Hello, everyone and welcome to the first member webinar of 2022. I hope that you all had a nice and relaxing holiday break and that your batteries are fully charged, ready to face the patients and work of the upcoming year. So today's webinar is going to be about unique diseases of the feline cornea and those of you who attended my previous, webinar in December 2021, we know that I'm going to be talking about About these 5 diseases in blood on sequesttru using cleatitis, acute scleratopathy, and Florida keratopathy.

All of them are diseases that we see just in cats or nearly just in cats. Here is a picture of a very nice and cute kit. So let us start things off with syphron and for those of you not familiar with the word, lion is adhesions between the conjunctiva and the cornea, more precisely the conjunctiva of the globe.

Lobe, the eyelids or the third eyelids and the cornea, as you can see here, an extreme case where in fact the entire cornea is covered by conjunctiva, we can't really see the cornea or any inner or intraocular structures. The most common cause of symbilefarron is herpetic disease and that's because the herpes virus causes ulceration of both the conjunctiva, as you can see here on the picture on the left, and of the cornea, as you can see in the picture on the right. And when the animal blinks, you have two ulcerated tissues, the cornea and the conjunctava of the eyelids coming in contact with each other and as you know, and as you can imagine, if two ulcerated tissues come in contact with each other, why they adhere to each other and that's how simpleone or these adhesions are formed.

So as I said, really herpetic disease in cats is the most common cause of simarron, though trauma, chemical burns, and just chronic irritation are also possible causes, really anything that would cause restoration of both the cornea and the conjunctiva may induce yon, but the most common cause is herpetic disease and obviously as a result of these adhesions, we have reduced tear drainage caused Often it will involve the lower puncta. We have restricted eye movement because if the palpibral conjunctiva is adhered to the cornea that would restrict movement of the eyelids. The third eyelid may be elevated as .

In the picture you'll see next and obviously vision in this eye is severely reduced cause most of the Most of the cornea is covered by conjuntava, as you can see here. So the diagnosis of symbilaron is really quite straightforward. You can actually see the adhesions between the lids or the conjunctiva and cornea.

Here you can see very nicely the adhesions between the inner aspect of the third eyelid and the cornea. Here again, the 3rd. I just come up to cover most of the cornea and you see also cornea, bulbar con sorry, a bulbar conjunctiva invading the cornea.

So you're actually seeing this tissue adhered, it is often vascularized. You can see the blood vessels of the conjunctiva covering the cornea and you can see the pigment of the conjunctiva covering the cornea if the conjunctiva is pigmented, you can also see it here in this picture and here the pigment on the conjunctiva the third eyelid and that's a point I'll come back to later when we talk about fiance sequesttrum. We all know that we get Corneal pigmentation in dogs as a result of chronic irritation such as in the case of dry eye and other ocular surface diseases in dogs.

In cats, we don't have corneal pigmentation per se, so when you see pigment on the corneal surface, it is either sequester, which we'll be talking about next, or pigment of the conjunctiva due to the presence of syleron. If you're still not sure whether what you're seeing is Indeed Singleron, why you can put a drop of topical anaesthetic in the eye and then take a swab or forceps as you're seeing here and just move this conjunctiva, it will be freely moving. The inner aspect, the deeper aspect of the conjunctiva, as you can see here too, is adhered to the cornea, but the outer, the upper aspect of it is freely moving and can be moved with a swab and or forceps.

So, obviously, as I said, this condition has great impact on the animal's welfare, as I said, it reduces the drainage, restricts eye movement, and as you can see in this case, definitely reduces vision, so it's definitely something that we want to treat, but the problem is that Even though we've tried both medical and surgical treatment, both are very, very frustrating and long-term prognosis is poor. Another very nice picture of Singlero in this case adhesions from the bulbar conjunctiva. You can see it covering most of the eye and you can see the blood vessels of the conjunctiva covering the cornea.

So if we try medical treatment, here is a protocol given to me by my dear friend, David Maxx from UC Davis, who's probably the world's number one authority on feline herpetic disease, and this is the protocol. That they would use at the University of California Davis to treat these cats if they were opting for the medical treatment and you can see that we are talking about antiviral drugs and we are talking about antibiotics given Anywhere from 2 to 5 times a day, but as I said in the previous slide, it's not very rewarding. Here is a case from UC Davis on day one.

Again, the cornea is completely covered both by the third eyelid and by palpiro conjunctiva. So this is a picture on day one, and this is the same cat 2 years later. So obviously there is some Improvement I can now see the faint outline of the iris and the pupil here, which I couldn't see here.

Most of the pigment that was here is gone, but if this is all you have to show for 2 years' work of topical treatment, provided 2 to 5 times a day, I don't think the owners will be very happy. The cat won't be happy and you won't feel a great sense of satisfaction either. Which is why many of us don't attempt medical treatment and we try surgical treatment, but the problem with surgery is that it has a very high recurrence rate and that's because if you think about it, when we open up these adhesions, when we dissect the 3 of the cornea, we're really creating two ulcerated tissues again.

So once again, at the end of surgery, we have an ulcerated corneal surface and ulcerated conjunctiva. Once again, they can come into contact and the adhesions will reform. So what are some of the ways we can attempt to address these cases surgically and to prevent recurrence.

Here is a case report out of Korea. So here is the CAT presentation again, you can't really see the cornea. A blade is used to dissect the conjunctiva off of the cornea.

You can see that at the end of the dissection, you have a transparent cornea. It looks absolutely great. However, as I said, this cornea has now got a superficial ulcer cause superficial corectomy has been performed as you can see here, and the conjunctiva that was dissected free of the cornea is also ulcerated.

So what they're doing here is taking the conjunctiva and suturing it to the limbus in order to prevent it from regrowing onto the corneal surface and then they place contact lens on the cornea again to prevent contact between the cornea and the conjunctiva. And this is what the cat looks like later, not picture perfect, but definite improvement and a visual eye compared to what it looked like previously. However, as you can see here, it is really just a single case report, so a single cat, I would bet that our colleagues in Korea tried it on more than one cat, but really they had just one successful cat in which to report it.

Another attempt out of Brazil in which again the conjunctiva was resection. As you can see in these pictures here, so it's been resectioned off of the cornea and then covered with frozen amnion, a graft, of fibroblastic tissue in order to prevent regrowth of the conjunctiva over the cornea, the amnion graft really allows very rapid healing of the Superficial keratectomy site and hopefully that would prevent the re-addhesions from forming and this is what the cat looks like 3 months later. Again, very nice result compared to what it looked like initially, but once more, we are talking just about 3 cats that were studied in this report.

Another option, my teachers Kirk Gillette and Dennis Brooks from the University of Florida in a textbook they have authored advocate placing a silicon sheet after performing the keratectomy. So here is the keatectomy being done to remove the conjunctiva and then a silicon sheet is placed over the cornea to. It to heal without reformation of the adhesion.

So you can really see lots and lots of methods being tried. However, Dennis Brooks and Kurt Gelato say that the procedure I've just described provides good results in animals where the symphon was secondary to trauma and chemical burns, which I also mentioned as possible causes of symph. But it is less useful in cats, when the symphon is secondary to herpetic disease due to the recurrence of adhesions.

So really none of the surgical methods nor the medical meth protocol that I've presented provide us with very good success rates. I these cases are Very, very frustrating cause as I showed you, we can perform very nice surgery and restore corneal clarity, but the problem is recurrence. Owners should be warned about it, and many veterinary ophthalmologists just refuse to perform these surgeries because of the high recurrence rate.

The next disease I want to talk about is corneal sequesttrum, a disease where we have a higher success rate of treatment. Sequetrum. Is the lesion shown here, it may be an amber to brown to black plaque that forms in the central or para central cornea as you can see here and if you look at it histop pathologically, it is actually degenerated or necrotic.

Tissue. So necrosis forming in the cornea presenting as, as this brown to black lesion which may vary in size from very small to covering more than half the cornea and varying in depth from very superficial to full thickness. With mascularization that may be present or absent, as you can see in this series of pictures, so you can see the range of colours really from amber to brown to black.

You can see that in some cases it is highly vascularized and in other cases there is no vascularization whatsoever. So what causes this sequesttrum which has been reported maybe once or twice in dogs and cats, but it's really a uniquely feline disease. Well, we are talking about reed prediction, herpetic involvement, chronic irritation and iatrogenic causes.

So looking at BRIS, here is a case series published by my colleagues at the in Great Britain, looking at 64 cases involving ATIs and you can see that 31 of the 6 4 cats were Persian cats, so definitely a breed predisposition. However, it is not a genetic predisposition. We believe that Persian cats and Excuse me, Persian cats and other brackety breeds such as the Burmese that you can see here and other cats are simply predisposed because in bracketphalic cats, you have very exposed corneas and ocular irritation as a Mentioning a few slides is definitely associated with the disease.

So we are not talking about genetic predisposition, we are just talking about breeds that because of their skull conformation are predisposed to the disease, . You see that we're talking about mature cats, not very young, not very old. Most cases are unilateral.

6 cases were bilateral and again of the 6 cases that were bilateral, 5 were in Persian cats. So this is the first cause that's associated with sequetrum breed predisposition. The second one is herpetic disease and really I guess you can say that just about any disease of the cornea in cats, in any corneal disease in cats, you should suspect herpetic involvement.

We saw it previously in simarron and we see it again now in this case of corneal sequesttrum. Here is A study published actually some 23 years ago, 1998, but still considered a classic looking for herpetic DNA in cats with Lynohilic keratitis, which is a disease we'll, we're talking about next, and corneal sequesttrum. You can see that in normal cats they isolated Herpetic DNA in just one of 17 cats or 6%, while in cats with corneal sequesttrum they isolated DNA in more than half the cases, so herpes is definitely suspected of being involved in the pathogenesis of corneal sequesttrum.

Other causes include, as I hinted previously, irritation of the corneal surface. So we are talking about pre predisposition, lacephalic breeds with this conformation that causes the eyes to be exposed. We're talking about irritation due to entropion.

Paper published by David Williams from Cambridge, dry eye, another cause of sequesttrum and you can see this is a dry eye, just by looking at the dull reflection of the camera flash. Any ocular surface disease again, herpes should be always at the back of your mind and reduce corneal sensitivity. Shown here being tested in a dog, the dog doesn't blink in response to touching the cornea with fine filament and as I said, the central cornea of lacephalic cats is less sensitive than that of the domestic short hair.

Another reason why racephalic cats may be predisposed to the disease. And the final cause is you. You may be guilty of triggering squetrum either by previous use of steroids and then maybe because of steroids you cause latent herpes to become active, to start shedding and cause recurring disease or by performing great keraotomy.

I'm sure you're all familiar with boxer ulcers where we have a very Superficial ulcer that refuses to heal due to a structural defect, you can tell them due to the loose epithelial lips at the periphery of the ulcer. Well, we get very similar ulcers in cats and we can treat them in a variety of ways, but one way you don't want to heal, treat them is the way we used to treat them in dogs. We needle keratotomy, which is what you are seeing here, cause that would cause sequester in up to 30% of cases as shown in this paper out of New York.

So superficial keatectomy or simply dry debridement is the suggested treatment for the so-called boxer ulcers when you see them in cats rather than in dogs. So now that we know what's the clinical appearance of sequesttrum and the possible causes, let's address treatment and people have debated the use of manual removal, medical treatment, and surgical treatment. Well, actually, I want to take manual removal right off your list of possible treatments.

I know that sometimes it's very tempting to try and remove them manually. I mean, take a look at this picture here and it looks like a plaque of anal tar that's on the corneal surface. You really just want to take your 4.

Forceps and grab it by the edge and peel it off the cornea. The problem with this approach, as I said earlier, is that some of these can be full thickness and really when you grab this lesion with the forceps, you don't know how deep it is. Here is a study looking at corneal sequestrum.

With OCT that allows us very high resolution imaging of the cornea and we can see that some of them are full thickness. So please tempting as it may be, don't try to remove it manually. Instead, some people would opt for medical treatment and yes, medical treatment can be considered but only in heavily vascularized lesions such as this one because in this lesion.

We have blood vessels to bring the drugs you'll be providing to the lesion itself. In this equestrium where there are no blood vessels on the cornea, well, there are no blood vessels to bring the drugs to the lesion and therefore I wouldn't even try it in this lower case. But if you're going to try medical treatment in this case, well, it's quite intensive, we are talking about topical and or systemic doxycycline, number one for its antibiotic pro properties against possible chlamydophyla involvement and because of the immunomodulatory properties of doxycycline, we're talking about topical and Oric antiviral treatment because of the involvement of herpes virus and it say it's due to the pain and secondary inflammation, likewise, the tropicamide and hyaluronic acid, artificial tears because of the involvement of herpes and dry eye in the pathogenesis of the disease.

So, yes, you can see that we do have a medical protocol in place. It's quite intensive, but I admit I, I sometimes use it when I see heavily vascularized lesions, when the cat cannot be anaesthetized for medical reasons or when the owner can't afford surgery, but most ophthalmologists will tell you that while you are trying this medical. Treatment, the cat is experiencing pain because after all, we are talking about necrosis of the cornea, which sounds painful.

I've never experienced it myself, but I bet it's painful and you can see signs of pain in our patients. And while sometimes mental treatment may be successful in other instances, it will fail and all we're doing is really delaying the inevitable surgery. So when talking about surgery to resolve sequests, we are talking about currectomy simply to remove it.

So here is a small sequetrum here. You can see that we're talking about Light brown lesion, we have demarcated the edges of a healthy cornea around it with a trephine and removed it with superficial cortectomy. However, deeper lesions, deeper sequestrus, it will not be enough to leave the exposed cornea like that following the crotectomy and we need to fill it up with various grafts.

So just looking at the procedure when we're talking about thoatectomy, as I said, we do use our blade or A trephine sorry here or refine to outline the area that I want to remove and then with a curto as you can see here and forceps, we just lift the edge of the area that we demarcated and we use this keratome to remove the layers with superficial or deeper layers of the cornea until all of the sequestru has been removed. So, if it was a superficialism, we may leave it exposed, but many would argue that this is an older approach and nowadays more and more people tend to fill in the defect, no matter how superficial it is in order to provide greater tectonic strength and in order to reduce the prevalence. Of recurrence because sometimes these do recur.

So how can we fill in the defect? We can use lots and lots of methods, some of them have been described in my previous talks about surgical treatment of corneal ulcers. We can use a corneal conjunctival transposition whereby after removing this lesion, I would cover it with Peripheral cornea, so I would transpose this peripheral cornea to the centre and this peripheral lesion would be covered with the conjunctiva.

I can do a simple conjunctiva graph and use all sorts of biological scaffolds such as intestine submucosa, urinary gland. The matrix, amnion membrane, even cornea from the same patient, from other patients of the same species or even different species. It really depends on the experience of the surgeon, the length of the surgery, need for coronal clarity, obviously corneal.

Conjunctile transposition would be superior to just conjunctable graph, etc. Etc. So these are some of the options that you can discuss with the veterinarian you'll be referring to cause I imagine that in most cases you will not be performing the surgery yourself, you just want to know what are the options that Can be provided to fill in the defect.

And a method that I sometimes use in cases once again when we have a very superficial lesion and I cannot initize the cat or the owners cannot afford the surgery is by using the diamond burr, the instrument that we're using to treat. Boxer ulcers in dogs can be used to remove superficial sequestrus as presented in this conference paper in 2018. We've tried it in a number of cases, as you can see here, here is the cat with a superficialsesttrum, we are bearing it, we've removed nearly all of it, maybe a bit of brownish tissue left.

Here but obviously most of it has been removed and then we just cover it with a contact lens in order to increase patient comfort while it is healing. So this is an option that you could try in some cases if you have the diamond bar and really for all the so-called boxer ulcers in showing up in your clinic, I do recommend that you buy this instrument. It is really not expensive.

So keys to success when treating corneal sequestrus, again, exposed corneal surface is a risk factor in the pathogenesis of the disease, which is why you want to evaluate the lack of thalamus of the patient, whether it is able to blinker and after the procedure, you do. Want to protect the eye with a contact lens as I've shown you earlier or maybe with a partial torsoy in order to address these points. We want to control the herpetic disease that is probably at the background of this disease and as I said, because Hepatic disease and dry eye per se are involved in the pathogenesis of sequesttro.

You will make a patient very happy if you treat it with artificial tears rich in hyaluronic acid. Another enigmatic disease, that we see nearly always in cats. I think it's been described in a few horses is it was infelicittis.

And osinophilic keratitis can be defined as an aberrant response of the cat's immune system to herpes virus. So here is a drawing of a herpes virus, looks very much like the coronavirus and And due to an invariant immune response, we have a shift in the equilibrium and instead of normal healing processes, we get ahilic keraitis. So yes, herpetic disease is once more in the background of this disease.

As I said, you should suspect her. Is in most ocular surfaces, diseases in cats. We saw it in simarron, we saw it in sequesttrum.

Now we're seeing it in in keatitis. This is the first, the same study that I showed you earlier, that proved a 55% prevalence of herpetic DNA in cats with sequesttru. Well, the same study also looked at 59 cats with LNP keratitis and found herpetic DNA in 3 quarters of them again, as opposed to just 1 of 17 cats in the normal control group.

So definitely herpes is involved in the pathogenesis of Einilteratitis. What are the clinical signs of the disease? Well, we are talking about infiltrating tissue.

As you can see here, that often has single or multiple plaques on it that may be white or pink or yellowish. It often starts at the limbus, usually at the lateral limbus, as you can see here, though sometimes it is dorsal, it may be in one eye, it may be in both eyes, sometimes involves the conjunctiva. But usually involves just a cornea and if it involves a cornea, while sometimes we do see a corneal ulcer present, sometimes it is absent.

And here are a few more pictures showing you the lesions so We are seeing an infiltrative process in the cornea in all of these pictures. It looks like granulation tissue as I've said in the previous slide, but often it will be associated with. Cellular infiltration as you saw in the locks in the previous slides and as you can see in this picture and in this picture here.

So when you see this kind of lesion, you suspect it inophilic keratitis, however, I bet you would also be suspecting squamous cell carcinoma, which is another disease characterised by infiltrating tissue on the corneal surface and therefore we confirm our diagnosis by taking a corneal scrape and looking at it under the microscope. It is needed first to rule out squamous cell carcinoma, as I said, and also to justify the use of steroids with which we are going to treat these lesions because as we have said in talks during the previous year, use of steroids should be carefully considered in cats because it may bring the herpes virus out of latency and cause shedding and recurrent disease. So we take a scrape, we put a drop of topical anaesthetic in the eye and use a spatula or a special brush or even the blunt aid of a scalpel blade to take our cytological sample.

Here is what it looks like. So again, topical anaesthetic, we rest our hand on the patient, brisk scraping action by the spatula, the brush, or the blade, and we submit it to cytology. Often the question comes up of which of the three instruments should be used.

So here is actually a paper comparing the three methods published by my colleagues at the University of Florida. They actually looked at equine keratiis, but the results are the same for cats. The conclusion is that really The scalpel blade provides the most diagnostic samples.

All three techniques are useful, but the scalpel blades gave the most diagnostic samples. I really like this study, because if nothing else, it tells you that the cheapest instrument gives the best results. You don't have to invest money in a special site to brush or in a specialised spatula.

And once you've collected your sample, by whatever means you submitted to cytology and really just one mass cell or one eosinophil are enough to confirm the diagnosis, cause these are not cells that are normally present in the cornea, so you don't need a whole lot of them really just one cell is sufficient to confirm the diagnosis. Once we've confirmed the diagnosis, It is trying to trick the cat and we are talking about an apparent immune response. So obviously we are looking at immunosuppressive or immunomodulating drugs and actually every drug in the textbook has been used.

We're talking about steroids, gastro acetate, rancinolone, cyclosporin, tacrolimus, . The fact that there are so many drugs being used tells you that really there is no consensus on a single protocol, each. One of us has his or her own protocol, but I think both of them are based on starting with topical treatment, perhaps steroids together with cyclosporin, and if that doesn't work, maybe you would add, excuse me, a systemic immunosuppressive only or immunomodulatory drugs, and the key is to try and taper very Very slowly.

That's why we always start with a minimum of two drugs like topical dexamethasone and topical cyclosporin. If there is a response, great, I would start weaning it slowly off the cyclosporin and then I'm left only with the dexamethasone and I'll wean it off the dexamethasone. But when I say winning, I'm talking about 4 to 8 months of treatment, very, very Frustrating because we are talking about a lesion that looks quite benign, but just like with any immune mediated disease, the treatment can be very frustrating and really the key here is to try different combinations.

Again, you can see some studies being quoted here, some of them use topical gastro acetate, which is a wonderful new development because it's not associated with the Side effects of systemic gasterol acetate, topical cyclosporin, you can see when it's used alone, there is a high recurrence rate, topical tacrolimus and subcutaneous streams alone. So really lots of protocols out there. The key is, patience and very, very slow tapering.

Just two weeks ago, I had the veterinarian say, well, I treated this condition for 2 weeks. With antibiotics and steroids, it went away, so I stopped treatment and it came back. What did I do wrong?

Well, number one, I don't think antibiotics were needed in this case cause we are talking about a new mediated disease and number 22 weeks is definitely too short a treatment, as I said, I usually taper it over several months. However, as I've said previously, although many of these protocols do involve the use of steroids or other immunosuppressive drugs, and that brings up the question of herpetic disease cause obviously, just like with stress, the use of steroids may trigger shedding, reactivation and shedding of the latent virus and recurring herpetic disease and therefore some people would advocate in these cases to begin prophylactic treatment against the herpes virus at the same time or even before you provide the immunosuppressive treatment. So again from my friend David Mag.

You see Davis, over there, they would start with an antiviral drug. Again, please remember that 3/4 of the cats were positive for herpetic DNA recheck in 1 or 2 weeks to see that the herpetic disease is under control. Give it an in triamcinolone injection, recheck again, to make sure that this drug did not cause resurgence of the herpetic disease and now you start with topical dexamethasone, stop the antiviral and slowly, slowly taper.

So here is one protocol for you to try, but as I said, many, many protocols out there. Acute bulu keratopathy, this is definitely a disease that's only been described in cats to the best of my knowledge. Here is what acute buluskeratopathy looks like, very, very scary lesion you see this huge bulge, on the surface of the cornea.

It looks almost like iris prolapse with a huge perforation, but It's not an irri prolapse cause if you look carefully, you see that the rest of the cornea and the interior chamber and the eye are actually normal looking. This is, as the name implies, just a huge bulla. OK, so we are talking about acute sclerotopathy.

So again, we are talking about very rapid progression as implied by the name. We're talking about the of a huge ula on the surface of the cornea, accompanied by signs of pain. As you can see in this picture, in the previous picture it may cover considerable area of the cornea, but as I've said previously and as you can see here, the surrounding cornea and the intraocular structures are completely normal.

Usually we are talking about young cats usually unilateral. Here are a couple of studies looking at it, again, look at this huge scary bulla on the surface of the cornea with the rest of the cornea and intraocular tissues being completely normal. You can see here that 2/3 of the cats are domestic shorter, so no genetic.

Predisposition, young age, and in half of them, it developed in less than 24 hours. So imagine that the owners went to work in the morning, everything was fine. They come back in the evening and this is what their cat's eye looks like.

They have every right to be terrified and so do you cause it's a very scary vision. And what triggers it. This is really an enigmatic disease.

We have no idea what triggers it. One hint, comes from this study, that, reports that 50% of the cats were treated with top or systemic steroids prior to presentation. Maybe again, that means that herpes resurgence is involved, but we really have no idea.

How do we treat this? Well, this is definitely an emergency case. I'm sure the owners will quickly show up in your clinic because as I said, it's characterised by acute onset and you want to treat it very, very fast because this bulla may rupture and if it ruptures, it may cause a very painful ulcer or even corneal perforation and iris prolapse.

Thankfully, treatment is very easy. Despite the dramatic appearance, we are talking about using the 3rd eyelid as a pressure bandage, which is applied over this huge bulla. So here is a paper out of Pennsylvania reporting a 3rd eyelid flap as treatment for acute corneal hydros, another name for acute sclerotopathy in 21 eyes, and the median healing time was 3 weeks.

And you can see that here, in this case, this is the first picture that I showed you this terrifying, looking bulla. It was covered with a 3rd eye for 3 weeks, sutures were open and this is what the eye looks like now. There is some scarring, there is some fibrosis, but we, this eye was definitely saved and it was effectively treated with a very simple procedure.

The last disease I want to talk about is called Florida keratopathy, and Florida keratopathy is characterised by Multiple wide round lesions appearing on the corneal surface. You can see that they vary in size and number in these two pictures, but always if you look at them closely, you see that the centre is more densely white and it's surrounded by a fainter hallow as you can see here and here, mostly in cats but also in dogs. It's a lesion in the cornea, however, if you stain it, there is no corneal ulceration, there is no pain, they don't progress and therefore they have no clinical significance.

We regard it as an incidental finding, owners will often show up with it cause They noticed this strange lesion, but I tell them it's just like dirt on my glasses or dirt on your car windshield. There is no acity, so yeah, maybe vision is somewhat affected in this picture here, but again, no alteration, no pain, no progression, and because we really don't know what triggers it, we do not, we can't offer any treatment, . The disease was first discovered in Florida as implied by the name some 50 years ago.

Again started in cats, but then we started seeing it in dogs. There is geographical, predilection for the disease. So in the southeastern United States, in the Caribbeans, I see lots of cases here in Israel.

I know that my colleagues in Brazil see lots of cases. In other countries, it's less commonly reported, though I've heard from colleagues that it is present in cats in the United Kingdom. And even though the disease has been around for some 50 years, we still don't know what causes it.

Some people have suspected viral involvement. Again, we are talking about a disease of the feline cornea, so it's always a good bet to suspect viral involvement. Recently, some people have suggested that it's due to fire ants stinging.

But as someone who's lived in Florida for 4 years while I was training in veterinary ophthalmology, I can tell you that if you ever get stung by a fire ant, it's a very painful lesion. I don't believe that it would cause such a mild lesion with no pain and no inflammation and no infection cat eye. So most people do not sign on to this theory.

We really don't know what causes Florida erroopathy, but as I said, because, there is no pain or ulceration or progression involved, it does remain an enigma, we haven't been able to identify it. So these are a number of diseases that we sometimes see in cats. Again, we discussed just to repeat, we discussed in leon adhesions between the conjunctiva and the cornea.

It's easy to diagnose them. Unfortunately, it is very challenging to treat them both medically and surgically, which is why it is a very very sad complication of therapeutic disease cause it does reduce vision infected cats and we don't offer a good solution. Sequester, corneal necrosis, you can remove it surgically and they heal very nicely.

They're very easily diagnosed because you see the brown to black, black plaque on the cornea, but you should refer it to an ophthalmologist for surgical. Removal, aero xenophilic ratitis, infiltrating tissue into the cornea, take a scrape, see a single muscle or a single aerosinophil that confirms your diagnosis. Try immunosuppressive or immunomodulatory treatment, keeping in the back of your mind that it may trigger herpetic disease and remember to slowly, slowly taper the treatment.

Acute bulloskeratopathy, the scary bulla that appeared on the cat's cornea within 24 hours, very scary looking, very painful. It is an emergency because it may cause perforation. But easily treated with a 3rd eyelid flap and finally these Florida spots, you should recognise them just to tell the owners that it's a very, very benign lesion and they don't need to worry about it.

So I thank you for joining me for this discussion of corneal disease in household cats. I haven't seen them in these big cats, but I shall keep on looking. Thank you very much for your attention and see you next time.