Editorial Type:
Article Category: Research Article
 | 
Online Publication Date: 01 Dec 2015

Use of Ultrasonography and Computed Tomography in the Diagnosis of Panophthalmitis in a Tuatara (Sphenodon punctatus)

BVSc,
DVM, CertVA, DACVS,
BVSc (Hons),
BVSc, DACVP, and
DVM, DECZM (Zoo Health Management)
Page Range: 78 – 81
DOI: 10.5818/1529-9651-25.3.78
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Abstract

A 605 g, mature, male tuatara (Sphenodon punctatus) was presented with periorbital swelling, exophthalmos, and hyphema of the right eye. Ultrasound examination showed distortion of the globe, an altered lens contour, heterogeneous vitreous content, and a loss of ocular and retrobulbar tissue planes. Computed tomography demonstrated displacement of the scleral ossicles but an absence of orbital bone lesions. A decision was made to enucleate the right eye. The tuatara was premedicated with medetomidine (0.06 mg/kg) and morphine (1 mg/kg). Intravenous alfaxalone (5 mg/kg) was administered to facilitate intubation. Maintenance anesthesia was achieved using 1–2% sevoflurane. Perioperative support included intraosseous 0.45% saline with 2% dextrose (combined 50% each) at 10 ml/kg/h and thermal support via a forced-air blanket. Transpalpebral enucleation of the right eye was performed and the excised tissue submitted for histopathologic evaluation. Postoperative analgesia was provided using morphine (1 mg/kg). Histologic sections of the excised tissue showed disruption of the anterior, posterior, and vitreous chambers attributable to the presence of abundant hemorrhage, proteinaceous fluid, and fibrin admixed with macrophages and aggregates of heterophils. This material extended between the scleral ossicles and into the extraocular skeletal muscle and surrounding glandular tissues. The lens capsule was almost completely replaced and bordered by several layers of multinucleated giant cells and epithelioid macrophages. There was extensive disruption of lens fibers. A Young's fungal stain showed large numbers of fungal hyphae in the peripheral lens fibers and in the cytoplasms of surrounding multinucleated giant cells. The histologic diagnosis was fungal panophthalmitis with phacolysis.

Copyright: © 2015 Association of Reptilian and Amphibian Veterinarians
Figure 1.
Figure 1.

Dorsal plane ocular sonograms of a tuatara with panophthalmitis. (A) Normal left eye as compared with affected right eye (B). Anatomic structures include the cornea (1), anterior lens capsule (2), posterior lens capsule (3), vitreous cavity (4), retrobulbar space (5).


Figure 2.
Figure 2.

Tuatara with panophthalmitis positioned for CT scanning. (A) Rostral sponge removed to show positioning. (B) Final position of the unsedated tuatara.


Figure 3.
Figure 3.

Dorsal (A) and axial plane (B) CT images of a tuatara with panophthalmitis. Rostral is to the top of image (A). Dorsal is to the top of image (B). Anatomic structures include the OS lens (a), OS vitreous cavity (b), OD globe (c), pharynx (d), and sections of the scleral ossicles (s) at the eye margins. The OD lens is not identified.


Figure 4.
Figure 4.

Three-dimensional dorsal plane CT image of a tuatara with panophthalmitis (L denotes left). Anatomic structures include the OS scleral ossicles (a), displaced OD scleral ossicles (b), and position of the pineal eye (c).


Figure 5.
Figure 5.

Photomicrograph of the OD globe of a tuatara with panophthalmitis. The scleral ossicles (S) are displaced. The lens (L) is bordered by layers of multinucleated giant cells and epithelioid macrophages (box) and is disrupted (D). Heterophilic infiltrates are present in the cornea (C). (H&E, ×1.25 magnification). Corneal displacement occurred during specimen processing.


Figure 6.
Figure 6.

Photomicrograph showing numerous fungal hyphae within degenerate lens fibers (Young's Fungal stain, ×40 magnification).


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