Dr. Goedele Storms
Bouvier des Flandres of 5.5 years old, male non castrated.
Chronic conjunctivitis that has been treated with systemic NSAIDs and cephalosporins without any improvement. Has been living for months in the south of Europe (Greece) and Eastern Europe, is currently living in Belgium.
Ocular exam: left eye: no menace response, PLR (direct and indirect) present, palpebral reflex present, enophthalmos, marked protrusion of third eyelid, normal retropulsion, hyperemia of bulbar and palpebral conjunctiva, thickened dorsal conjunctiva, cornea: nasoventral superficial perilimbal vascularization, diffuse discrete corneal edema, no Tyndall effect, lens: ok, fundus: multiple elongated, elevated white-pink structures, in tapetal region, below retinal vessels, which lift the retinal vessels, elevated/swollen optic nerve head (see picture) Ocular exam of the right eye is normal CBC and biochemistry: within normal limits, Leishmania serology negative.
Histology conjunctiva and eyelids: suppurative and mildly eosinophilic blepharitis, suppurative conjunctivitis, no presence of Onchocerca spp.
Has anyone seen similar fundic lesions? What do I have to include in the differential diagnosis?