Eye Discharge

Eye discharge, also known as ocular discharge, is a common clinical sign encountered in small animal
internal medicine. It can result from various underlying conditions and requires a thorough diagnostic
approach for accurate diagnosis and appropriate treatment. This comprehensive overview aims to
provide small animal veterinarians with insights into the causes, diagnosis, and treatment of eye
discharge.

Causes of Eye Discharge:

1. Conjunctivitis: Inflammation of the conjunctiva, the thin mucous membrane covering the inner
surface of the eyelids and the front of the eyeball, often leads to watery or mucopurulent
discharge. Bacterial, viral, allergic, and irritant causes can lead to conjunctivitis.

2. Keratoconjunctivitis Sicca (Dry Eye): A deficiency in tear production results in inadequate

lubrication of the cornea and conjunctiva, leading to mucoid discharge and ocular discomfort.

3. Corneal Ulceration: Ulcers on the cornea can cause a combination of discharge, pain, and
squinting. In some cases, ulcers can become secondarily infected, leading to purulent discharge.
4. Entropion and Ectropion: Abnormal eyelid conformation can result in excessive tearing and
secondary discharge.

5. Epiphora: Excessive tearing or epiphora can lead to a buildup of tears and discharge around the
eyes, often caused by congenital anatomical abnormalities or irritation.
6. Uveitis: Inflammation of the uveal tract within the eye can lead to watery or purulent discharge,
along with other ocular signs.

7. Foreign Bodies: Particles, hairs, or other foreign objects in the eye can cause irritation and
subsequent discharge.

8. Glaucoma: Elevated intraocular pressure due to glaucoma can cause eye discomfort, redness,
and discharge.

Diagnosis: Accurate diagnosis of the underlying cause of eye discharge involves a combination of
thorough clinical examination, diagnostic tests, and sometimes specialized procedures:

1. Physical Examination: Observe the nature of the discharge, its color, consistency, and quantity.
Examine the eyelids, conjunctiva, cornea, and anterior chamber for signs of inflammation,
foreign bodies, or anatomical abnormalities.

2. Fluorescein Staining: To assess for corneal ulcers or abrasions, apply fluorescein stain to the eye
and use a cobalt blue light to detect any staining patterns.

3. Schirmer Tear Test: Measures tear production to diagnose dry eye (keratoconjunctivitis sicca).

4. Tonometry: Measures intraocular pressure, helpful in diagnosing conditions like glaucoma.

5. Microbiological Testing: Culture and sensitivity testing can identify causative organisms in cases
of infectious conjunctivitis.
 6. Radiography and Ultrasonography: If underlying systemic diseases are suspected, imaging
techniques can help diagnose conditions affecting the orbit or surrounding structures.

Treatment: Treatment of eye discharge depends on the underlying cause:

1. Antibiotics: For bacterial infections, topical or systemic antibiotics are prescribed based on the
causative organism and sensitivity testing.

2. Antiviral Medications: In cases of viral conjunctivitis, antiviral medications may be considered.

3. Tear Substitutes: For dry eye (keratoconjunctivitis sicca), artificial tears or cyclosporine eye drops
are used to improve tear production and lubrication.

4. Corticosteroids: In cases of inflammation, corticosteroid eye drops may be prescribed to reduce

swelling and irritation.

5. Surgical Correction: Corrective surgery may be required for conditions like entropion, ectropion,
or foreign body removal.

6. Pain Management: Analgesics or pain-relieving medications can be used for discomfort

associated with certain eye conditions.

7. Management of Underlying Diseases: Treating systemic conditions such as uveitis or glaucoma

is essential for comprehensive eye care.

‫بس غير مقنعين كثير بس خدي نظره‬BASIC INFORMATION

Definition

 Abnormal secretions on or around the eye(s).

 Secretions can be watery (serous), contain mucus (mucoid), or contain white blood cells, mucus,
and bacteria/fungi (mucopurulent).

 Abnormal overflow of tears down the face is epiphora.

Epidemiology

 Species, Age, Sex: Dogs and cats; age of onset varies, depending on cause.

 Genetics, Breed Predisposition: Depends on cause, with breeds predisposed to various eye
conditions.

 Risk Factors: Outdoor animals prone to infectious causes of conjunctivitis and ocular trauma.

 Contagion and Zoonosis: Certain infectious causes of conjunctivitis are contagious and/or
zoonotic.
Clinical Presentation

 History, Chief Complaint:

 Clear, watery, white to gray, mucoid or green-yellow, thick secretions on the eye(s) or
eyelids.

 Sudden, progressive, or persistent in nature.

Behavior/Exercise

 Some patients benefit from activities that serve as a controlled outlet for compulsive behavior
(e.g., retrieving, herding, agility, flyball), although they can be too arousing for others.

 Tailor treatment to the individual.

Drug Interactions

 TCAs and SSRIs should not be given with monoamine oxidase inhibitors (MAOIs), found in flea
and tick collars, dips, and some cognitive dysfunction medications.

 TCAs: use with caution in cases with cardiac arrhythmias or liver or thyroid disorders.

 Use of SSRIs with tramadol may increase serotonin syndrome risk.

 Coadministration of certain SSRIs with tramadol may decrease its metabolite.

 Start both medications at reduced doses if necessary.

Possible Complications

 Paroxetine: avoid in kidney disease; anecdotal reports of constipation in cats.

 Gabapentin dose reduction needed in patients with renal disease.

Recommended Monitoring

 Cats receiving paroxetine: monitor stool consistency.

 Animals taking BDZs require a physical exam every 6 months.

 Yearly physical exam, blood tests, urinalysis, and thyroid screen recommended for animals taking
other psychotropic medications.

PROGNOSIS & OUTCOME

 Prognosis varies from guarded to very good based on factors like treatment initiation time,
owner compliance, communication, and treatment adjustments.

 Untreated OCD seldom improves and often worsens over time.

PEARLS & CONSIDERATIONS

 Repetitive behaviors often misunderstood by owners; early intervention is key.

  Incorporate behavior-related questions in veterinary visits.

 Boredom is insufficient explanation for OCD; consider other factors.

 Support from veterinary staff is crucial for correct identification and treatment of OCD.

Prevention

 Consider temperament when selecting breeding stock.

 Instruct owners to watch for worsening signs or triggers of repetitive behaviors.

Technician Tips

 OCD can disrupt home situations; support from veterinary staff is vital.

Client Education

 Treatment of OCD is lifelong and subject to adjustments.

 Relapses may occur with treatment discontinuation or life changes.

 Planning ahead can minimize stressors' effects on OCD patients.