Diagnostico y tratamiento de emergencias oftalmicas

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Proceeding of the NAVC North American Veterinary Conference
Jan. 13-27, 2007, Orlando, Florida

www.tnavc.org

Reprinted in the IVIS website with the permission of the NAVC http://www.ivis.org/

Published in IVIS with the permission of the NAVC
Exotics – Avian

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DIAGNOSIS AND TREATMENT OF AN OPHTHALMICEMERGENCY
Michael P. Jones, DVM, Diplomate ABVP (Avian) Dianne Hendrix, DVM, Diplomate ACVO College of Veterinary Medicine The University of Tennessee Knoxville, TN This report describe the diagnosis and treatment of an adult bald eagle presented with the chief complaints of being unable to fly and blood in the anterior chamber of the left eye. PHYSICAL EXAMINATION On initial physicalexamination, the eagle was in good body condition but appeared ataxic and demented. Ophthalmologic examination revealed horizontal nystagmus in both eyes (OU), shallow lacerations (5 mm) at the dorsal orbital rim OS, and on the caudallateral surface of the cere on the left side and clotted blood around the eyelids (OU). A menace response was noted OD but not OS. Although the cornea looked normal in botheyes on slip lamp biomicroscopy, visibility of the right eye was limited due to hyphema. Further evaluation via a slit lamb of the left eye revealed hyphema (approximately 50% of the anterior chamber) with hypopyon mixed in with the hyphema. The left pupil was also nonresponsive and miotic. Examination of the posterior segments via indirect ophthalmoscopy was unsuccessful. A small amount of blood wasalso noted in the trachea. DIFFERENTIAL DIAGNOSES Differential diagnoses for this condition include: trauma (vehicular, gunshot, other eagle), lens-induced uveitis due to rupture of the lens capsule, endophthalmitis (bacterial or fungal), septicemic disease (bacterial, viral, fungal or parasitic infections), toxicity (lead, or redenticide toxicity), or hypovitaminosis B (thiamine deficiency) orE. INITIAL LABORATORY DIAGNOSTIC TESTING AND THERAPY A complete blood count (CBC), biochemistry panel, and blood for aspergillosis titers were submitted. The results of the CBC revealed a heterophilic leukocytosis with a relative lymphopenia and monocytosis. Biochemical analysis revealed hyperglycemia, hypalbuminemia and elevated aspartate aminotransferase (AST). Aspergillosis titers were negative.Initial therapy consisted of vitamin E (150 mg) IM, vitamin B complex (0.1mL) IM, CaEDTA (90 mg) IM, dexamethasone (10 mg) IM, and IV 2.5% dextrose. The neuorologic signs resolved within 12 hours of hospitalization. The following day the eagle also received enrofloxacin due to the presence of the hypopyon and heterophilia and itraconazole. Triple antibiotic solution was given to treat uveitis OS;the hyphema OD resolved without treatment.

RADIOGRAPHY Whole body radiographs, including radiographs of the skull, were performed. Whole body radiographs of the coelomic cavity were within normal limits. Radiographs of the skull revealed the presence of two metallic foreign bodies within the anterior and posterior orbit OS, presumably the result of a gun shot. OCULAR ULTRASOUND Three dayslater an ocular ultrasound was performed to identify and localize the pellets within the eye because the hyphema was not resolving. The first pellet in the anterior chamber OS was identified by focal hyperechogenicity. The second pellet was not identified during ultrasonography. Hyperechoic material, suggestive of hemorrhage or fibrin was present in the vitreous OU. Tissue plasminogen activator (tPA)0.1 mL (25 µg) was injected through the cornea into the anterior chamber for fibrinolysis and aid in the visualization of the pellet. One day later the clot in the anterior chamber had resolved and the pellet was clearly visible in the anterior chamber. The pupil was also slightly mobile. SURGICAL INTERVENTION Once the location of the pellet in the anterior chamber was confirmed surgical removal...
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