhD CertVOphthal FRCVS
Synonyms Pannus, Uberreiter's syndrome

Introduction

  • Cause : immune-mediated corneal condition affecting primarily the middle-aged German Shepherd dog German Shepherd Dog. Ultra-violet light a predisposing factor.
  • Signs : bilateral lesions first seen at ventro-lateral limbus.
  • Progressive, potentially blinding, but no discomfort or irritation.
  • Same as keratitis Keratitis.
  • Diagnosis : history, clinical signs, ophthalmic examination.
  • Treatment : chemotherapy. Topical steroid or cyclosporine.
  • Prognosis : will recur without regular treatment.

Diagnosis

Clinical signs

  • Bilateral non-irritant, pink, fleshy, elevated, vascularized and pigmented corneal lesions Pannus: German Shepherd Dog 4 years , Pannus: German Shepherd Dog 9 years originating from the ventrolateral limbus. Lateral, medial, ventral and dorsal quadrants are affected in that order.
  • Bilateral corneal pigmentation and scarring.
  • Nictitating membrane thick.
  • Conjunctivitis Conjunctivitis , and plasma cell thickening of nictitating membrane.
  • Visual impairment in advanced cases. Culture and then always perform Schirmer tear test Schirmer tear test , before any other procedures.
  • Fluorescein stain Fluorescein test , if ulceration present - denuded stroma stains green with fluorescein, staining accentuated by UV light (Woods lamp) (unusual in CSK).
    Multi-dose vials may be contaminated with Pseudomonas - use strips or single-dose vials.
    Descemet's membrane doesn't stain.
    Aqueous stains bright yellow-green with fluorescein, useful for detecting perforation.
  • Rose Bengal stains devitalised epithelium (KCS), but may be painful on instillation.

Diagnosis

Differential diagnosis

  • Ulcerative keratitis Ulcerative keratitis.
  • KCS Keratoconjunctivitis sicca.
  • Nodular episcleritis Episcleritis.
  • Corneal granulation tissues from old ulcers.

Sequelae

Prognosis

  • Will recur → requires maintenance steroid therapy.

Expected response to treatment

  • Regression of vascularization (relatively rapid improvement).
  • Loss of corneal pigmentation (relatively slow improvement).

Reasons for treatment failure

  • Condition more difficult to control in young dogs living at high altitudes.
  • Ulceration develops.
  • Poor owner compliance.

Sources

Publications

Refereed papers

  • Williams D L, Hoey A J & Smithermann P (1995) Comparison of topical cyclosporin and dexamethasone for the treatment of chronic superficial keratitis in dogs. Vet Rec 137 , 635-639.
  • Chaukin M J, Roberts S M et al(1994) Risk factors for development of chronic superficial keratitis in dogs. JAVMA 204 , 1630-1634.
  • Petrick S W & van Rensburg I B K (1989) Corneal anatomical differences in the etiology of chronic superficial keratitis. JSAP 30 , 449-453.

Other sources of information

  • Gelatt K N (ed) (1999) Veterinary Ophthalmology. 3rd Edn. Lippincott: Williams & Wilkins. ISBN 0683300768.

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