X. Yespas. American Institute for Computer Sciences.

Sometimes the duty is to do nothing to refrain from interfering with the person s right to autonomy purchase ceftin 500mg online. Debate arises in duty-based ethics when there is conflict between principles discount ceftin 250 mg otc, or confusion about the validity discount ceftin 250mg with mastercard, relevance or meaning of a principle discount ceftin 250mg visa. Teleological theories of ethics, such as utilitarianism, regard actions to be right if they produce desirable outcomes. Moral rules may be useful as rules of thumb, but they are not sacrosanct, and should be disregarded if they are likely to result in an undesirable outcome in the instance. By contrast, restricted or rule utilitarians place more faith in moral rules than the3 judgement of the individual, who may lack the necessary knowledge, experience or wisdom to anticipate the full range of consequences. It is postulated that established moral rules have been created, and have survived, because they tend to lead to positive outcomes. Furthermore, rules offer security and protection: the ability to trust that individuals will behave in certain agreed ways is in everyone s interest. For these reasons, rule-utilitarians believe that the most desirable outcome is more likely to result in the long term if moral rules are followed. The rule-utilitarian commitment to moral principles and rules is based on a perception of their utility, rather than the deontological position that they are intrinsically right. Debates arise in teleological ethics when there is disagreement about which consequences are desirable, for whom they should be sought, and how they might be calculated reliably. The individual has a fundamental obligation to make a judgement about what is right in a given situation, and to act accordingly. The responsibility to be a conscious moral agent, and make choices, is inescapable: in this sense we are condemned to freedom. An action is right only if the person has acted in good faith : that5 is, in accordance with his or her own personally constructed values. The relevance of this doctrine to the ethics of health care is that it explodes the myth that a professional is somehow different from a non-professional. There is no escape from the duty to think for oneself: it is a form of moral dereliction, or bad faith, to pretend to be are enslaved. One reason is that subjective individual judgements would be variable, unpredictable and sometimes unacceptable to the majority. They may be guided by self-interest, warped by prejudice or hampered by the difficulty of grasping moral thinking. The public therefore has a right to be reassured that duties will be performed in full, in an acceptable way, notwithstanding the idiosyncrasies of individual practitioners. Furthermore, practitioners need some guidance: it is unreasonable and unrealistic to expect that we all have the time and capacity to strip down an ethical issue and invent an acceptable response many times each day, without a clear map. Besides, from many ethical perspectives it is part of the nature of morality that we are bound by rules we have not chosen. Health advisers have particular ethical duties attached to their professional role, outlined in the Code of Professional Conduct for Sexual Health Advisers. For example, it may be difficult to offer supportive and non-judgemental care to a person who is known to be seriously abusive to others; the duty to protect confidentiality may oblige a health adviser to be deceitful, or collude with the deception of others; a possible conviction that 210 abortion is wrong is at odds with the obligation to offer impartial counselling to a patient who is considering a termination. An individual health adviser may find a team decision on an ethical dilemma to be personally unacceptable for example, a decision about whether to refer a young person to social services, against their wishes. There may also be occasions where duties attached to other social roles conflict with professional duties. It is important for health advisers to have a safe and supportive arena, such as supervision, where these issues can be ventilated and explored. Some principles, such as beneficence, are consequentialist by nature; consequentialist theories recognise the importance of rules; our professional ethical code contains both rule and goal based elements; all approaches require9 individuals to make personal decisions about what is right in a given situation. It is not possible to address an ethical issue adequately without considering all elements: prima facie principles, consequences, professional obligations and personal integrity. These are described and discussed in relation to a range of ethical choices encountered by health advisers. An autonomous person is a rational being who is free to make decisions and act, or permit actions on his/her behalf, accordingly. For some deontologists, such as Kant and Sartre, it is a requirement of moral agency, and therefore intrinsic to the core value of persons. A person who lacks autonomy therefore potentially has less status as a human being. For this reason, it cannot be violated or surrendered: autonomy is both a right and a duty. Utilitarians have also stressed the importance of autonomy because it enables individuals to pursue their own goals. The assumption here is that the individual is the best judge of what will maximise his or her well- being. The following table summarises the ways in which health advisers might facilitate, respect or promote autonomy. There would be some duty to encourage her to change her mind, even though this challenges her autonomy, because he is entitled to information that will allow him to protect his health, and that of future partners. The health adviser might be tempted to help the patient make the right choice. However, such paternalism (see Paternalism, below) would weaken his autonomy by allowing him to avoid responsibility for the decision. The decision appears to be against the person s interests Legally competent patients cannot be obliged to undergo interventions against their wishes, regardless of the potential benefits for themselves. However, situations arise where a patient makes a fully informed choice that appears to be against his or her interests. The dilemma for the health adviser is whether to accept the patient s choice without comment, or to challenge the decision. Any attempt to encourage, persuade, cajole or pressurise a person into making a particular choice violates autonomy to some degree. For example, an intravenous heroin user might request a test for hepatitis C while heavily sedated by drugs and/or alcohol. In this condition, s/he would not be able to make an autonomous decision because the capacity to reason would be temporarily impaired, and consent would not be valid. The assertion that an action is right if the consequences are beneficial is central to utilitarian ethics. As health advisers we have a professional duty to seek certain benefits for certain people. Primarily, there is a duty to promote the sexual health of the patient, the contact of infection and the wider community. Regarding patients, there is an additional duty to safeguard and promote broader aspects of health and well-being. As health advisers we have a duty to minimise the damage we do to patients, contacts or the community in the process of trying to do good, given that whenever we try to help others we inevitably risk harming them. Paternalism involves denying a person autonomous control in order to protect them from harm. In health care this may take the form of giving only selective information, or overriding stated wishes, or doing things for the patient that they ought to do for themselves.

In some cases buy 250 mg ceftin visa, ease should not be ruled out by nding a normal rectal vague signs of partial anorexia ceftin 250 mg mastercard, decreased milk produc- temperature buy generic ceftin 500 mg. The grunt or groan is most apparent when the animal arises discount 500 mg ceftin amex, lies down, or is made to move about. Abdominal pain can be difcult to detect in these patients because the diffuse severe pain overwhelms any localized attempt to elicit pain by deep abdominal pres- sure. The animal will be reluctant to rise or move about and in most instances will progress to a shocklike state within 12 to 48 hours. As the animal s condition deterio- rates, the body temperature also may plummet from the early fever to normal or subnormal. The cow has an anxious expression, sal perforation is the principle differential diagnosis for arched stance, and appears gaunt. Some patients with hard- Radiography of the reticulum has been a useful ancil- ware disease with acute localized peritonitis and most lary procedure in teaching hospitals and referral centers to patients with acute diffuse peritonitis will show a degen- aid in detecting reticular foreign bodies and abscesses of erative left shift in the leukogram. The procedure is very helpful in than 10 days) hardware disease, serum globulin is often confusing cases of abdominal disease or in conrmation elevated ( 5. Experi- have hypoproteinemia as a result of uid and protein ence with such radiographic studies and the subsequent loss into the peritoneal cavity, but this does not occur as surgical ndings allow clinicians to diagnose, determine commonly as with abomasal perforation. Because of the need or approach for surgery, and prognosticate more forestomach and abomasal hypomotility or stasis, pa- specically than possible without this ancillary aid. A tients with hardware disease have a hypochloremic, hy- portable unit has reportedly been used to take radio- pokalemic, metabolic alkalosis that varies in severity in graphs of the reticulum in cattle restrained in dorsal re- direct proportion to the degree of stasis. However, it is difcult to keep cows in that with subacute or chronic hardware disease that has position and the forced positioning of the cow could caused complete rumen stasis may have a profound worsen the peritonitis. It is debatable whether alkalosis of Diagnosis this magnitude totally results from the disease present or The diagnosis of traumatic reticuloperitonitis is based is accentuated by oral administration of ruminotoric primarily on physical examination and is aided by labo- laxative medications before blood collection. In cattle with obvious of pathophysiology for alkalosis of this magnitude, the signs of peritonitis, perforating abomasal ulcers are the prognosis is not hopeless. Perforating abomasal are abdominal ultrasonography and reticular radio- ulcers tend to cause pain in the midventral abdomen on graphy. Acute pyelonephritis or necrotic lesions of the cervix or vagina may present similar to hardware. With pyelonephritis, the urine may be discolored and rectal examination reveals an en- larged ureter. If an active magnet is already present in a cow having signs of peritonitis, abomasal ulceration is more likely than hardware disease. A compass can be used during physical examination to detect an active magnet in the reticulum. The compass is moved slowly into position behind the elbow on the left thoracic wall. A 60- to 90-degree deection indicates the presence of a strong magnet in the reticulum. In cows with normal rectal temperatures, hardware disease must be differen- tiated from indigestion and ketosis. Note uid and gas interfaces around metallic foreign body suggestive of reticular abscess formation. B, Radiograph of cow with ventrally located draining stula associated with traumatic reticuloperi- tonitis. C, Abdominal radiograph of a cow with hardware showing an abscess (gas) ventral to the reticulum oor. D, Radiograph of the anterior abdomen showing a uid line of a large perireticular abscess. In severely alkalotic Except for valuable cows, conservative treatment is indi- patients, alkalinizing ruminotorics should be avoided. Conservative therapy results should be evaluated within This treatment consists of a magnet administered orally, 48 to 72 hours. If the cow is not improving or if appetite and rumen activity wax and wane, rumenotomy may be indicated. The magnet only moves to the desired location in the reticulum through effectual ruminoreticular contractions. Therefore if the rumen remains static, it is unlikely the magnet will move into the reticulum to grasp and hold the foreign body. It is revealing to note the number of cattle that are referred to teaching hospitals that possess a magnet or magnets A within the rumen rather than the reticulum when the magnet has been administered as a therapeutic rather than prophylactic aid. If the affected cow already has a magnet at the time signs develop, exploratory laparotomy and rumenotomy may be indicated initially rather than conservative therapy. This situation may occur when the foreign body is extremely long ( 15 cm) and extends off the magnet to a dangerous level or is not attached to a magnet, as in the case of an aluminum needle. Rumen- otomy and object removal should be performed immedi- ately in valuable cows to limit further movement of the object and worsening peritonitis. When laparotomy and rumenotomy are elected, it is best not to explore the se- rosal surface of the rumen and reticulum if adhesions are obvious. During rumenotomy, a careful palpation of the entire B reticulum is indicated to nd the offending foreign body, which may remain only partially in the reticular wall. Antibiotic therapy should be continued a minimum of 3 to 7 days to control existing localized peritonitis C completely and to discourage secondary reticular ab- scesses at the perforation site. Penicillin, ceftiofur, ampi- cillin, and tetracycline all have been used successfully for this purpose. B, Left paralumbar solutions, and long-term antibiotic treatment often fossa laparotomy with rumen wall attached to a rumen are necessary. Reticular ab- scesses also are fairly common sequelae and often occur on the cranial or right wall of the reticulum where they directly, or indirectly, cause dysfunction of the ventral vagus nerve branches and result in signs of vagus indiges- tion. Signs of vagus indigestion vary from mild rumino- reticular disturbances to omasal transport difculties or abomasal dysfunction/impaction. Ingesta from the reticulum leaked from this stula secondary to migration of a metallic foreign body. Therefore when hardware disease is suspected as the cause of vagus indigestion, a meticulous search of the right wall of the reticular mucosa is indi- cated during rumenotomy. Prevention B All breeding age heifers or heifers 1 year of age, as well as young bulls, should receive strong prophylactic mag- nets. Not to recommend this for valuable cattle repre- sents negligence, and the loss of a single valuable dairy cow because of traumatic reticuloperitonitis is inexcus- able. The rior abdomen and ventral thorax of a 96-point cow with effectiveness of magnets is apparent at slaughterhouses, acute traumatic reticulitis. The wire has moved into the where an impressive array of metallic foreign bodies are right thorax and was successfully removed via a stand- found trapped tightly to magnets. Therefore this typical disten- tion results in an L-shaped rumen, as viewed from the Diseases Affecting the Vagus rear or palpated per rectum. In severe cases, the rumen Innervation of the Forestomach ventral sac not only lls the entire right lower quadrant and Abomasum Vagus Indigestion of the abdomen but also may expand into the right up- The vagus nerve may be damaged anywhere along its per quadrant so the rumen assumes a V shape.

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We have used isoupredone in late pregnant cows to im- prove the clinical signs long enough to allow delivery of the calf 500mg ceftin overnight delivery. L-asparaginase has also been used successfully as short- term therapy but is expensive 500mg ceftin amex. Several or internal from compressive lesions such as a tumor other calves in this group suffered long bone or verte- or abscess causing a compressive myelopathy buy ceftin 250mg low cost, as just bral fractures over a period of 4 weeks buy ceftin 500 mg fast delivery. Nutritional factors must be considered in vertebral body abscess may develop acute spinal cord calves and growing heifers when vertebral fractures or signs if the diseased bone acutely fractures. Riding injuries either Clinical Signs caused by great weight discrepancy between mounted Clinical signs are sudden in onset and not obviously and mounting cows or the mounted cow slipping on a progressive unless the patient struggles excessively or is slippery surface may predispose to thoracolumbar verte- handled too vigorously (i. The clinical signs will reect the that fall while caught in chutes or even stanchions may fracture site and the neuroanatomic diagnosis (see fracture cervical vertebrae. The latter is more likely if the introductory section on spinal cord signs) (see video head is restrained in the chute or stanchion when the clip 45). Cattle trapped under divider bars in tie recumbency, have an anxious expression, and be unable stalls or free stall barns may struggle excessively and frac- to right themselves into sternal recumbency. Mature bulls with anky- examination may raise suspicion of the fracture loca- losing spondylosis eventually may fracture a vertebral tion based on observation and palpation of dorsoven- body if forced to mount after showing early signs of tral or lateral deviation of the vertebral spines. In severe cases, caudal vertebrae are usually caused by cows being nociception and the cutaneous trunci reex may be re- mounted during estrus activity or because of cystic ova- duced caudal to the site of the fracture and these are ries. Dystocia also may be a cause of sacral and caudal easily performed tests during the neurologic examina- vertebral injury or fracture. A cow with severe thoracolumbar spinal cord in- being caught under pipe partitions also may injure the jury seldom demonstrates the Schiff-Sherrington syn- sacral-caudal vertebrae. Malicious or sadistic handlers drome with thoracic limb extension and hypertonia often fracture caudal vertebrae by excessive force ap- coupled with paraplegia and hypotonia in the pelvic plied to the tail during tail restraint. Affected cattle may causes, frequently more than one animal in the group have reduced tail mobility and varying degrees of peri- will suffer either long bone or vertebral fractures within a neal anesthesia. Special equip- Pain is a pronounced feature of most vertebral frac- ment may be necessary to perform diagnostic radiogra- tures, and cattle with fractures may show anorexia and phy of adult animals, but calves and younger cattle may increased heart and respiratory rates. Particular attention should be or epidural abscess patients also show pain, but cattle directed to bone density if nutritional causes are consid- with compressive neoplasms usually do not. The use of large doses of corticosteroids is no longer consid- ered to be efcacious and should not be used in preg- nant cows or cattle thought to be at high risk of infec- tion. Prognosis is guarded-to-poor for all cattle with vertebral fractures, but younger animals with nondisplaced fractures have the best chance of recovery. Extremely valuable calves may be candidates for referral to orthopedic specialists. It may also be possible to surgi- cally repair crushed tail heads having sacral and caudal vertebral injuries or displacements. Sacrocaudal injury with crushed tail head and associated Assessment and correction of dietary inadequacies bilateral overexed hocks and fetlock dorsal buckling and weakness in the hind limbs caused by injury of the must be performed whenever multiple animals are spinal nerve roots that contribute to the tibial nerves. Vertebral Malformation Vertebral malformations without a spinal cord malforma- tion are uncommon. They usually involve thoracic verte- brae and slowly compress the spinal cord secondary to a progressive kyphosis that develops at the site of the mal- formation as the calf grows. Diagnosis can be made by obser- vation and palpation of the kyphosis and radiographs. Initially the heifer Degenerative myeloencephalopathy is an inherited dis- could not stand with her pelvic limbs. Now, with assist- order in Brown Swiss cattle that causes progressive neu- ance, she can support weight. The sacrocaudal vertebrae are because of the layperson s impression of a weaving gait elevated dorsally from the lumbosacral junction caudally. Motor Neuron Disease A congenital motor neuron disease occurs in Brown Swiss calves that is inherited as an autosomal recessive gene. These calves exhibit a progressive neuromuscular disorder at birth or within the rst few weeks of life. When ambulatory, their gait is very short-strided, and they fatigue rapidly and collapse. They progress in a short period to recumbency with loss of tone and re- exes and develop severe muscle atrophy. Although the vertebral malformation was present rian degeneration occurs in their intramedullary axons since birth, overt signs of ataxia and paresis did not be- and throughout their distribution in the peripheral come obvious to the owner until the heifer was 6 months nerves. Signs Delayed Organophosphate Toxicity The disease becomes apparent at 5 to 8 months, and signs continue to worsen until the animals become un- Cattle that have access to some forms of organophos- able to rise usually between 18 and 36 months of age. This will begin with a spastic paresis degeneration progresses, thoracic limbs will be simi- and ataxia in the pelvic limbs and progress to the tho- larly affected, and these cattle will fall if turned quickly racic limbs. There are no signs of brain many triorthocresyl phosphates, which are often a com- involvement. There is usually a delay of a few weeks between the period of consumption and Diagnosis neurologic signs. The toxicity affects the ability of neu- The progression of neurologic signs with no evidence of rons to maintain their axons, which results in a dying associated discomfort tends to rule out trauma or verte- back axonopathy. In contrast, animals with Weaver syndrome would not A rare spinal cord ischemic disorder has been observed be expected to have abnormal hemogram or globulin in a calf that was anesthetized for surgery to evacuate values. Postsurgically this calf with Weaver syndrome, whereas it may or may not be was unable to stand in the pelvic limbs and exhibited a in cattle with an abscess. After differential for cattle with Weaver syndrome, but gener- 2 weeks, there was no change in the neurologic signs. At ally neoplasms progress quickly to cause recumbency, necropsy there was an asymmetric severe ischemic de- whereas those with Weaver syndrome are more slowly generation in the lumbosacral segments centered in the progressive. Histopathology of This lesion is similar to what has been described in the spinal cord from cattle with Weaver syndrome has horses that have been anesthetized for various surgical shown a primary axonal degeneration and secondary procedures that require a period of dorsal recumbency. Lesions appeared more severe in the It is hypothesized that during surgery some organ posi- thoracic region. Holsteins and Guernseys are the disorder that causes overextension of the pelvic limbs most frequently affected dairy breeds. Preexisting post- secondary to severe contraction of the gastrocnemius leggedness (straight pelvic limbs) may be observed as muscles. One or both pelvic limbs can be involved, and a conformational defect in most animals before the affected cattle have very straight pelvic limbs with over- onset of signs. Initially affected cattle show has also been called Elso heel because the condition crampiness as they attempt to rise and subsequently tends to appear in animals whose genealogy dates back extend the affected pelvic limb caudal to their body. Affected calves have extremely straight pelvis is lowered, and the head and neck may be raised. When forced to stand, the Within minutes, the muscles relax, and the animal may affected limb (or limbs) is often held extended caudally assume a more normal stance except for the conforma- with only the tips of the hooves contacting the ground tional straight pelvic limbs. The gait is awkward and stiff because of the affected cattle become more spastic when they at- the difculty advancing the limb. In the early stages, the tempt to rise and after rising may extend their pelvic limb may relax or intermittently relax following the limbs caudally and shake them as if attempting to re- gastrocnemius contraction that occurs after the calf rises lieve the gastrocnemius muscle contraction. The calf may also raise its head and pelvic limb caudal extension and shaking may occur neck dorsally when showing overextension of the limb.

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The most common isolates from adult cattle masses obviously have been present and enlarging for and bulls are A best 500mg ceftin. In extremely some time before pathologic exophthalmos discount ceftin 250mg amex, the pathol- chronic cases cheap 500 mg ceftin with visa, uid pus may be replaced by a pyogranu- ogy may appear very acute once the degree of exophthal- lomatous mass of tissue that lls the sinus ceftin 250 mg line. When the si- mos prevents the eyelids from completely protecting the nuses cannot be ushed, these patients have an extremely central cornea. At this point, exposure damage and desic- poor prognosis because they often develop fatal menin- cation of the central cornea coupled with severe blepha- gitis. Saline, dilute iodine solutions, and other nonirri- moderate exophthalmos but without exposure keratopa- tating lavage solutions may be used. Analgesics such as thy may change to a blind, proptosed eye with complete aspirin (240 to 480 grains orally twice daily for an adult corneal desiccation in less than 48 hours. Successful treatment usually requires 2 weeks of local therapy, systemic antibiotics, and analgesics. Maxillary Sinusitis Treatment of maxillary sinusitis re- quires differentiation of primary sinusitis, tooth root in- fections in the cheek, sinus cysts, and neoplasia. Diseased teeth should be removed, and a trephine hole should be drilled into the sinus to allow lavage into the nasal or oral cavity (depending on cause). Because the maxillary sinus has less of a labyrinth-like anatomy than does the frontal si- nus, one hole may be drilled using a 1. Culture of the purulent material in the si- nus is essential for selection of appropriate systemic anti- biotic therapy. Analgesics may relieve some of the pain associated with eating and thus improve appetite. Pregnant cattle with conrmed lym- phosarcoma masses seldom live through more than 2 to 3 months of gestation. Embryo transfer attempts in cows with conrmed lymphosarcoma frequently are unsuccessful because of the cow s catabolic state. Squamous cell carcinoma may occur in an orbital lo- cation but usually is preceded by lid, conjunctival, or corneal squamous cell carcinoma. Orbital squamous cell carcinomas are locally invasive, tend to metastasize, and have a grave prognosis. Carcinomas of respiratory epithe- lial origin also have been observed in older dairy cattle (more than 8 years of age). Although prognosis is poor, affected cattle may be productive for 1 to 3 years with these slow-growing tumors. Neurologic Diseases Diagnosis depends on nding other evidence of lym- phosarcoma in the patient. Unlike cases with an orbital abscess, serum mous cell carcinoma, carcinoma, and adenocarcinoma) globulins and inammatory markers are often normal in that invade the orbit causing upper respiratory dyspnea cattle with lymphosarcoma. Aspirates from the retrobul- and decreased air ow from one or both nostrils, as well bar region may be helpful in some affected cattle. Tumors have a hopeless The lymphoid tumors can be palpated along the perior- prognosis. Cattle with conrmed orbital lym- thalmos, absence of all ocular tissue, is seldom an ap- phosarcoma usually die within 3 to 6 months as a result propriate term because histologic section of orbital tis- of diffuse lymphosarcoma. Physi- cal, toxic, and infectious causes have been suggested but seldom are conrmed to explain all sporadic microph- thalmia. In Guernsey and Holstein calves, the de- fect has been linked with cardiac and tail anomalies. Most commonly these calves have a ventricular septal defect and wry tail, as well as unilateral or bilateral mi- crophthalmia. Tail defects other than wry tail have been observed in some Guernsey and Holstein calves with microphthalmia and/or ventricular septal defect. In Guernseys, these malformations are thought to be caused by a recessive trait, but in Holsteins, the exact mode of inheritance is unknown. Congenital megaglobus results from anterior cleav- age abnormalities or multiple congenital anomalies producing glaucoma in utero. The resulting absence of an anterior chamber causes congenital glaucoma and buphthalmos. Convergent strabismus with or without associated relative exophthalmos has been described as an inher- ited trait in Jersey and Shorthorn cattle. Bilateral relative exophthal- mos ( bug-eyed cows ) is a condition that has been observed in several dairy breeds and probably is a ge- netic trait. Exophthalmos in these cows does not pro- gress to a pathologic state or exposure keratitis because the eyelids still cover the cornea adequately. The calf also had Congenital nystagmus has been observed in several congenital absence of the tail and a ventricular septal breeds and is common in Holsteins. It persists throughout the animal s life and does not seem to interfere signicantly with vision. The temporal bulbar conjunctiva has become pigmented as a result of chronic exposure. Enucleation has been successful in these cases, and the relatively rare incidence rules against inheritance. Microphthalmic globes usually are not treated, but if no other anomalies exist, the owner may elect to raise a calf with unilateral microphthalmos. Chronic conjunctivitis occurs in some microphthalmic patients and, if persistent and severe, may dictate enucleation to stop chronic discharge and y irritation, thereby aiding patient comfort. Acquired Diseases Acquired megaglobus may follow severe intraocular in- ammation of exogenous or endogenous cause. Endophthalmitis and pan- ophthalmitis secondary to septic uveitis or ocular perfo- ration may also cause megaglobus. If megaglobus is se- vere enough to cause exposure keratitis, the affected globe should be enucleated to prevent eventual perfora- tion or panophthalmitis. Neurologic Diseases Unilateral facial nerve palsy causing ptosis and exposure keratitis is common in calves affected with otitis media/ interna and adults affected with listeriosis. Trauma may cause facial nerve injuries resulting in neuroparalytic keratitis in bovine patients of any age. The most com- mon cause of bilateral eyelid paralysis in cattle is stan- chion trauma wherein a cow pulls back against a stan- chion until her head is trapped along the temporal ridge between the ears and orbit. Signs of neuroparalytic keratitis include lacrimation, ptosis, absence of palpebral response, and progressive corneal exposure damage. Treatment requires therapy for primary diseases and protection of the cornea with frequent application of antibiotic ointments or tarsor- rhaphy. Cattle with facial nerve paralysis appear to be much less likely to develop corneal ulcers than in many other species. Treatment of stanchion paralysis requires warm compresses, systemic antiinammatories, and pro- tection of the cornea with ocular lubricants or broad- spectrum antibiotic ointment if indicated. Tetany of the retractor oculi muscles pulls the improvement in appetite and production as a result of resolution of pain and irritation caused by the enlarged globe caudally in the orbit, allowing passive prolapse of globe. Inammatory Diseases Less frequently, megaglobus follows intraocular neo- plasia or granulomatous infections of the uveal tract.

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