Retina, Choroid, Sclera

Chapter 11 Retina, Choroid, Sclera

INTRODUCTION

The retina is a multicellular layer 100 to 250μm thick that lines the posterior segment of the eye. It is sandwiched between the vitreous and retinal pigment epithelium (RPE) and choroid, from which its outer layers receive nutrition. The normal retina is almost transparent; the cellular arrangement is such that light can pass through the retina with limited impediment to reach the photoreceptors (rods and cones) that absorb light and convert it into electrochemical energy. The photoreceptors are adjacent to the RPE. Some light is absorbed by the retinal layers, however, which becomes evident when the retina undergoes degeneration and becomes thinner. In dogs and cats some of the light incident on the retina is absorbed as it passes through the photoreceptor layer. The light then hits the tapetum cellulosum in the choroid, which acts as a mirror and reflects the light back via the retina, where more is absorbed to maximize the light-gathering power of the eye. For this to be possible, little light must be absorbed in the intervening RPE cell layer, and it is for this reason that the RPE is largely nonpigmented over the area of the tapetal fundus. The tapetal fundus occupies the upper hemisphere of the fundus. The nontapetal fundus occupies the lower hemisphere of the posterior segment and also surrounds the periphery of the tapetal fundus superiorly, nasally, and temporally.

Figure 11-97 Rod-cone dysplasia type 1 in a 14-month-old Irish setter—the same dog as shown in Figures 11-98 and 11-99. This photograph shows the peripheral tapetum and marked tapetal hyperreflectivity and vessel attenuation.

Figure 11-98 A-B A, Rod-cone dysplasia type 1 in an Irish setter at 4 months of age. Note the juvenile fundus, which ophthalmoscopically appears normal. B, Rod-cone dysplasia type 1 in the same dog at 10 months of age. This photograph is of the same dog as shown in Figures 11-97 and 11-99. Tapetal hyperreflectivity, vessel thinning, and optic atrophy can be seen.

Figure 11-99 Rod-cone dysplasia type 1 in a 14-month-old Irish setter—the same dog as shown in Figures 11-97 and 11-98. Tapetal hyperreflectivity, vessel thinning, optic atrophy, and glial proliferations at edge of the nerve (gliosis) can be seen.

Figure 11-184 Mastiff (2 years old) with retinal dysplasia. Clinically this resembles multifocal retinal detachments with hemorrhage, although the red material settling out in the detached areas is slightly more orange or brown than blood would appear. Similar-looking dysplasias have been described in other giant breeds.

Figure 11-185 Mastiff (2 years old) with retinal dysplasia, with bullous retinal detachments and ventral gravitation of red-colored material. Same dog as shown in Figures 11-184 and 11-186.

Figure 11-186 Mastiff (2 years old) with retinal dysplasia in the nontapetum. Same dog as shown in Figures 11-184 and 11-185.

The layered structure of the retina, RPE, choroid, and sclera can be reduced to a schematic to illustrate how in various areas of the normal fundus the ophthalmoscopic view appears as it does. The appearance of and variations in the fundus owe much to the pigmentation in the eye as a whole, which can vary considerably among species and individual animals or even between the two eyes of an animal.

NORMAL FUNDUS IN DOGS

Normal Tapetum in Dogs

When a dog’s tapetal fundus is viewed ophthalmoscopically, retinal vessels are superimposed on the highly colored tapetum. The only visible components of the retina are the blood vessels. The RPE in this region is nonpigmented to allow light to reach and be reflected by the tapetum. Therefore, the RPE layer is not visible either. The tapetum is visible as the aggregate of numerous tapetal cells that overlap one another to make a layer of variable thickness, depending on the location in the posterior segment, and varies between eyes according to the amount of pigment in the eye because the tapetum consists of modified pigment cells. The tapetum may be gray, violet, blue, green, yellow, or reddish orange. The surface area of the posterior segment covered by the tapetum also may vary, tending to occupy a larger area in larger dog breeds (and including the optic nerve in the tapetal area) and a smaller area (usually more on the temporal area of the fundus) in small breeds. Some dogs have no tapetum at all. The border of the tapetal and nontapetal fundus may be sharply defined (usually more likely in short-coated breeds) or irregular with interlocking of tapetal and nontapetal regions (in longer-coated animals). Dogs of same breeds often have the same tapetal appearance and often color.

Because the tapetum acts as a mirror to reflect light for a second pass through the retina, the underlying choroid and sclera in the tapetal area of the fundus are not usually visible (at least if the tapetum is well developed).

Figure 11-1 This schematic shows a cross-section through a normally pigmented tapetal area of the fundus. The vitreous is not shown but would be above the retina in this figure. RPE overlying the tapetum is not pigmented. Black dots in the choroid represent melanin, because the choroid in these animals is pigmented, although this cannot be seen ophthalmoscopically. The viewer looks down on these layers from above.

Figure 11-2 Normal retina. Some myelination of the optic disc is visible.

Figure 11-3 Normal retina with a speckled tapetum, the result of variable thickness of the tapetal cell layer.

Figure 11-4 Normal retina in a springer spaniel. The tapetum is orange.

Figure 11-5 Normal retina. The tapetum is speckled.

Figure 11-6 Normal retina in a black Labrador retriever. Typical tapetum in many canine breeds.

Figure 11-7 Normal fundus in a German shorthaired pointer with a large amount of optic nerve myelination.

Figure 11-8 Normal retina with a yellow-orange tapetum in a golden retriever.

Figure 11-9 Normal retina with a yellow-red tapetum and a well-myelinated disc.

Figure 11-10 Normal retina. The dark areas around the disc are areas where the tapetum ends before the optic disc begins; choroidal pigment is visible here (sometimes called conus).

Figure 11-11 Normal retina with odd myelination of the optic disc. The dark areas around the disc are areas where the tapetum ends before the optic disc begins; choroidal pigment (conus) is visible here.

Figure 11-12 Normal retina. Tapetal and nontapetal junction is feathered (scalloped); the disc is circular, because little extension of myelination is present along the axons in the retina around the disc.

Figure 11-13 Normal retina. Extension of myelin out from the disc is limited, and a small pigmented conus surrounds the disc.

Figure 11-14 Normal retina. A physiologic cup is visible in the center of the optic nerve. The circular outline of the optic nerve can be seen inside the myelinated area of the nerve head. The neurons at the edge of the nerve are losing myelin (hence the gray tint to the nerve).

Figure 11-15 Normal retina. Variable color is present in the tapetum. Note the variable filling of the vessels on the disc. Arterioles tend to be more tortuous than the retinal veins.

Figure 11-16 Normal retina. The arterioles are tortuous but still within normal limits.

Figure 11-17 Normal retina. End-on capillaries (regularly spaced dark spots) can be seen in parts of the tapetum (similar to stars of Winslow in the horse).

Figure 11-18 Normal retina. The vessels over the optic nerve are prominent; the arterioles are tortuous but normal.

Figure 11-19 Normal canine retina with poor myelination in the optic nerve. A pigmented conus is present around the nerve. The arrangement of both arterioles and veins arising toward the edge of the nerve is more typical of the feline fundus. In dogs the veins usually arise more centrally on the optic nerve.

Figure 11-20 Normal retina. Pigment varies at the tapetal-nontapetal junction; pigment is present in the tapetum.

Figure 11-21 Normal retina. A pigmented conus is present around the optic disc; the blue-green speckling throughout the tapetum is the result of variable thickness of the tapetal cell layer.

Figure 11-22 Peripheral tapetum in a normal dog. The radiating dark lines appear to correspond to underlying choroidal blood vessels. This should be differentiated from thinning of the peripheral retina in dogs with degenerative retinopathies (e.g., progressive retinal atrophy [PRA]).

Figure 11-23 Normal weimaraner. The tapetal reflex through the pupil is white.

Figure 11-24 Normal retina in an Australian shepherd with a light-colored tapetum.

Figure 11-25 Normal retina with a gray tapetal color.

Figure 11-26 Normal retina. The tapetum is white with dark spots, which are the end-on view of capillaries passing through the tapetum from the deeper choroidal vessels to reach the choriocapillaris layer beneath the RPE. The nontapetum is subalbinotic.

Figure 11-27 Juvenile fundus. In a very young dog the tapetum is a gray to lilac color, which changes to mature tapetal color during the first 3 months of life.

Figure 11-28 Normal retina in a young dog; the tapetum is starting to take on its adult color.

Figure 11-29 Normal basset hound puppy at ages A, 4, B, 8, C, 13, and D, 18 weeks. A change in tapetal color occurs with the change in age.

Figure 11-30 Tapetal hypoplasia. If the pigment is absent in the RPE, as it is in the diagram, an area of thin or absent tapetum reveals choroidal vessels and pigment as islands within the tapetal fundus. Areas of absent tapetum may also be present with pigment in the RPE, which is visible as pigmented spots in the superior fundus or as a greatly enlarged nontapetum and reduced-to-absent tapetum (this is not illustrated).

Figure 11-31 Normal retina in a young dog. Small focal absences of tapetum are present, and RPE pigment at the tapetal-nontapetal junction and choroidal vessels is visible.

Figure 11-32 Normal retina. The tapetum has thinned areas through which choroidal vessels are showing.

Figure 11-33 Normal tapetal-nontapetal junction in a dalmatian. Choroidal vessels are showing through in patches where the tapetum is missing and the RPE is nonpigmented.

Figure 11-34 Normal retina in a collie. The tapetum consists of sparse, white islets of tapetal cells. The RPE is sparsely pigmented, resulting in the showing of choroidal vessels through the retina.

(Courtesy Dr. E. Dan Wolf.)

Figure 11-35 Normal retina. The tapetal-nontapetal junction is scalloped, the tapetum is missing in large areas, and the RPE is heavily pigmented.

Figure 11-36 Normal retina in an Australian shepherd. Few tapetal cells are present, and RPE is pigmented in the superior fundus. End-on vessels can be seen in the tapetum.

Figure 11-37 Normal retina. The tapetum is poorly developed; speckled tapetal cells of green and yellow predominate. Superiorly the tapetal color is somewhat diluted and is highlighted by reflection from the inner limiting membrane of the retina.

Figure 11-38 Normal Australian shepherd. The thin tapetum shows speckles of color throughout the superior fundus. The grayish reflex is a reflection from the inner limiting membrane of the retina.

Figure 11-39 Normal retina with a sparse, white tapetum.

Figure 11-40 Normal tapetum in a Border collie. Sparse tapetum is visible as red tapetal islets. The superior gray color is a flash artifact from the inner limiting membrane.

Figure 11-41 Normal retina. Small areas of tapetum are visible. Superiorly choroidal vessels can be seen through a sparsely pigmented RPE.

Figure 11-42 Normal retina. Small islets of tapetum are present in the superior fundus.

Figure 11-43 Normal retina. A few islets of tapetal cells are present superiorly. When such islets are present they are often in the temporal area of the fundus.

Figure 11-44 Normal retina. Several tapetal islets are shown.

Figure 11-45 Normal retinas in a miniature longhaired dachshund. The tapetum is very poorly developed; choroidal vessels can be seen through sparsely pigmented RPE.

Figure 11-46 Normal retina in an Australian shepherd. The tapetum is sparse and white; choroidal vessels can be seen through a minimally pigmented RPE.

Figure 11-47 Normal retina. No tapetum is present. The RPE is pigmented superiorly, so this part of the fundus looks dark brown. The RPE is sparsely pigmented inferiorly where the red glow from the choroidal vessels is visible.

Figure 11-48 Normal, juvenile fundus. Disc is not well myelinated. The tapetum is poorly developed at this age.

Normal Nontapetum in Dogs

In the nontapetum of a normally pigmented dog the RPE is pigmented. The ophthalmoscopic appearance of the nontapetum is brown to black, with retinal vessels overlying the RPE.

Figure 11-49 Schematic diagram of the nontapetum of a dog. The RPE is pigmented (brown ovals in the cells represent pigment granules). When the fundus is viewed, the choroid and sclera cannot be seen because of the overlying RPE pigment.

Figure 11-50 Normal dark-colored canine iris, which would be associated with a well-pigmented fundus.

(Courtesy Dr. Robert Playter.)

Figure 11-51 Normal dog. The nontapetal color is dark brown.

Figure 11-52 Normal dog. This is a typical dark-brown nontapetum.

Figure 11-54 Normal dog. The tortuous retinal venules are a normal variation.

Figure 11-55 Normal dog nontapetum; the blue color is the effect of the camera flash distributed across the retina. This view is of a more peripheral area of the nontapetum seen in Figure 11-53.

Figure 11-53 Normal dog. The diffuse mottling of the superior nontapetum is common.

Figure 11-56 Normal dog. Myelinated nerve fibers are visible as arcing white lines in an American cocker spaniel (blue color is camera flash artifact).

Figure 11-57 In dogs with a light (color dilute) coat color (e.g., chocolate Labrador retriever) the iris is a light brown, as in this German short-haired pointer, and fundus pigmentation can be expected to be correspondingly reduced.

Figure 11-58 Normal dog. The chocolate-brown color of the nontapetum is usually associated with a color dilute coat (e.g., a chocolate Labrador retriever).

Figure 11-59 Normal fundus in a liver-colored German shorthaired pointer. The RPE in the nontapetum is less pigmented than that of non–color-dilute dogs and looks reddish brown because of the underlying choroidal vessels and the bright reflection from the flash.

Figure 11-60 Normal dog with a color-dilute coat and reddish-brown nontapetum.

Figure 11-61 Normal greyhound; choroidal vessels can be seen in the periphery of the nontapetum because of absence of pigment in the RPE.

Figure 11-62 Red fundus. This phenomenon appears in some breeds with a poorly developed or absent tapetum but with some pigment in the RPE. The red appearance is assumed to be an optical effect of viewing red blood in the choroidal vessels through a thin layer of pigment.

Figure 11-63 Normal Siberian husky. A light-colored iris with reduced pigment in the fundus gives a reddish glow to the fundic reflex visible through the pupil.

Figure 11-64 Normal Australian shepherd. Development of the tapetum is very limited, most evident in the temporal fundus.

Figure 11-65 Normal tapetal fundus. Note scattered tapetal islets.

Figure 11-66 Normal juvenile fundus.

Figure 11-67 Nontapetum in a normal Australian shepherd.

Figure 11-68 Nontapetum in a normal Australian shepherd. Distinct choroidal vessels can be seen inferiorly in the far periphery.

Figure 11-69 Tigroid nontapetal fundus, so called because of the tiger-striped appearance of the choroidal vessels and choroidal pigment. The pigment is reduced or absent in the RPE, which allows the viewer to see retinal vessels superimposed on a background of choroidal vessels and pigment. The sclera is not visible because the choroidal pigment absorbs any light incident on it.

Figure 11-70 Normal dog. Tigroid fundus.

Figure 11-71 Normal Australian shepherd. Tigroid fundus.

Figure 11-72 Normal retina with choroidal vessels visible in nontapetum.

Figure 11-73 Normal merle collie. Choroidal vessels are visible on left side of photograph.

(Courtesy Dr. E. Dan Wolf.)

Figure 11-74 Subalbinotic fundus. Pigment is reduced or absent in the RPE and choroid. The resulting funduscopic appearance is of retinal vessels superimposed on choroidal vessels, all superimposed on the white background of the sclera.

Figure 11-75 Subalbinotic iris in a Siberian husky.

Figure 11-76 Normal Australian shepherd. No tapetum is visible in this photograph, and the tiger stripes of the choroidal vessels are visible on the right.

Figure 11-77 Normal dog. No tapetum is visible in this photograph, and the tiger stripes of the choroidal vessels are visible in the nontapetum.

Figure 11-79 Normal dog. Choroidal vessels are visible throughout the fundus. More peripheral area of the same fundus as shown in Figure 11-78.

Figure 11-78 Normal dog. Choroidal vessels are visible throughout the fundus.

Figure 11-80 Normal Siberian husky. Choroidal vessels are visible throughout the fundus.

Figure 11-81 Normal dog. Islets of tapetal cells are visible superiorly; choroidal vessels are visible throughout the rest of the fundus.

Figure 11-82 Normal Australian shepherd. Choroidal vessels are visible throughout the fundus.

Figure 11-84 Australian shepherd from Figure 11-83. Some areas of RPE are normally pigmented; other areas are nonpigmented, and choroidal vessels can be seen.

Figure 11-83 Heterochromia in an Australian shepherd.

Figure 11-85 Normal dog. Heterochromia with a fundus similar to Figure 11-86.

NORMAL FUNDUS IN CATS

As in the dog, the ophthalmoscopic view of the tapetal fundus of the cat shows retinal vessels superimposed on the highly colored tapetum. The only visible components of the retina are the blood vessels. The RPE in this region is nonpigmented to allow light to reach and be reflected by the tapetum. Therefore the RPE layer is not visible either. Compared with dogs, cats have fewer variations in the tapetum. Usually the tapetal color is yellowish, and the optic nerve is usually in the tapetum. The nontapetum in cats is usually dark brown, with retinal vessels superimposed. Blue-eyed white cats usually have no tapetum and have a subalbinotic fundus, similar to blue-eyed dogs. Blue-eyed cats with Siamese point coloring (e.g., Siamese, Himalayan) usually have a normal tapetum, but the nontapetum is subalbinotic.

Figure 11-86 Normal dog. Tapetum is sparse superiorly. Some areas of RPE are normally pigmented; other areas are unpigmented, and choroidal vessels can be seen.

Figure 11-87 Normal cat. The tapetal color is typical, and the optic nerve is surrounded by tapetum.

Figure 11-88 Normal cat.

Figure 11-89 Normal cat.

Figure 11-90 Normal cat with an odd variation on tapetal color.

Figure 11-91 Normal cat.

Figure 11-92 Two views of a normal fundus in a cat.

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Tags: Color Atlas of Canine and Feline Ophthalmology

Jul 31, 2016 | Posted by admin in INTERNAL MEDICINE | Comments Off

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