DISEASES,DIAGNOSIS AND MANAGEMENT OF

OCULAR FUNDUS

SUBMITTED TO – DR SP TYAGI

SUBMITTED BY – ABHISHEK S THAKUR

 Ocular fundus
Ocular fundus consists of:
 Upper tapetal fundus
 Ventral and surrounding non tapetal
fundus
 Optic disc(optic nerve head or optic
papilla)
 Maturation of the canine fundus

A. 5-weeks of age; B. 9-weeks of age; C. 12-weeks of age

 Normal fundus(Canine)

Predominantly yellow Predominantly green

 The bluish colour
Speckled
indicates immaturity
Normal Subalbinotic fundus(Canine)
INTERNAL STRUCTURE OF CANINE EYE
Histologically,the posterior segment contains from
superficial to deep,of following structures:
1) Posterior sclera
2) Choroid
a) Pigmented cells
b) Blood vessels
c) Tapetum lucidum-to enhance vision in dim light
I. Tapetum cellulosum-carnivores
II. Tapetum fibrosum-herbivores
3) Retina(9 layers of neurosensory retina & outer RPE)
4) Optic disk
Retinal layers
 Diseases of canine ocular fundus
 Either primary or manifestations of systemic diseases.

 Inherited abnormalities may be congenital or appear later

 Possible underlying causes for retinopathies:

 Trauma
 Metabolic disturbances
 Systemic infections
 Neoplasms
 Blood dyscrasia
 Hypertension
 Nutritional deficiencies
 Retinal detachment
• Separation of the retina from the underlying choroid.
• Occurs between the photoreceptor layer and the pigment epithelium
 Possible causes of retinal detachment and separation:
 Congenital disorders: Disorders include retinal dysplasia,CEA, and
multiple congenital anomalies.

 Serous detachments:
• Two types of serous detachments:
1. Exudative detachments
2. Hemorrhagic detachments

 Traction detachments(contraction of vitreal traction bands or pre-retinal

membranes pulls the retina off the RPE)
 Rhegmatogenous detachment
Signs:
• Acute loss of vision occurs

• Appearance of a floating sheet (i.e., the detached retina) seen behind the lens

• Retinal vessels are clearly visible on the retina

Ultrasound findings

• The classic appearance of a detached retina is “seagull sign”

• Causes of the detachment, such as subretinal fluid and vitreal inflammation

can be found
Ultrasound image of retinal
detachment

Classic “seagull wings” sign

(arrows), which is the
detached retina adherent to
the globe at the optic nerve
head and the ora ciliaris
retinae.
 Collie eye anomaly(CEA)
• Congenital ocular syndrome
• Defects of posterior vascular fibrous tunics of eye
• Pathogenesis:abnormal mesodermal differentiation
• Severity:no apparent visual deficit to total blindness
• Choroidal hypoplasia-diagnostic lesion(always bilateral)
 Clinical signs
• Four main defects included in CEA syndrome:
a) Choroidal hypoplasia
b) Posterior polar colobomas
c) Partial or complete retinal detachments
d) Intraocular hyphema

(MOST ACCURATELY DIAGNOSED AT 6-7 WEEK OLD PUP)

Choroidal hypoplasia

Choroidal hypoplasia
temporal to the optic disc
in a 2-year-old Shetland
Sheepdog.
 Posterior polar colobomas
 Colobomas are congenital malformations caused by incomplete closure
of the embryonic optic fissure

 Appearance of colobomas

 Colobomas of retina and choroid- focal areas of hypopigmentation

 Colobomas of the optic nerve -gray indentation in the optic disc

Colobomas

Coloboma of the optic

nerve head in a 7-week-
old Collie pup. Note the
downward dipping of
vessels into the
colobomatous defect.
Colobomas

Coloboma in conjunction
with a partially deformed
disc and choroidal
hypoplasia in a 2-year-old
Collie.
 Retinal detachment
• Partial/total retinal detachments in about
10% of CEA affected collies.
• Most often unilateral,bilateral cases
sporadic.
Retinal detachment

Complete retinal
detachment in a 3-year-
old blue merle Collie.
 Interocular hemorrhage
 Haemorrhages in posterior segment of the eye

 Predisposing factors-colobomatous defects and retinal detachment

 Fragility of capillaries leads to sudden leakage of blood,which passes

throgh the vitrous and into the aqueous fluid ,causing hyphema
 Interocular hemorrhages

A) SUBRETINAL HAEMORRHAGE B)INTRARETINAL HAEMORHAGE C)PRERETINAL HAEMORRHAGE

 Retinal dysplasia
• Anomalous differentiation of retina
• Linear folding of the sensory retina and formation of rosettes composed
of variable number of neuronal retinal layers around central lumen.

Known causes include:

• hereditory
• viral infections(canine herpes,feline panleucopenia,BVD,BT)
• vitamin A deficiency
• x-ray irradiation
• certain drugs and intrauterine trauma
Bilateral multifocal retinal dysplasia in a 1-year-old Labrador Retriever.
Several grayish, hyporeflective streaks and spots are seen in
the tapetal fundus. A. Right eye. B. Left eye.
 Clinical signs
 Grossly divided into three different forms:
1. Focal or multifocal retinal dysplasia
2. Geographic retinal dysplasia
3. Complete retinal dysplasia with detachment

• Usually, multifocal retinal dysplasia does not affect vision,

whereas the second type can cause marked visual impairment
and the third form blindness.
Forms of retinal dysplasia
Unilateral geographic retinal dysplasia . Severe horse shoe-shaped
funduscopic changes are seen in the central tapetal region
 Focal and multifocal retinal dysplasia with no visual problems. A. Right eye, with a focal, small dysplastic lesion in the
midperipheral tapetal fundus. B. Left eye, with multifocal lesions that are dot-, streak-, and Y-shaped in the tapetal fundus near
the major blood vessels.
 Canine Oculo-Skeletal Dysplasia: Dwarfism
with Retinal Dysplasia
• An 8-month-old Labrador Retriever with retinal dysplasia
and skeletal abnormalities.
 Canine Multifocal Retinopathy (cmr)
 Autosomal recessive Inherited multifocal serous and bullous retinopathy
 Lesions-
• Multifocal gray to tan fundic patches
• Vary in size from barely visible to larger than the optic disc.
 Canine multifocal retinopathy (cmr)/retinal pigment
epithelial (RPE) dysplasia
A. Note the serous retinal detachment around the optic nerve B. In the midperipheral tapetal fundus -multiple grayish,
head and the multiple circular, tan fundic patches in the slightly elevated circular lesions.
nontapetal fundus.
 THE RETINAL ATROPHIES (RAs)
A group of inherited (bilateral) retinal diseases, resulting in
photoreceptor dysfunction and death & leads to visual impairment
and ultimately blindness.

 Early-onset (dysplastic) canine RAs

 Late-onset (degenerative) canine RAs

 Congenital stationary night blindness (CSNB)

 Cone degeneration(Hemeralopia)
Breeds commonly affected: Cocker Spaniel, Bull Mastiff, Labrador Retriever, Golden
Retriever, Dachshund and Collies

Tapetal hyper reflectivity and marked vascular attenuation

RETINAL PIGMENT EPITHELIAL DYSTROPHY (RPED)

• Disease of the retinal pigment epithelium

• Pathological accumulation of lipofuscin
(may be associated with more widespread secondary retinal
degeneration)

Central progressive retinal atrophy (CPRA)

Similarities between this disease and deficiencies in the availability and

absorption/metabolism of vitamin E have been noted.
Breeds commonly affected: Labrador Retriever, Golden Retriever, Cocker Spaniel and Collies.

Multiple discrete
areas representing lipofuscin accumulation are visible
 Clinical Signs of Hereditary Retinal
Degeneration/Progressive Retinal Atrophy
(PRA)

 Most common clinical sign of early disease -impaired vision in dim light and
darkness (i.e., night blindness)

 Ophthalmoscopic lesions are-

 Bilaterally symmetric hyperreflectivity of the tapetal fundus

 Decreased pigmentation of non tapetal fundus
 Attenuation and decrease in number of retinal vessels
 Atrophy of the optic papilla
 Cortical cataracts in later stages
 An advanced case of retinal degeneration (PRA) in a 5-year-old
Tibetan Terrier
A. The tapetal fundus is hyperreflective, and only B. The nontapetal fundus is decolored and
ghost vessels are visible hyperpigmented in striae and patches
Secondary cataract observed in a 7-year-old Miniature
Poodle with PRA.
 CANINE CHORIORETINITIS
It is the inflammation of the choroid and the retina

Etiology:
• Trauma
• Presence of (local or systemic) neoplasia
• Hereditary factors
• Infectious causes
Viral(canineadenovirus-1 and canine parvovirus)
Protozoal (Toxoplasma gondii)
Bacterial (Ehrlichia canis, Rickettsia rickettsia, Leptospira spp andBorrelia)
Fungal (coccidioides, aspergillus, blastomyces and histoplasma)
 CHORIORETINITIS
 In acute inflammation there may be:

 Perivascular cuffing (appears gray-white)

 Perivascular opacities
 Retinal edema /cellular infiltration

 Appearance:

• In tapetal area -grayish hyporeflective lesions

• In the nontapetal area- grayish to white in color
 Hemorrhages in severe cases
 Chronic inflammatory lesions :
(Retinal edema, tapetal hyporeflectivity,cellular infiltration, and other signs of active
retinitis are missing)

 In Nontapetal fundus:
• Pale, light brown areas of depigmentation
• Retinal vessels decrease in size and number in affected areas.
• Areas of pigment clumping

 In Tapetal fundus:
• Irregular,hyperreflective areas having distinct border
Active (A) and inactive (B) chorioretinitis in a German shepherd dog.
In the active stage of the disease, the clump is surrounded by At the inactive stage, the edema has been replaced by focal
focal retinal edema, seen as a region of dull tapetal reflection retinal degeneration, seen as a region of tapetal
with blurry borders. hyperreflectivity with sharp borders
 CHOROIDITIS
 Choroiditis (or posterior uveitis),is an inflammation strictly confined to the choroid

Ophthalmoscopically:
 Nongranulomatous choroiditis in the tapetal fundus cause loss of tapetal reflectivity
 In the nontapetal fundus, areas of increased redness observed.

 Complete destruction of the tapetum lucidum during the chronic stages of severe
choroiditis.
 INFECTIONS AFFECTING OCULAR FUNDUS
 Viral diseases
• Canine distemper
• Canine herpesvirus
• Mokola virus
• Infectious rhinotonsillitis
 Tick borne diseases
• Canine ehrlichiosis
• Rocky mountain spotted fever(RMSF)
• Bartonella
 Bacterial chorioretinitis
• Leptospira spp.
• Brucella spp.
 Mycotic diseases
• Acremoniasis
• Aspergillosis
• Blastomycosis
• Histoplasmosis
• Cryptococcosis
• Coccidioidomycosis(coccidiomycosis)
• Geotrichosis
• Pseudallescheriasis
• candidiasis
chorioretinitis in a dog with distemper
Toxoplasmosis Coccidioidomycosis

Blastomycosis Ehrlichiosis
 Algal disease
• Protothecosis
 Protozoal disease
• Toxoplasmosis
• Neosporosis
• Leishmaniasis
 Parasitic diseases
• Toxocara chorioretinitis
• Angiostrongylosis
• opthalmomyisis
 Specific retinopathies

Sudden acquired retinal degeneration syndrome(SARDS)

 unknown cause
 sudden and permanent blindness in affected adult dogs

Clinical signs :

• sudden loss of vision, usually within days or 1–2 weeks.

• pupillary dilatation and unresponsive pupils

• The main diagnostic technique to distinguish between SARDS and central causes of sudden-onset
vision loss is electroretinography.
• In SARDS, the ERG is nonrecordable,while with central causes of blindness, the ERG is relatively
normal.
 Sudden Acquired Retinal Degeneration Syndrome
(SARDS)
The ERG was unrecordable, and the diagnosis of sudden acquired
retinal degeneration syndrome was made.
Note degeneration of the photoreceptor outer segments and the
abnormally short inner segments. Also, there is a reduction in the
number of photoreceptor cell nuclei in the outer nuclear layer.
 Retinal Toxicities
 Systemic toxicities
 Drug induced retinotoxicity
• Vasodilating drugs
• Ethambutol
• Diphenylthiocarbazone
• Hydroxypyridinethione
• Quinine
• Rafoxanide
• Chloroquine
• Azalide
• Closantel
• Thiram
 Sensitive neuroretinal tissues may be damaged by exposure to potentially harmful
pharmacologic agents, frequently enrofloxacin in cats and ivermectin in dogs.
Etiology:
• Ivermectin- chronic exposure or ingestion of equine anthelminthic
• Enrofloxacin maximum dose 5mg/kg/24hr

Collie breeds including the Australian Shepherd and Shetland Sheep dog are potentially
more susceptible to ivermectin toxicity because of a hereditary defect associated with
the MDR1 gene.
 Retinopathy Induced by Light and Oxygen
 Retinopathy Induced by Radiation
•

tapetal hyperreflectivity and vascular attenuation

•
Irregular linear to vermiform areas of retinal edema
 RETINOPATHIES OF NUTRITIONAL
CAUSES
 Vitamin A Deficiency
• Systemic vitamin A deficiency is characterized by night blindness in several species
 Vitamin E Deficiency
• Ophthalmoscopic signs:
• Mottled tapetal fundus appearance, particularly centrally, with numerous,discrete
yellow-brown foci.
• The central fundus became hyperreflective, and there was an attenuation of the
retinal vessels.
• The ERG was nonrecordable at 4 months of age.
Vitamin E deficiency
Multiple pigmented lesions typical of
vitamin E deficiency and also
CPRA/RPED were present across the
entire tapetal fundi of both eyes.
 VASCULAR DISEASE PROCESSES
Systemic Hypertension
 Most common ocular findings :
• Posterior segment hemorrhage (retinal, preretinal, and vitreal)
• Retinal detachment
• Hyphema
 Hyperviscosity Syndromes
• Distended and tortuous retinal blood vessels
• Retinal hemorrhage

 In severe cases:-
• Retinal edema
• Retinal detachment
• Papilledema
 Hyperviscosity syndrome
A. Hyperviscosity due to polycythemia has resulted in
retinal vasculature dilation and a preretinal hemorrhage
B. Hyperviscosity due to multiple myeloma has resulted
in retinal vascular dilation and a focal area of retinal
detachment dorsal to the optic nerve head.
Hyperlipidemia
• Milky pink coloration to retinal vessels in the nontapetal fundus

Diabetic Retinopathy
• Thickening of the vascular basement membrane,
• Pericyte loss,
• Microaneurysm formation
• Capillary closure.
Diabetic retinopathy
There are several small retinal
hemorrhages in the central tapetal
fundus.
 RETINOPATHIES WITH IMMUNOLOGIC
DISEASES
Immune-Mediated Thrombocytopenia
 The presenting sign:
• Petechiation and ecchymosis of the gingiva or conjunctiva
• Hyphema and retinal hemorrhage common findings
Autoimmune Hemolytic Anemia
 Clinical sign:
• Retinal vessels are light red and difficult to follow
Systemic Lupus Erythematosu
• Ocular lesions include:
• Hemorrhages and serous retinal detachments
TREATMENT:
• Systemic corticosteroid treatment, 1–2 mg/kg per day, is used for several
weeks and then tapered to a low maintenance dose.
 SECONDARY RETINAL DEGENERATIONS
Glaucoma
 Leads to retinal degeneration because of high IOPs
In acute stages:
• Retina may appear normal/show areas of edema

• Histopathological studies of eyes removed shows:

• All retinal layers are affected
• Progression of retinal changes occur rapidly
• Within 1 day of the onset of glaucoma:

 Necrosis of retinal ganglion cells develops

 Induction of apoptosis of cells in the ganglion cell layer and inner and
outer nuclear layers
 Release of taurine and glutamate from photoreceptors
 The effects of raised intraocular pressure (IOP) on retinal function can
be detected by electroretinography.
A case of chronic
glaucoma

• Generalized
hyperreflectivity of the
tapetal fundus in the
central and midperipheral
areas.
• Retinal vessels are
attenuated
• Cupping of the optic nerve
head.
 NEOPLASTIC AND PROLIFERATIVE
CONDITIONS
 Primary Tumors
• Astrocytoma
• Medulloepithelioma
• Choroidal Melanomas
• Ocular Melanosis
 Secondry tumors
 Metastatic Tumors
• Lymphomas
Pigmented choroidal and retinal neoplasm in Pigmented raised choroidal lesion in the peripheral
conjunction with generalized retinal atrophy. tapetal fundus .Most likely represents a choroidal
melanoma
• ocular melanosis
Lymphomas
Multiple retinal hemorrhages in a
10-year-old dog under treatment for
a B-cell lymphoma.
 Structural visualisation of fundus
• Ophthalmoscopy
• Scanning laser ophthalmoscopy(SLO)
• Optical coherence tomography(OCT)
• Adaptive optics
• Ultrasonography
• Angiography
 Opthalmoscopy
• Direct ophthalmoscope
• Indirect ophthalmoscope
• Panophthalmoscope
• Fundus camera
• Corneal surface contact lens
• Smartphone
 Direct ophthalmoscope
• Most commonly used imaging device
• Principle: The direct ophthalmoscope directs a beam of light into the
patient’s eye and places the observer’s eye in the correct position to
view the reflected beam and details of the interior of the eye.
Technique
Image using direct ophthalmoscope
 Indirect ophthalmoscope
• Principle: A convex lens (typically 20 to 30 D) is placed between the
observer’s eye and the patient’s eye and an inverted virtual image is
formed between the lens and observer.
Technique
Picture using indirect ophthalmoscope
Panophthalmoscope
Technique
Pictures using a panophthalmoscope
 Fundus camera
• The optical design of fundus camera is based on the principle of
monocular indirect ophthalmoscopy, where the Observer’s eye is
replaced with a camera.
• A fundus camera is a complex optical system, which forces illumination
and imaging systems to share a common optical path
 Modes
• Colour: Retina is illuminated by white light and examined in full colour.
• Red-free: Imaging light is filtered to remove red colours, improving
contrast of vessels and other structures.
• Angiography:The retina is illuminated with an excitation colour which
fluoresces light of another colour where the dye is present
Technique
Pictures using fundus camera
 Smartphone
Smartphone + Condensing lens
Principle: It follows the principle of indirect ophthalmoscopy, where the
observers eye is replaced by a smart phone.

Options:
• Using both hands
• Special fundus examination stand
• Tripod stand
• Self stick
 Smartphone + D-eye

• It is a portable digital retinal imaging system which is to be

attached to the smartphone using a specially designed frame.
Technique
Pictures using D eye
 Scanning laser ophthalmoscopy(SLO)
• Diagnostic imaging technique
• The laser beam is used to scan the fundus
• Can also be utilized in an angiography mode
 Ultrasonography
• Used to detect, for example, a detached retina or posterior segment
neoplasm.

• Used to study space-occupying conditions (e.g., neoplasms in the

choroid close to the ciliary body).

• B-mode is generally preferred to A-mode ultrasonography

 B-mode ultrasound images of a normal globe

A) A detached retina B) A posteriorly luxated lens

 Angiography
used to evaluate disease processes in which the vasculature of
the eye is involved, such as
• Vascular anomalies
• Posterior segment neoplasms
• Hypertension
• Retinal detachment
• Inflammatory processes
• Diabetic retinopathy
• Degenerative processes
A. Scanning laser ophthalmoscopy (SLO) image obtained with infrared light (830 nm) in a normal dog.
B. Angiography performed using indocyanine green (ICG) and an infrared (795 nm) laser stimulus C.
Angiography performed using fluorescein (FL) dye and a blue (488 nm) laser stimulus
 Functional testing of retina
Electroretinography
• Electroretinography (ERG) is the study of electrical potentials produced
by the retina when light strikes it
• Light of varying intensity, wavelength, and flash frequency is directed
onto the retina and the resulting potential differences are detected by
electrodes placed around the eye
• Amplified and form a characteristically shaped wave that can be
recorded on paper or stored electronically and assessed for amplitudes
and implicit times
 Purpose of the ERG
• To differentiate blindness of retinal origin from that of optic nerve or
central origin
• To verify adequate retinal function prior to cataract surgery.
An electroretinogram being performed on the right eye
of a dog. Note the ground and reference (subcutaneous) and
corneal
contact lens electrodes as well as the yellow stimulator from
which light A normal electroretinogram
flashes are emitted.