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Hypopyon in Dogs

By: Dr. Noelle McNabb

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Hypopyon is the accumulation of white blood cells within the liquid of the anterior (front) chamber of the eye. The cells are released from inflamed blood vessels located within the iris and the tissues behind the iris (ciliary body).

When inflammation of the iris and ciliary body occurs, also called anterior uveitis, these blood vessels leak cells and protein into the anterior chamber. In small quantities, the accumulation of cells in the anterior chamber fluid results in a cloudy or hazy appearance to the eye. When inflammation of the iris is severe, larger quantities of white blood cells are released from blood vessels and gravity causes them to accumulate on the bottom of the chamber or fill it entirely. Hypopyon usually appears white-to-yellow in color. Some clumps of cells may stick to the back of the cornea, producing tiny specks on the cornea.

In addition to cells, certain proteins are released from inflamed blood vessels that transform into strands called fibrin within the anterior chamber. Fibrin is commonly observed with hypopyon in eyes with severe anterior uveitis.

Hypopyon can develop in any eye with severe uveitis. For that reason, hypopyon represents a symptom of serious ophthalmic disease. Hypopyon is often caused by bacterial infections of the eye, or from systemic viral, fungal, bacterial, parasitic and protozoal infections that manifest within the eyes. Therefore, diagnostic tests are often essential in determining the underlying cause of this symptom.

Severe corneal ulceration also results in hypopyon.

What to Watch For

  • Evidence of eye pain
  • Dramatic color change, often yellow or cloudy, on the surface of the eye or within the anterior chamber         
  • Difficulty in viewing details within the eye
  • Reduced vision or blindness
  • Reddened or "bloodshot" conjunctiva
  • White, gray or dark spots on the back of the cornea
  • Excessive squinting and blinking
  • Increased ocular discharge in the form of tears or a mucous- or pus-like discharge
  • Possible swelling of the eyelids

    Diagnosis

    Diagnostic tests for hypopyon may include:

  • Physical examination to determine the presence of a systemic ailment that is manifesting within the eyes, and a history of prior or on-going treatment of a systemic or ophthalmic disease.

  • Complete ophthalmic examination including close scrutiny of the anterior chamber, tonometry to evaluate for the presence of glaucoma, fluorescein staining of the cornea to assess for the presence of ulceration, and examination of the structures in the back of the eye. Your veterinarian may refer your dog to a veterinary ophthalmologist for further evaluation using specialized instrumentation.

  • Ocular ultrasound examination may be performed when hypopyon obscures details within the back of eye, particularly if there is no corneal ulcer present.

    Your veterinarian may recommend other diagnostic tests on a case-by-case basis. Tests may include:

  • Complete blood count (CBC)

  • Biochemistry

  • Urinalysis

  • Serum tests for fungal infections (e.g. blastomycosis, coccidioidomycosis, cryptomycosis, histoplasmosis)

  • Serum tests for tick-transmitted infections (e.g. Rocky Mountain spotted fever, ehrlichiosis)

  • Serum test for parasitic infections (e.g. heartworm)

  • Thoracic and abdominal radiographs (X-rays) may be recommended to determine the presence of lung disease (infection or cancer), organ enlargement and abnormal fluid accumulation

    Treatment

    Preliminary treatment for hypopyon is usually initiated while the results of specific diagnostic tests are pending. These include:

  • Aggressive therapy with topical and systemic antibiotics if a corneal ulcer is responsible for the hypopyon

  • Topical corticosteroids to reduce inflammation of the iris and ciliary body if anterior uveitis is responsible for the hypopyon and there is no corneal ulcer present

  • Topical treatment with 1% atropine to dilate the pupil, relieve pain, and decrease the chance of adhesions forming between the iris and the lens

  • Oral nonsteroidal anti-inflammatory medications, such as aspirin or carprofen, to reduce the uveitis. These may be used in the presence of many different types of infections.

  • Oral corticosteroid medications, such as prednisone. These medications provide strong anti-inflammatory effects, but are contraindicated in the presence of most systemic infections and all corneal ulcers. They are NOT prescribed until important diagnostic tests are completed that exclude a systemic infection as the cause for the hypopyon, and until the presence of a corneal ulcer is ruled out. Oral corticosteroids are often reserved for those rare cases that are not due to infections and do not respond to other medications.

  • Treatment for glaucoma (elevated pressure within the eye) in some eyes with severe hypopyon. See the Client Education article on the Glaucoma in the Dog.

    Home Care

    Do not delay in bringing the pet to a veterinarian for examination as most causes of hypopyon are potentially vision threatening and require immediate medical attention.

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