Exotis ISSN 2398-2985

Reptiles

Periocular masses / lesions

Contributor(s): Vetstream Ltd, Nathalie Wissink-Argilaga

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Introduction

  • Cause: hypovitaminosis A, local/systemic infection, neoplasia, trauma, husbandry inadequacies.
  • Signs: eyelid swelling, ocular discharge and conjunctival hyperemia, firm swelling.
  • Diagnosis: clinical signs, diagnostic sampling, surgical exploration and resection of mass.
  • Treatment: topical treatment, surgical removal of mass.
  • Prognosis: dependent on specific condition.
  • Periocular inflammatory diseases are clinically the most common ophthalmic disorders in lizards.
  • Infectious agents do not cause all periocular diseases, but many inflammatory diseases do result from or give rise to secondary bacterial infections; the majority of ocular diseases are a sign of more generalized infection.
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Pathogenesis

Etiology

  • The most common cause of eyelid pathology in reptiles is hypovitaminosis A [Hypovitaminosis A].
  • Blepharitis and conjunctivitis Conjunctivitis have been noted with other causes; infection either local or systemic, this being particularly important as conjunctivitis may occur as a sequel to septicemia.
  • Trauma can lead to significant adnexal pathology either directly or with substrate occluding the palpebral aperture. Trauma can be caused by bites from prey items, conspecific’s bites or scratches or self-inflicted secondary to irritation.
  • Viral disease may manifest as adnexal pathology; caiman pox has been reported with focal raised white or cream-colored papules. These lesions may occur anywhere on the skin but are perhaps most commonly seen on the delicate skin of the eyelid. Commonly seen viruses in chelonia, including Herpesviruses and ranaviruses can manifest with eyelid swelling.
  • Herpesvirus infection has been reported associated with proliferative and often ulcerative skin lesions in sea turtles as well as with tracheitis and conjunctivitis in the same species and periocular neoplasms:
    • Research has demonstrated association of two very similar herpesviruses in green sea turtles (Chelonia mydas) and loggerhead turtle (Caretta caretta) in Florida.
    • Secondary bacterial infection often occurs in association with these lesions.
  • The vast majority of masses are inflammatory lesions secondary to Gram-negative bacterial or fungal infection. For the most part they are granulomatous in nature and not fluid-filled like a cat-bite abscess, so can be very difficult to differentiate from neoplasms which can also be seen in this area.
  • Adnexal mass lesions may be inflammatory, infectious and neoplastic concurrently. Commonly seen periocular neoplasia is squamous cell carcinomas in bearded dragons ; other masses are purely infectious.
  • Other causes of adnexal pathology include parasitic infestations; in one study surgical exploration of a mass in a chameleon revealed microfilaria of the fillaroid genus (in that case Foleyella, a relatively common parasite in chameleons). Eyelid lesions can be secondary to snake mite (Ophionyssus natricis) infestation, causing irritation, which might lead to dysecdysis (poor shedding), keratitis and corneal ulceration Corneal ulceration.
  • Cystic structures associated with the nasolacrimal system can also occur with dacryops, an acquired lacrimal cyst reported in a terrapin resulting in periocular swelling together with exophthalmos; another report demonstrated a vascular anomaly, an orbital varies, as a cause of exophthalmos and periocular swelling.
  • The heterophilic inflammatory cell infiltrate in reptiles followed by macrophages, leads to a granulomatous response with formation of giant cells somewhat similar to those in the caseous lesions seen in mycobacterial disease in man. The abscesses seen in reptiles are thus mostly solid at their core rather than fluid pus-filled as with neutrophil-dominated abscesses in mammals .
  • Poor husbandry, especially low humidity, low temperature, dehydration and poor diet can lead to dysecdysis that can present as remnants of shed skin around the eyelids.

Diagnosis

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Treatment

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Further Reading

Publications

Refereed papers

Other sources of information

  • Wilson B (2017) Lizards. In: Exotic Animal Medicine for the Veterinary Technician. 3rd edn. Eds: Ballard B & Cheek R. Wiley-Blackwell. pp 95-136.
  • Williams D L (2012) Periocular Lesions - Infection and Inflammation. In: Ophthalmology of Exotic Pets. Wiley-Blackwell. pp 169-171.

Reproduced with permission from Bonnie Ballard & Ryan Cheek: Exotic Animal Medicine for the Veterinary Technician © 2017, and David L Williams: Ophthalmology of Exotic Pets © 2012, published by John Wiley & Sons.


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