Clinical and pathological findings in three dogs with a corneocentric presentation of nodular granulomatous episcleritis

Abstract

Purpose To describe the clinical signs, management, histopathologic findings, and outcome of three dogs with a corneocentric presentation of nodular granulomatous episcleritis (NGE). Methods Three dogs of varying breeds were presented for a unilateral, nonpainful, and infiltrative corneal lesion in the dorsal aspect of the eye. Clinical response to symptomatic topical treatment directed at a presumed inflammatory or immune‐mediated cause was poor. Due to this, and concerns of neoplasia, ultrasonography (n = 1), incisional biopsy (n = 2), and/or enucleation (n = 2) were performed. Results The inflammatory infiltrate observed on histopathology was identical to that seen in nodular granulomatous episcleritis in all three cases. However, atypically the inflammation was confined to the cornea and limbus, without episcleral or conjunctival involvement. Inflammation of the cornea was full thickness to Descemet's membrane. Following enucleation (n = 2), there were no postoperative complications, and no reported ophthalmic disease in the remaining eye. Currently, the single non‐enucleated case remains controlled with systemic and topical immunosuppression. Conclusion To the best of the authors’ knowledge, this is the first report of an NGE condition purely affecting the full thickness of the cornea, without episcleral or conjunctival involvement. The authors propose this to represent an atypical corneocentric variant of NGE. This clinical presentation can resemble neoplasia; incisional biopsy is recommended for a definitive diagnosis. Further research into the optimal treatment strategies for this variant of NGE is required.

Bilateral Sterile Pyogranulomatous Keratitis in a Dog

“…Classically, these lesions are primarily confined to the sclera [19]. However, recent work has presented three cases of corneocentric variants of NGE [20]. It is important to note that the microscopic features of corneocentric NGE do not fit the described microscopic findings of this case.…”

Clinical and pathological findings in five dogs with nodular histiocytic iritis in the United Kingdom: A case series

“…Previous reports of atypical 'NGE' have used similar terminology to try to promote clinical recognition and understanding of the described condition. 6,11,12 However, this terminology is technically incorrect because the episclera is not involved, so the term nodular histiocytic iritis was chosen to describe this intraocular presentation of NGE-type inflammation.…”

“…Anterior uveal involvement has been described in three dogs with concurrent lesions of the episclera, conjunctiva and/or nictitating membrane 6 . A recent report describes a corneocentric presentation without episcleral involvement 12 . To the best of the authors' knowledge, restriction of NGE‐type inflammation to the anterior uvea has not been reported.…”

“…6 A recent report describes a corneocentric presentation without episcleral involvement. 12 To the best of the authors' knowledge, restriction of NGE-type inflammation to the anterior uvea has not been reported.…”

Posteriore Skleritis bei einem Hund

“…Entzündungen der Sklera und/oder der Episklera im vorderen Bulbusbereich beim Hund lassen sich im Rahmen einer ophthalmologischen Untersuchung relativ gut diagnostizieren und wurden in der Literatur beschrieben [1][2][3][4][5]. Dahingegen fällt bei einer posterioren Skleritis die klinische Symptomatik weniger eindeutig aus.…”