Importance of the Opthalmological Examination
Presenter – Pip Boydell CertVOphthal MRCVS of Animal Medical Centre Referral Services
Hearing last week’s webinar speaker, Pip Boydell, describing the eye with phrases such as ‘the mirror of the soul’ gave me a good insight into how passionate he is over his chosen subject. Mr Boydell then went on to use perhaps more ‘vetty’ terminology by describing the eye as ‘ the most diagnostic inch of the body’.
We see a number of ocular cases walking through the door in practice and Mr Boydell wanted to point out that some will be an indicator of systemic disease. There is a long list of diseases which can cause secondary ocular conditions. Examples in cats include hypertension, toxoplasmosis, FeLV and FIV. Examples in dogs include Borreliosis, Neospora and Diabetes Mellitus where sometimes the first obvious sign of the disease to an owner may be the formation of cataracts.
Interestingly it has now been shown that E. Cuniculi may transmit across species and this is another condition that may present with ocular signs in cats, dogs and rabbits.
Skin disease must also be considered when an animal presents with ocular disease. Mr Boydell was keen to stress that the eyelid is, after all, part of the skin, and cytology should be performed on the eyelid to rule out diseases such as demodicosis. Allergic disease is also a common cause of ocular signs with Mr Boydell stating that around 80-90% of cases that are referred to his clinic at this time of year will be showing allergy related signs. The standard work up for diagnosing allergies should be carried out on these cases including checking for fleas, food trials, intradermal skin testing and trial therapies.
There are of course many cases seen with ocular signs that are suffering from a condition directly related to the eye. A thorough examination is essential whatever the underlying cause, and Mr Boydell went into great detail explaining techniques that are available to us including direct and indirect opthalmoscopy, slit lamp biomicroscopy and tonometry. A word of advice from Mr Boydell was to consider trying some of these techniques on ourselves before subjecting our patients to them. A slit lamp being used with a bright light and full beam is not pleasant and by experiencing this discomfort we will hopefully adjust the examination for our patient.
A number of techniques, including those mentioned earlier, were discussed in much greater depth within the webinar. However Mr Boydell was keen to stress that it would take hours and hours to discuss these techniques with the necessary detail, so the webinar is just to offer a taster of what we should be doing. We have to remember that the art of opthamology is a real specialism, so much so, that some medical schools don’t even teach their budding doctors to examine eyes, they are just expected to refer their cases to a specialist.
Of course in veterinary practice we also have this option but there are cases where this won’t be a possibility and for these cases, we must be pedantic about our ocular examination and most importantly we must practice, practice and practice.
The Stethoscope (MRCVS)