Anterior uveitis in cats treatment. Iridocyclitis in a cat. Ophthalmological examination of a cat with uveitis

Practice shows that cats, unlike dogs, are much less likely to suffer from various eye diseases. Unfortunately, problems do occur, although not so often. Uveitis is a fairly common pathology in cats. The disease can be classified as chronic. It must be treated quickly, otherwise the pet will suffer a lot.

You should know that uveitis occurs with all kinds of eye injuries. This often happens during fights with their own kind. In fact, there are a lot of reasons:

1. Uveitis develops when the eyeball is removed.
2. Oncological diseases of cats can also be the root cause.
3. Pay attention to the systematics of conjunctivitis.

Veterinarians say that uveitis is a complication of a more terrible and difficult to tolerate disease. That is why pathology needs to be noticed in the early stages and treated as quickly as possible. You can be sure that your pet will be grateful to you.

Uveitis: signs and manifestations

To be precise, uveitis is an inflammation of the uveal tract. This is the pigmented, vascular part of the eyeball, which includes the iris, ciliary body, and choroid. In short, this disease affects almost all areas of the eyeball. From this it is time to conclude that the pathology can lead to complete loss of vision in an animal.

As for the symptoms, they can manifest themselves either individually or as a whole complex. Here are some of them:

1. Presence of strabismus.
2. Particular sensitivity to light.
3. Possible volvulus of the third eyelid.
4. Change in shape or pupil.
5. The visible part of the eyeball begins to turn red. Possible lacrimation.
6. The retina may darken significantly.
7. Uveitis in cats is in most cases accompanied by the presence of glaucoma or cataracts.

If you notice various changes in the eyes of a cat, you should immediately contact a professional.

Uveitis as a disease is observed in both small kittens and adults. This means that age has no effect on the manifestation of pathology.

How does the disease appear?

According to statistics, in 60% of all cases the root cause cannot be identified. In any case, the causes can be the most banal, ranging from simple trauma to conjunctivitis.

Please note that the presence of uveitis in kittens leads to the development of more serious diseases: infectious peritonitis or toxoplasmosis. Lymphomas and melanomas are oncological causes of uveitis pathology. Yes, as you can see, there are many reasons, but you should carefully monitor the condition of your pet and its immunity.

Correct treatment

In order to prescribe effective treatment, one should start from the cause. In cases where this disease is associated with cancer, the eye is surgically removed. In other cases, unique anti-inflammatory therapy is used.

There's no need to panic. Doctors say that for some felines, just using tablets is enough. First of all, it is necessary to find out whether there is a suspicion of glaucoma, which leads to blindness. As you know, this is a fairly common practice for this pathology.

Let us repeat once again that you should only contact professionals. This is due to the fact that not every clinic has a special instrument - a tonometer for measuring intraocular pressure. By neglecting the conditions, there is a risk of leaving your pet without vision.

Experts note that very frequent headaches are observed. Yes, the cat won’t say anything about it, so watch its behavior. Lethargy and meowing are already a reason to pay special attention to this.

Drugs used

Many argue that mydriatics are very important - drugs that reduce spasms of the ciliary muscle and also relieve pain. The use of these medications minimizes the chance of pathogenic substances entering the blood.

The use and dosage should be prescribed by the attending physician. Please note that home treatment may lead to complications. As soon as you notice something is wrong or your cat begins to complain of feeling unwell, there is no need to search for information on the Internet - immediately go to the veterinarian. It is important to follow all the necessary instructions from a professional, as they lead to a full recovery for your furry pet.

Correctly selected medicine makes it possible to prevent possible complications and the occurrence of new infections. A decrease in pain reactions, as well as an improvement in the cat’s general condition, indicates that he is recovering, and medications only have the best effect on your animal.

Before taking treatment measures, you should pass all tests and also prepare for research. Yes, the cat may be uncomfortable, but its health and ability to see depend on it.

The disease occurs as a consequence of injuries, viral, bacterial or toxoplasma infections, systemic fungal diseases, ascariasis, severe intoxication or metabolic disorders. In severe cases, iridocyclitis can lead to blindness.

Symptoms of the disease

Lacrimation, photophobia, yellowness of the iris, constricted pupil that reacts poorly to light, mucopurulent discharge from the inner corner of the eye.

Diagnosis of the disease

To diagnose conjunctivitis, the following methods are used: - analysis of the clinical picture of the disease - smear from the conjunctiva (determination of the pathogen and its sensitivity to drugs)

Treatment of the disease

Before contacting the veterinarian, move the cat to a darkened room and keep it calm. Instill eye drops with atropine, eye drops "Iris", which have a pronounced bactericidal effect on most gram-positive and gram-negative bacteria (including Pseudomonas aeruginosa) for lesions of the conjunctiva, cornea and deep endocular structures. Iris drops are instilled into the conjunctival sac, 1-3 drops, depending on body weight. Gamavit intramuscularly. The main treatment, depending on the severity of the disease, is prescribed by the doctor. In order to prevent the development of posterior synechia and create rest for the iris and ciliary body, use a 1% solution of atropine 4-6 times a day, GLP with atropine or complex GLP with dicaine, sulfapyridazine and atropine once a day. For purulent iritis, a good effect is obtained from subconjunctival administration of a mixture consisting of 0.5 ml once every 3-4 days. 0.5% solution of novocaine, 0.1 ml. 1% atropine solution, 0.1 ml. hydrocortisone or prednisolone, 20-25 thousand units. antibiotic. The use of eye ointments with antibiotics in combination with novocaine blockade of the cranial cervical sympathetic ganglion or with retro bulbar blockade gives a good effect. In chronic cases of iridocyclitis, the use of tissue preparations is indicated.

Uveitis (iritis, iridocyclitis) is the general name for an inflammatory process in any part of the vascular system of the eye, regardless of the cause. Anterior uveitis in dogs and cats (iritis, iridocyclitis) is an inflammation of the iris and ciliary body. Posterior uveitis in dogs and cats (iritis, iridocyclitis) is an inflammation of the choroid or main choroid of the eye, usually with parallel inflammation of the retina (chorioretinitis).

Content:

Uveitis in cats and dogs can occur regardless of age, breed or gender.

Because of the variety of causes of anterior uveitis, the patient's history will vary and should be used by clinicians as a tool to develop a diagnostic plan.

Causes of uveitis

• Intraocular inflammation begins with local tissue damage (eg, trauma, infection, immune-mediated processes, tumors).
• Bilateral anterior uveitis often indicates a systemic disease process.
• Various inflammatory agents cause vasodilatation and an increase in their permeability.
• The result of a disruption of the barrier between the eye and the bloodstream is an increase in protein content in the anterior chamber of the eye and the passage of inflammatory cells into the anterior chamber and surrounding tissues.
• The causes of uveitis may be external (blunt or penetrating trauma; corneal ulceration or infection) or internal (systemic or primary ocular disease).

  The causes of uveitis can be:

• Systemic infectious causes – fungal (blastomycosis, histoplasmosis, coccidioidomycosis, cryptococcosis); algae (protothecosis), rickettsia (erlichiosis); bacteria (brucellosis, borreliosis, any bacterial septicemia); protozoa (toxoplasmosis, leishmaniasis); viral (canine viral hepatitis); wandering larva syndrome in nematode helminth infections.
• German Shepherds are predisposed to disseminated saprophytic fungal infections (aspergillosis, candidiasis, penicillinosis, pecilomycosis)
• Immune-mediated causes - exposure to lens proteins (cataracts or lens rupture); uveodermatological syndrome; idiopathic; uveitis with uveal cysts; reactions to vaccines; scleritis
• Neoplastic causes are primary intraocular tumors or metastases from other tissues.
• Metabolic causes – hyperlipidemia
• Other causes are systemic hypertension, hyperviscosity syndrome, lens luxation.

• Systemic infections - viral (viral leukemia FeLV, viral immunodeficiency FIV, viral peritonitis FIP, possibly feline herpes virus type 1, FHV - 1); protozoa (toxoplasmosis, leishmaniasis), bacterial (bartonellosis, and any cause of septicemia), fungal (blastomycosis, histoplasmosis, coccidioidomycosis, cryptococcosis).
• Immune-mediated - cataract or lens rupture, idiopathic causes.
• Neoplastic causes are primary intraocular or metastases from other tissues.

Symptoms and signs of uveitis

What the owner observes before going to the doctor:

• Long-lasting redness (scleral hyperemia) or clouding of the eye (corneal edema).
• Eye pain (paw rubbing, restlessness, squinting)
• Decreased vision
• There is an episode of previous trauma.
• Weight loss, lethargy, or decreased appetite may indicate a systemic cause.
• Bilateral uveitis suggests systemic disease as a possible cause.

Symptoms

• Injection (strong blood filling) of the conjunctival or scleral vessels.
• Cloudiness of the cornea, which can make examining the anterior chamber of the eye difficult.
• Corneal edema - mild to significant. Inflammatory cells can sometimes be detected by hypopyon (leukocyte exudate) in the anterior chamber or precipitates on the cornea.
• Fibrin or blood clots in the anterior chamber.
• Miosis (constriction of the pupil)
• Swelling of the iris and dilation of blood vessels are better visible if the iris is light in color. Posterior synechiae (adhesions) cause the iris to stick to the lens capsule - this causes the abnormal pupil shape seen in chronic cases. May be weak or extensive.
• Increased intraocular pressure, when the outflow of fluid from the eye is blocked, can be increased or normal.
• If the cause of anterior uveitis is a systemic disease, corresponding signs may also be identified.

Diagnosis of uveitis

Differential diagnosis. What uveitis-like diseases need to be excluded or confirmed, and how to do this?

• Conjunctivitis - there is only injection of conjunctival vessels, discharge from the eyes, there are no intraocular changes associated with anterior uveitis, intraocular pressure is normal, pain is usually moderate and relieves with local anesthetics.
• Episcleritis/scleritis (inflammation of the sclera, the white of the eye) - there is an injection of the vessels of the sclera and conjunctiva, periorbital corneal edema, thickening of the sclera (possibly), intraocular pressure and the state of the anterior chamber are normal until signs of anterior uveitis develop.
• Glaucoma – there is increased intraocular pressure, the pupil is often dilated, the eyeball may be enlarged in size (buphthalmos), the cornea may have a groove.
• Any other pathology that can cause injection of scleral and conjunctival vessels (keratitis, Horner's syndrome, etc.).

Diagnosis of uveitis

• Eye examination, including fluorescent staining of the cornea and determination of intraocular pressure.
• To identify possible systemic causes of the disease - general clinical examination, general blood test, serum biochemistry, urine test. Subsequently (serology, microbiological studies, imaging studies), if necessary, are carried out based on the results of the physical examination and initial laboratory tests.
• An ultrasound examination of the eye will reveal a primary eye disease if direct examination is not possible due to clouding of the eye media.
• Examination of the intraocular fluid and vitreous humor may also be needed to make a diagnosis; intraocular fluid is used for cytology, culture studies and determining the presence of bacteria and sensitivity to antibacterial agents, polymerase chain reaction, and antibody composition.

Histopathological findings

• Corneal edema and, in chronic cases, neovascularization (sprouting of new blood vessels), corneal precipitates (clumps of white blood cells on the corneal endothelium).
• The anterior chamber of the eye contains erythrocytes, leukocytes, fibrin.
• Iris – infiltration with leukocytes (cell composition depends on the etiology); adherence of the iris to the lens (posterior synechiae); adherence of the iris to the cornea (anterior synechiae); periridal fibrovascular membranes (in chronic cases).
• Ciliary body - infiltration with leukocytes, similar to the iris.
• Lens - pigment migration on the capsule; posterior synechiae, in chronic cases, cataracts.

Treatment of uveitis in dogs and cats

Attention! This information is for informational purposes only and is not intended to be a comprehensive treatment for each individual case. The administration declines responsibility for failures and negative consequences during the practical use of these drugs and dosages. Remember that the animal may have individual intolerance to certain medications. Also, there are contraindications to taking medications for a particular animal and other limiting circumstances. If you use the information provided instead of the assistance of a qualified veterinarian, you do so at your own risk. We remind you that self-medication and self-diagnosis only bring harm.

Treatment goals for anterior uveitis:

• Causal therapy for the identified cause (treatment of corneal ulcer, infection, neoplasia, lens luxation, etc.).
• The general treatment for all cases of anterior uveitis is to stop inflammation, prevent and control complications caused by inflammation (eg, posterior adhesions, glaucoma), and relieve pain.

Drugs of choice in the treatment of uveitis

Glucocorticoids:

• Prednisolone acetate 1% suspension every 1-12 hours
• Dexamethasone solution 0.1%, 0.05% ointment every 1-12 hours
• The frequency depends on the severity of the inflammation.
• Reduce use once inflammation resolves.

Subconctival injections:

• Methyl prednisolone acetate
• Betamethasone
• Triamcinolone (rarely used for anterior uvetitis). Use a single injection in severe cases followed by topical application. Do not use in cats with suspected herpesvirus type 1 infection.

Systemic drugs
Prednisolone tablets orally every 12-24 hours. Only if systemic infection is excluded.

Nonsteroidal anti-inflammatory drugs

Local solutions

• Diclofenac 0.1% every 6 -12 hours
• Ibuprofen 0.03% every 6-12 hours
• Suprofen 1% every 6 -12 hours
• Ketarolac 0.5% every 6-12 hours
• Frequency depends on severity of inflammation

Systemic drugs

• Aspirin can be increased to a single dose every 12 hours, but the interval between doses will increase to 48-72 hours.
• Meloxicam
• Kaprofen
• Ketoprofen every 24 hours
• Karpofen
• Deracoxib

Local mydriatics/cycloplegics (paralyzing accommodation)

• Atropine sulfate 1% solution and ointment every 8-24 hours
  Pupil dilation to prevent posterior synechiae. Reducing spasm of the ciliary muscle to reduce pain intensity.
  The frequency of administration depends on the severity of the inflammation. A reasonable technique is required to achieve the desired result.

Additionally

Contraindications
Local and subconjunctival glucocorticoids are contraindicated for corneal ulcers.
Methylprednisolone acetate can lead to subconjunctival inflammation, resulting in additional discomfort.
Topical application of atropine can significantly reduce tear production, resulting in dry eye.
Long-term use of topical atropine may lead to the development of secondary glaucoma.
The use of non-steroidal anti-inflammatory drugs in cats is dangerous due to severe side effects.
Avoid drugs that constrict the pupil (pilocarpine, latanoprost, etc.)

Information for owners

The use of topical glucocorticoids is contraindicated in the development of corneal ulcers.
Prevent self-injury with a special collar if necessary.
Repeated examination is often necessary for moderate to severe inflammation.
Further training depending on the primary cause.

Patient monitoring

Repeat examinations every 1-7 days depending on severity and response to treatment.
Monitor intraocular pressure, as it may increase with decreased inflammation. If it increases with stable or worsening inflammation, this indicates obstruction of the outflow of intraocular fluid and the development of glaucoma.

Possible complications

Posterior synechiae cause an abnormal pupil shape (dyscoria).
Often secondary glaucoma.
Formation of secondary cataracts.
Lens luxation
Retinal rejection.
Systemic complications depending on the underlying cause.

Expected course and forecast

The latter for the eye itself depend on the severity and ability to control inflammation and secondary glaucoma.
Systemic consequences depend on the type of disease.

Uveitis is an inflammation of the choroid of the eye (uveal tract). The choroid is the middle layer of the eye. Anatomically, it is represented by the following components: the iris, the ciliary body and the choroid itself (choroid). The anterior part of the uveal tract consists of the iris and ciliary body, the posterior part of the choroid.

Inflammation of the choroid is usually classified depending on which parts of it are affected:
1. Anterior uveitis: inflammation of the iris and ciliary body; also known as iridocyclitis.
2. Posterior uveitis: inflammation of the choroid; also called choroiditis.
3. Panuveitis: the inflammatory process affects all parts of the choroid.

Due to the fact that the choroid is located between the fibrous membrane of the eyeball (cornea, sclera) and the retina (inner membrane of the eye), with uveitis, adjacent structures may be involved in the inflammatory process:
. Endophthalmitis is an inflammation of the choroid, anterior chamber of the eye, vitreous body and adjacent structures of the eye.
. Panophthalmitis - the inflammatory process affects all membranes of the eyeball (fibrous, vascular and retinal).

The nature of the clinical signs observed with uveitis is determined by which parts of the uveal tract are affected by the inflammatory process. Clinical signs indicating the presence of pain (blepharospasm, retention lacrimation, photophobia) are usually associated with the presence of anterior uveitis or panophthalmitis. When only the posterior part of the uveal tract is involved in the inflammatory process, patients usually experience loss or decreased vision during fundus examination.

Nonspecific signs of uveitis:
1. Eye pain: manifested by lacrimation, blepharospasm and photophobia.
2. Redness: may be due to injection of conjunctival or episcleral vessels. Episcleral vessels are usually darker in color, do not cross the limbus, and are larger in diameter. These vessels are injected for deep lesions of the cornea and intraocular tissues. When these vessels surrounding the cornea are injected into a characteristic pattern, the phenomenon is called ciliary tide. Episcleral vascular injection and ciliary tide are associated with deep corneal lesions or intraocular pathologies.
Superficial vessels of the conjunctiva are usually injected for superficial pathologies. These vessels originate in the vault, have a smaller diameter, branch and actively sprout. Topical phenylephrine can be used to constrict superficial blood vessels.
3. Corneal edema: diffuse inflammation of the cornea observed in uveitis may be a consequence of endothelial damage and dysfunction.

Specific signs of uveitis:
1. Miosis - constriction of the pupil occurs due to the release of prostaglandins. Inflammatory mediators can cause contraction of the iris and ciliary muscle. Spasm of the ciliary muscle is the cause of pain in uveitis. Miosis may not be observed in uveitis as a result of: pupil dilation caused by drugs (atropine, tropicamide), adhesion of the iris (anterior and posterior synechia), and atrophy of the iris.
2. A characteristic sign often observed in uveitis is opalescence of the aqueous humor. In uveitis, the blood-ophthalmic barrier is disrupted, allowing proteins and cellular material to enter the anterior chamber of the eye. Opalescence is observed as light scattering or the presence of opacities in the anterior chamber of the eye.
Assessment of the degree of opalescence of aqueous humor must be carried out in a darkened room.
A point light source is brought to the surface of the cornea. It is best to use a slit lamp, or use an ophthalmoscope with appropriate adjustment. The assessor should not view the area of ​​interest directly with optical aids. Instead, it should be at a 45 degree angle to the light beam. Opalescence is graded from 1+ to 4+, where 1+ is mild opalescence, and 4+ is strongly expressed. With a score of 4+, the lens is almost opaque.
Cells that enter the anterior chamber of the eye usually settle at its bottom. Hyphema is a collection of red blood cells in the anterior chamber of the eye. A hypopyon is a collection of pus in the anterior chamber of the eye. Corneal precipitates are formed when inflammatory cells adhesion to its surface.
3. Changes in the iris: In the initial period, diffuse inflammation or nodule formation may be observed in the iris as inflammatory cells accumulate in the stroma of the iris. There may also be a change in the color of the iris due to this infiltration of cells. Also, as a result of inflammation, synechia may develop. With anterior synechia, there is an adhesion of the iris to the cornea; with posterior synechia - adhesion of the iris to the surface of the lens. Sometimes, with severe posterior synechia, the junction of the iris with the lens is observed over 360 degrees. As the pathology progresses, bombardment of the iris may occur. In this case, the iris protrudes into the anterior chamber of the eye due to the accumulation of fluid in the posterior chamber of the eye.
When the pathological process becomes chronic, redness of the iris (rubeosis) develops due to fibrovascular proliferation, or the iris may acquire a darker color due to melanocytic proliferation.
4. Reduced intraocular pressure: observed with progressive uveitis and is the result of decreased secretion of aqueous humor and increased uveoscleral outflow due to the release of prostaglandins.

Changes observed in chronic anterior uveitis
Such changes include the development of cataracts. In uveitis, diffuse and cortical cataracts are usually observed. Eversion of the lens can also be observed as a consequence of rupture of the fibers of the ciliary girdle.
Also, with uveitis, secondary glaucoma can develop due to the formation of scars in the iridocorneal angle or as a result of blocking the normal flow of fluid through the pupil (posterior synechia). Atrophy of the eyeball may also develop as a result of atrophy of the epithelium of the ciliary body.

Changes in the posterior uveal tract
. Vitritis: inflammation of the vitreous body.
. Chorioretinitis: Usually when the choroid becomes inflamed, the retina also becomes inflamed. In this case, the following changes may be detected: perivascular infiltration, chorioretinal granulomas or edema, local hemorrhages in the retina, the presence of subretinal exudate.

Areas of retinal damage are usually raised above the surface, have unclear boundaries, and have altered reflectivity (darker than the surrounding tissue).
. Chorioretinal scars: atrophy or loss of normal tissue structure that occurs when the pathology becomes chronic. Scars are usually flat, have clear borders and, if located in the tapetum area, are usually brighter than the surrounding tissue and have increased light reflectivity.

Differentiation of etiological factors of uveitis
Based on a complete ophthalmological examination, the clinician needs to determine whether the cause of uveitis is endogenous or exogenous. Exogenous factors are usually easily identified during examination (eg, blunt trauma, infection, or corneal ulcer), and appropriate procedures should be performed once identified.

Diagnosis of uveitis

Diagnostic tests are usually carried out sequentially, the choice of diagnostic methods is based on the clinical picture, history and results of clinical and ophthalmological examination.

A full clinical examination is indicated if the patient has no obvious signs of exogenous uveitis, if the lesions are bilateral, if the pathological region involves the posterior part of the uveal tract, and if immunosuppressive therapy is being considered as a treatment option.
After collecting anamnesis data, a full clinical examination is performed. It is also necessary to conduct a complete blood test, determine a biochemical profile, urine tests, and conduct an X-ray examination of the chest if a fungal or oncological disease is suspected.
A cytological examination is carried out in the presence of lesions associated with impaired flow of intraocular fluid, fine-needle aspiration biopsy - of all skin lesions, enlarged lymph nodes or organs. The determination of the titer is carried out taking into account whether the given area is endemic for a particular infectious disease, whether there was a possibility of contact of the animal with the infectious agent. Obtaining an aspirate of fluid from the anterior chamber of the eye for bacteriological culture, cytological examination and PCR research can be performed with a cautious prognosis if the use of other methods has not brought diagnostically significant results.

Treatment of uveitis

The main goal in the treatment of uveitis is, if possible, to eliminate the cause of the disease, relieve the inflammatory process, relieve pain and preserve vision.
The choice of anti-inflammatory agents used is based on the presence or absence of corneal ulcerations. The frequency of use of anti-inflammatory drugs is determined based on the severity of clinical manifestations. Discontinuation of topical anti-inflammatory drugs should be carried out gradually, since abrupt discontinuation of the drug can lead to a rapid return of clinical signs of uveitis.

Drug treatment of uveitis

Anti-inflammatory drugs
1. Topical corticosteroids are the basis of most treatment protocols in cases where the fluorescein test result is negative. Corticosteroids are contraindicated in the presence of corneal ulcers. Prednisolone acetate 1% or dexamethasone 0.1% are the most appropriate choices for the treatment of uveitis due to the fact that these drugs penetrate the cornea and reach therapeutic concentrations in the anterior chamber of the eye. The frequency of use of drugs depends on the clinical manifestations and may vary depending on the degree of opalescence.
Discontinuation of drugs should be carried out gradually as clinical symptoms (redness, opalescence, presence of cells, miosis, low intraocular pressure) are eliminated.
2. Corticosteroids for topical use - before prescribing them, it is necessary to conduct appropriate diagnostic studies to exclude systemic infections. Otherwise, severe complications may develop. Based on the results of screening diagnostic procedures, such as blood tests, urine tests, chest x-rays and clinical examination, no abnormalities should be detected - only in this case is it possible to prescribe systemic corticosteroids. The use of systemic corticosteroids should be considered when there is a risk of vision loss. Prednisone is administered at a dose of 0.5-2 mg/kg/day and discontinued after the inflammatory process is stopped.
3. Steroid preparations for subconjunctival administration - can be used in cases that are difficult to treat, in cases where administration of drugs by other routes is difficult, or when systemic use of corticosteroids is contraindicated due to the clinical condition of the patient. Possible complications when using these drugs include injury to the eye with a needle as a result of non-compliance with the injection technique, or the development of corneal pathologies (ulceration, band-like keratopathy), which complicate further treatment. The following steroid drugs are commonly used for subconjunctival administration: triamcinolone (4-6 mg/eye) and dexamethasone (0.75-1.5 mg/eye).
4. Nonsteroidal anti-inflammatory drugs for topical use are safe in cases where corneal ulceration occurs, however, these drugs are not as potent as steroid drugs. For severe inflammation, these drugs are effective in combination with topical steroids.
The most commonly used:
flurbiprofen 0.3%, diclofenac 0.1% and suprofen 1%.

5. Non-steroidal anti-inflammatory drugs for systemic use - the results of clinical trials are awaited, there are no contraindications. The most commonly used are caprofen and meloxicam.
6. Other immunosuppressive drugs for systemic use - more potent immunosuppressive drugs are used in cases that are difficult to treat or when the pathogen has been eliminated. Such drugs act on various immune mechanisms.
Azathioprine is effective against immune pathologies caused by both B and T cells. During the initial phase of treatment, patients receive a loading dose of 2 mg/kg/day for 7-10 days; then the dose of the drug is reduced every day to a level at which clinical manifestations can be controlled. This drug also has a myelosuppressive effect, is hepatotoxic and can cause the development of pancreatitis. Due to possible toxicity, after finishing taking the drug at a loading dose, it is recommended to conduct a detailed blood test, determine the level of liver enzymes and platelet counts, then every 3 months, and every 3-6 months thereafter. Corticosteroids are often used initially in treatment until therapeutic concentrations of azathioprine have been achieved; in some cases, it is necessary to prescribe prednisone on days when azathioprine is not administered (every other day).
Oral cyclosporine may be effective for uveitis but is used infrequently. However, this drug is effective only against pathologies caused by T cells.
7. Mydriatics - used to relieve pain (cycloplegic effect), which is caused by spasm of the ciliary muscle. Mydriatics also help stabilize the blood-ophthalmic barrier. It is preferable to use 1% atropine due to its duration of action.
1% tropicamide does not have a pronounced mydriatic and cycloplegic effect. The frequency of use of the drug is determined by the severity of the clinical manifestations of uveitis: weak - every other day, moderate - once or twice a day, strong - two or three times a day until the pupil dilates, and then as long as necessary to maintain the pupil in this state.
Caution must be exercised in cases where there is normal intraocular pressure in the presence of signs of severe inflammatory process in the eye. Atropine is contraindicated in cases where secondary glaucoma occurs; if necessary, it is possible to use tropicamide along with locally applied carbonic anhydrase inhibitors.
Atropine may cause decreased tear secretion and is contraindicated in the presence of dry eye ulcerations. In my experience, cats salivate excessively when using atropine solution, so it is preferable to use it as an ointment. I do not use atropine ointment if there are deep ulcers or if there is a risk of corneal perforation.
8. Antibiotics for topical use - indicated only in the presence of corneal ulcers or abscesses in the stroma.
9. Carbonic anhydrase inhibitors - dorzolamide and brinzolamide can be used three times a day in the presence of secondary glaucoma. They reduce the level of aqueous humor formation and are not dependent on outflow.

Antibiotics/antifungals for systemic use
In severe cases, it is possible to use these drugs to treat toxoplasmosis, bartonellosis, and diseases transmitted by ticks. The use of these drugs can only be considered if there are appropriate indications based on general clinical and special diagnostic studies.

Signs that should be assessed during regular examinations during the treatment of uveitis in dogs and cats

If the treatment used is effective, pain relief occurs, as evidenced by a decrease in the severity of symptoms such as blepharospasm and photophobia. The intensity of hyperemia should decrease, the transparency of the intraocular fluid should increase. The pupil should be dilated, intraocular pressure should normalize.

Renee Carter, DVM, DACVO