True Emergencies
• Acute Primary Glaucoma
• Luxated Lens
• Globe Proptosis
• Corneal Laceration
• Deep/Progressive Ulceration
Emergency #1
Acute Primary Glaucoma
• ACUTE: Often occurring over hours
• PRIMARY: Developing in absence of an overt underlying cause
• GLAUCOMA: Pathologic elevation in IOP
• Inherited abnormality of the ICA places certain animals at risk (breed and individual variation)
Poster Children: Classic Exam Findings
• Blepharospasm
• Elevated TE
• Corneal edema
• Episcleral congestion
• Fixed, dilated pupil
• Vision loss
Diagnostics
• IOP>>25 mmHg
• Hyperemic ON
• Do NOT pharmacologically dilate!
Why it's an Emergency
• Exquisitely painful condition
• Permanent vision loss occurs over hours with greatly elevated IOP
• Vision loss by degenerative optic neuropathy*
• The higher the IOP, the less time required for permanent blindness
• The globe is buphthalmic*
• The dog lost vision last month
• The patient is a cat
When in Doubt...Mannitol
Fwiw
Beyond ER Treatment
• Prompt referral for further evaluation & treatment, options
• Gonioscopy of ICA to confirm primary glaucoma
• Surgical procedures are available for visual globes that may be useful to control IOP for very committed clients
o Laser TSCP
o Goniovalve placement
Long-Term Consequences
• Ultimately
o BLINDING
o PAINFUL
o BILATERAL
Long-Term Options
• Topical anti-glaucoma tx has been shown to delay the onset of primary glaucoma given prior to IOP elevation
o ** TREAT THE OTHER EYE**
• Chronic glaucoma usually ultimately requires some sort of surgical salvage procedure
o Enucleation
o Evisceration with intrascleral prosthetic placement
o Cyclocryoablation
o Pharmacologic ciliary body ablation
Emergency #2
Primary Lens Luxation
• Many terrier breeds have a primary lens zonule abnormality
• Zonules gradually break down spontaneously until lens comes loose around middle age
• Occasionally will see what appears to be a senile breakdown in older poodles, etc.
• Differentiate from luxation due to chronic inflammation, buphthalmia, trauma
