What is wrong with this middle-aged dog’s eye?

Also known as spontaneous chronic corneal epithelial defects, indolent corneal ulcers are superficial, non-infected corneal epithelial defects that fail to resolve through the normal wound-healing process. There appears to be a predilection for boxers to develop this defect, but any breed can be affected. The average age of affected dogs is 8 to 9 years, but boxers can be affected at any age.

In all cases, a thorough ophthalmic examination should be performed to identify any underlying condition that may impair the normal healing process. These include eyelid abnormalities (e.g. entropion, ectropion, step defect from previous trauma or surgery), foreign body, abnormal hairs (e.g. distichia, trichiasis, ectopic cilia), a deficient tear film or conformational issues (e.g. prominent eye).

The typical appearance is a ring of loose epithelium surrounding a superficial corneal ulcer that appears as a halo of less intense fluorescein staining around a darker center. Therapy typically involves epithelial debridement using a diamond burr, grid keratotomy and/or anterior stromal puncture. A topical antibiotic is required until the corneal ulcer is fluorescein stain negative. If no debridement is performed, these defects can take months to heal.



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What is the diagnosis for this young cat’s eye?

Symblepharon is abnormal adhesion of conjunctival tissue to the cornea or to another conjunctival surface. The condition can be minor (a very thin tissue strand) or extensive and blinding (covering the entire globe). It typically results from severe conjunctivitis, which in cats is caused most commonly by feline herpes virus type 1 (FHV-1). With severe conjunctivitis, there can be large areas of conjunctival and corneal ulceration. The ulcerated areas will form adhesions to one another and to the ulcerated corneal surface. Symblephara are permanent adhesions that occur most commonly with a severe primary infection. They are less likely to form in older cats with recurrent herpesvirus conjunctivitis outbreaks. Surgery to sever the adhesions can be attempted, but many adhesions recur despite aggressive surgical correction.

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This 1-year-old pit bull terrier is experiencing no discomfort or systemic signs. What ophthalmic condition would you diagnose?

Extraocular myositis is a focal inflammatory myopathy observed most commonly in young, predominantly large- or giant-breed dogs.

The typical presenting signs are exophthalmos without protrusion of the nictitating membrane, and congestion of the episcleral vessels.

Physical examination often reveals fever, lethargy, weight loss, potential blindness and restricted jaw movement due to swelling of the masseter, temporal and pterygoid muscles.

 Advanced imaging (e.g., ultrasonography, computed tomography, magnetic resonance imaging), if pursued, would reveal swollen extraocular muscles.

 Histopathology of the inflamed muscles would reveal CD3+ lymphocytes and macrophages as the predominate cell types.

Most patients with extraocular myositis respond well to a course of immunosuppressive steroids administered over three to four weeks.

 However, detrimental side effects can occur with chronic inflammation. With uncontrolled or chronic inflammation, fibrosis of the extraocular muscles can result in enophthalmos with strabismus.

 If enophthalmos is severe, a corrective procedure may be required to reposition the eye.

 While its appearance is similar to Graves disease in people, extraocular myositis has no known association with hypothyroidism or hyperthyroidism.

 It should be differentiated from masticatory muscle myositis. Masticatory muscle myositis also results in exophthalmos, but the third eyelid is typically elevated due to swelling of the pterygoid muscle.

What is the diagnosis for this young Burmese cat’s eye?

C. Prolapse of the gland of the third eyelid (“cherry eye”)

Prolapse of the gland of the third eyelid is less common in cats than in dogs. It has been reported most often in Burmese cats, with cases also reported in Persian and domestic shorthaired cats. Burmese cats are mostly affected as kittens, but the age of onset can be later in domestic shorthairs. Surgical repositioning of the gland is recommended and is equally effective in cats and dogs. If the gland is removed, the cat is predisposed to developing dry eye.

What are the discolored lesion on this cat’s cornea?

Corneal sequestration can occur as a primary stromal disease in Persians and Himalayans, or it can be a secondary issue. Secondary causes of corneal sequestrum formation include chronic corneal ulceration, keratitis and irritation from entropion. This cat had a history of entropion following an episode FHV-1 recurrence resulting in conjunctivitis and superficial corneal ulceration.

Corneal sequestra appear as areas of amber, brown or black discoloration. The depth and size of these lesions can vary greatly. A keratectomy (excision of corneal tissue) can be performed to remove the necrotic cornea. A grafting procedure is required if the keratectomy site is deep or to prevent recurrence. If a graft is not performed, a soft contact lens or a temporary tarsorrhaphy should be placed to help decrease the chance of recurrence.

As you can see from these cases, pets of all ages can suffer from a host of ocular conditions that require a wide range of diagnostic testing and treatment—many of which must be performed at specialty veterinary hospitals by board-certified veterinary ophthalmologists. That means costs can quickly add up.

Owners who have pet insurance are well positioned to afford any unexpected veterinary care their pet may require throughout its lifetime. Keep in mind that no pet insurance plan covers pre-existing conditions, so getting it when the pet is young is the best way to plan for any health concerns that may arise. This is especially important for breeds that are predisposed to certain diseases (e.g. glaucoma in poodles, cataracts and other ocular conditions in Siberian huskies).

 for best practices for broaching the pet insurance conversation with your clients.

Dr. Joslin earned her DVM degree from Oklahoma State University in 2013 and become a diplomate of the American College of Veterinary Ophthalmologists in 2018. She practices at Mount Laurel Animal Hospital in Mount Laurel, New Jersey.

1. Ledbetter EC, Gilger BC. Diseases and surgery of the canine cornea and sclera. In: Gelatt KN, Gilger BC, Kern TJ, Eds. 

, 5th ed. Baltimore, MD: Lippincott Williams & Wilkins; 2013:988-992.

2. Stiles J. Feline ophthalmology. In: Gelatt KN, Gilger BC, Kern TJ, Eds. 

, 5th ed. Baltimore, MD: Lippincott Williams & Wilkins; 2013:1485.

3. Spiess BM, Pot SA. Diseases and surgery of the canine orbit. In: Gelatt KN, Gilger BC, Kern TJ, Eds. 

, 5th ed. Baltimore, MD: Lippincott Williams & Wilkins; 2013:808-810.

4. Webb AA, Cullen CL. Neuro-ophthalmology. In: Gelatt KN, Gilger BC, Kern TJ, Eds. 

, 5th ed. Baltimore, MD: Lippincott Williams & Wilkins; 2013:1862-1863.

5. Cullen CL, Webb AA. Ocular manifestations of systemic disease, Part 1: The dog. In: Gelatt KN, Gilger BC, Kern TJ, Eds. 

, 5th ed. Baltimore, MD: Lippincott Williams & Wilkins; 2013:1916-1917.

6. Stiles J. Feline ophthalmology. In: Gelatt KN, Gilger BC, Kern TJ, Eds. 

, 5th ed (ed). Baltimore, MD: Lippincott Williams & Wilkins; 2013:1495-1496.

Articles

Test your diagnostic skills by examining the following images and selecting the answer you think fits best. 

Image Quiz: Can you name these ophthalmic conditions?

The University of Georgia is now offering a non-thesis online master’s program in comparative biomedical sciences. The interdisciplinary program, with courses in lab animal research, clinical concepts, pathology, human and veterinary anatomy, and cell biology, among others, is intended to build a foundation for students planning to pursue careers in veterinary or human medicine, dentistry, or biomedical engineering or biomedical research.

Thirty credits earned over one to two years are required to graduate from the program.

Lisa K. Nolan, Georgia Athletics Association distinguished professor and dean of the College of Veterinary Medicine, says the program could not have been developed at a better time. “Students in this program will receive a broad curriculum of knowledge that will be of great benefit to them in their pursuits—all from the safety of their homes,” she says in a press release announcing the program.

Applications for the fall 2020 semester are due July 1. For more information, visit the UGA College of Veterinary Medicine’s 

The University of Georgia College of Veterinary Medicine will offer a comparative biomedical master’s program online starting this fall. 

UGA introduces online professional master’s program

The American Association of Feline Practitioners (AAFP) and the Winn Feline Foundation have announced the winners of the 2020 joint scholarships for feline clinical practice and feline clinical research scientist. These scholarships are awarded annually to students who are passionate about feline health and welfare, and the advancement of feline medicine.

Emily King, a junior at The Ohio State University College of Veterinary Medicine, received the clinical scientist scholarship, and Jessica Tondo, a junior at Western University of Health Sciences in Lebanon, Oregon, received the feline clinical practice scholarship.

Each recipient will receive $2500 to help further her education and passion for feline medicine and welfare, according to an 

King says she was “bit by the research bug” early on in her education, drawn decidedly to feline-specific research. She eventually explored the role of anatomic pathologists and how their research integrated into feline medicine. “With the knowledge and experience I hope to gain from this next step, I’d eventually love to apply this to feline-specific research, such as feline coronavirus or feline immunodeficiency virus,” King says.

After earning her bachelor’s degree in physiology from the University of Washington, Tondo pursued her dream of becoming a veterinarian. “I hope to advocate for feline health and wellness,” she says. “I have grown up with cats my whole life and am forever grateful for the love and compassion they provide.”

The annual scholarships are awarded to two college students who are dedicated to advancing feline medicine. 

AAFP, Winn Feline Foundation announce 2020 scholarship winners

The effects of COVID-19 on the veterinary profession have been sudden and far-reaching. Few practices or team members have been unaffected, and many of the ramifications are likely to be felt for some time to come.

While the pandemic has undoubtedly presented challenges, it also has brought out the profession’s ingenuity and catalyzed changes that can position practices for greater success in the post–COVID-19 economy.

In April, the AVMA conducted a large survey of practice owners to better understand the practical impact of COVID-19. We collected over 2,000 responses representing different practice sizes, types and patients, asking questions about client numbers, financial impact, operational changes, supplies and other topics.

The survey results paint a clear picture of how broadly COVID-19 has impacted veterinary medicine. They also highlight the creativity and innovation that have allowed veterinary teams to continue providing essential healthcare to patients while limiting spread of the coronavirus and prioritizing the safety of team members and clients.

Among the key findings from the April survey:

Almost every responding veterinary practice (98%) was limiting client contact due to COVID-19.

The most common operational change used by practices was curbside care—asking clients to wait in their vehicle during animal exam and treatment.

Over 30% of practices were using telemedicine, and close to 20% were seeing only emergency-related cases.

Nearly every practice reported a decline in revenue accompanied by a shortfall in the cash/income necessary to accommodate practice operation.

COVID-19’s impact has permeated practices completely, from the bottom line to the implementation of new service models and precautionary measures that safeguard the health of veterinary teams and clients.

On the operations side, fully 85% of practices surveyed had implemented curbside care as of April. Other changes included the adoption of contactless payment processing, taking patient histories by phone or virtually, and drive-through pickup and drop-off.

More than half of all practices were allowing client visits only by appointment in April, and nearly two-thirds had delayed at least some surgical procedures. A small number of practices (5%) had implemented staggered or dedicated service hours for senior citizens only.

Precautionary measures put in place to protect human health also were diverse. Just over one-third of practices had asked clients to maintain social distance from each other, and 31% had asked team members with symptoms of illness to go home. Some 14% had asked clients displaying symptoms to leave the facility, and almost 13% had asked clients to wash their hands.

More than 25% had asked staff to sanitize and reuse personal protective equipment (PPE), and 20% asked staff to limit PPE use beyond state requirements whenever possible. Over half of practices reported being unable to order PPE at some point during the pandemic, and more than 60% had trouble getting sanitation supplies.

There’s no question that veterinary practices have felt the financial effects of COVID-19. As of April, about half of practices surveyed had seen client visits drop by 50% or less.

More than 75% of practices reported that their clients had started buying pet food or medication online, likely in response to COVID-19. Of those, 73% of practices said clients had started buying online directly from the practice, and 23% said clients were using other online retailers (mostly Chewy, PetMed Express and Amazon).

To address these issues, more than 60% of respondents indicated they had applied or would apply for a Small Business Administration (SBA) loan. This was the most common strategy reported to maintain cash flow, and nearly all of those planning to apply for loans said they would use some or all of the money for payroll. About 60% of practice owners indicated they would forgo their own salary, and 60% said they would pull from business cash reserves. About 35% of respondents indicated they would rely on a business line of credit or use a personal asset to in fuse cash into the practice.

In many ways the pandemic has provided a pivotal push to spark transformation and accelerate change in the profession. Veterinary practices in the future will not look the same as they did before COVID19, and some of that change can be beneficial—after all, the need for transformation is ever-present. The one thing we need to keep asking ourselves is, “What more can we do?”

 includes resources to help practices continue innovating. These include telemedicine tools, guidance on bolstering cash flow, and resources to support expansion of services whenever the time is right. On the business and insurance side, AVMA PLIT and AVMA LIFE also have useful resources related to COVID-19; visit 

As AVMA leaders talk with practice owners, frontline veterinarians, technicians and others, one thing is clear: The COVID-19 crisis has forced the veterinary profession to evolve in some positive ways. Practices have implemented telemedicine and other virtual technology in rapid fashion, and they are exploring ways to deliver services in a better and more efficient way.

The speed with which practices rolled out curbside and concierge care, switched patient rechecks to virtual check-ins and implemented new safety protocols has been remarkable. Some of these changes, like curbside care or adjustments in how farm visits are conducted, may wane in the post-pandemic world. But others are likely to stay in place and could help make practices even stronger moving forward. Virtual and convenience-added solutions, such as telemedicine and online ordering, will remain relevant long after the COVID-19 recovery is complete.

Dr. Salois worked in private industry, government and academia before joining the AVMA in 2018 as director of veterinary economics. From 2016 to 2018, he served as director of global scientific affairs and policy at Elanco Animal Health, supervising a team of scientists in veterinary medicine, human medicine, animal welfare, economics and sustainability. Before joining Elanco, Dr. Salois was chief economist with the Florida Department of Citrus, where he led economic and market research activities to drive industry growth and profitability for citrus growers. He previously served as an assistant professor at the University of Reading in the U.K., and also has held positions with the University of Florida and University of Central Florida.

Survey results reveal that the pandemic has provided a pivotal push to spark change and propel the veterinary profession forward. 

How will COVID-19 transform veterinary practice?

Every member of your veterinary team should be able to confidently advocate for pet dental health. Not sure where to start? Consider these suggestions for making actionable recommendations in the examination room and promoting ongoing oral care at home.

Address dental care during every well visit

During wellness visits, be diligent about making dental health discussions as routine as taking a patient’s vital signs. When technicians initiate a conversation about a pet's dental needs, it adds substantial weight when the veterinarian repeats the same points later in the visit.

Make sure clients are aware of how common dental issues are in companion animals. Although dental issues are not always apparent to pet owners, 80% to 89% of dogs

 have some level of periodontal disease by the age of three.

Help clients understand that dental disease can cause pain and infection that, left untreated, will decrease their pet’s quality of life. Send your message home by providing real-life examples, such as a photos or radiographs comparing healthy and diseased teeth. Make sure clients know that, as for people, dental disease in pets is irreversible, but treatments are available to rectify problems. The intent is not to instill fear, but rather to help clients understand the full scope of the situation.

Too often clients perceive discussions about their pet’s oral health as “friendly suggestions” instead of medical recommendations. Consider how you approach the conversation and what small, impactful changes you can make to improve compliance. For example, rather than saying simply, “You should consider scheduling a dental appointment for Fido soon,” reiterate specific concerns (e.g. gingival recession, tooth fracture) from the exam and explain that you would like to schedule a full dental exam under anesthesia so the veterinarian can make a proper diagnosis.

Put “conversations with clients about dental care” on the agenda for your next staff meeting, and take the opportunity to share real-life experiences with one another. Discuss what tactics work best with clients and how to move beyond the common pushbacks. Evaluate the feedback and, as a group, come up with brief yet compelling recommendations that staff can make to clients about dental care.

Stress the importance of home dental care

Maintaining proper pet oral health cannot be done solely during annual visits at the veterinary hospital. As for people, regular toothbrushing is the best way to prevent periodontal disease in pets.

 It’s imperative that clients take the lead on cleaning their pets’ mouths and recognizing signs of pain or disease. The key to increasing compliance is keeping it simple. Here are five ways to keep your clients informed in and out of the hospital:

Explain in detail how to start the toothbrushing process and what products to use to ensure a pleasant experience for both pet and owner.

Maintain and distribute client handouts based on individual patients, such as young pets, cats, dogs with gingivitis, etc. (

Hint: For a plethora of handouts on a wide range of topics, including pet dental health, visit 

Keep the conversation going online by using your hospital’s social media platforms to educate clients about the need for preventive care. Aim to share at least one post a week.

Provide clients with specific oral health product recommendations, including those with the 

Veterinary Oral Health Council Seal of Acceptance

Include links to dental health articles in any post-appointment notes that are sent to clients.

And be sure to follow up after a dental procedure to see if the client has any questions about postoperative care or long-term maintenance.

Brunius Enlund K, Brunius C, Hanson J, et al. Dental home care in dogs - a questionnaire study among Swedish dog owners, veterinarians and veterinary nurses. 

Harvey C, Serfilippi L, Barnvos D. Effect of frequency of brushing teeth on plaque and calculus accumulation, and gingivitis in dogs

Gorrel C, Rawlings JM. The role of tooth-brushing and diet in the maintenance of periodontal health in dogs. 

Amanda Carrozza is a freelance writer and editor in New Jersey.

As a veterinary professional, you know how important your patients’ oral health is, but are your clients aware? Check out these tips on how to have a meaningful conversation with your clients about dental health. 

Make the conversation about dental health memorable

Like much of the world, my family is dealing with the realities of a highly contagious virus that until a few months ago none of us had heard of and almost no one could envision. We have no available prophylaxis, no known treatment and no parallel clinical experience; among our only defenses is the seemingly archaic method of quarantine. 

Be it government enforced or self-initiated, a quarantine is a restriction on the movement of people, animals or goods to prevent the spread of disease. Sometimes referred to as medical isolation, quarantine isolates those potentially exposed to but not necessarily infected by a communicable disease.

Quarantines have been applied for centuries in the face of everything from bubonic plague, leprosy and cholera to measles, chicken pox, diphtheria, scarlet fever and even syphilis. Isolation was at one time the best management we knew.

When I was a youngster, polio meningitis or encephalitis was perhaps the greatest fear among parents for their children. Two forms occurred: nonparalytic (also called abortive) polio and the much more damaging paralytic polio. The first major polio epidemic in the United States dates back to 1894 in Vermont, with 132 cases reported.

 In 1916, the country saw more than 27,000 cases of polio and 6,000 deaths from the disease.

 At its peak in the 1940s and 1950s, polio would paralyze or kill over half a million people worldwide every year.

I recall a number of kids early in my childhood who developed paralysis, several of whom never came back to school after being sick. The fear of paralysis and death from polio held the country hostage for over a decade. People lived in a shadow of fear.

Today the fear of COVID-19 infection is everywhere, and the parallels to polio are striking. Much as is the case with our latest nemesis, many people infected with polio experienced only mild symptoms; up to 95% had no symptoms at all. The non-paralytic form of polio frequently only lasted 7 to 10 days and did not lead to paralysis. In fact, less than 1% of all polio cases were paralytic. Both forms resulted initially in flu-like symptoms, which—not unlike coronavirus—included headache, sore throat and fever, among others. Needless to say, even though the symptoms were relatively minor in most cases and patients recovered fully with about a week, parents were terrified. The vast majority of people who contracted the disease didn't even know they had it.

Most of the diseases that people feared throughout history have been eradicated as a result of the development of safe and effective vaccines. One day, hopefully very soon, the pandemic that has become our global scourge will also be relegated to the medical history books. In the meantime, keep your distance, wash and disinfect your hands, and avoid contamination of your food.

Dr. Mike Paul is the former executive director of the Companion Animal Parasite Council and a former president of the American Animal Hospital Association. He is currently the principal of MAGPIE Veterinary Consulting. He is retired from practice and lives in Anguilla, British West Indies.

Lewis K. The story of polio. Arizona Department of Health Services website: https://www.azdhs.gov/documents/ preparedness/epidemiology-disease-control/infectiousdiseases-training/2018/story-of-polio.pdf. Published July 25, 2018. Accessed May 29, 2020.

The coronavirus pandemic has generated fear throughout the world, for many of the same reasons the polio epidemic did at one time.