MATERIALS AND METHODS

A 3-year-old Golden Retriever-crossbreed bitch was referred to veterinary hospital at the Azerbaijan Animal Rescue Center (AARC), Baku, Republic of Azerbaijan. She had a 6 month history of a swelling and redness of right eye with ophthalmic neoplasms tentative diagnosis and recommendation for emergency surgical removing. General physical examination was unremarkable. Also hematological factors and serum biochemical analyses were within normal limits (Vet., Lab., Station, IDEXX, USA). The menace responses and the pupillary light and palpebral reflexes were normal in both eyes. Schirmer tear test (Schering-Plough Animal Health, New Jersey, USA) values were 18.3 and 21.8 mm min^–1 in the left and right eye, respectively. Fluorecein (Branes-Hind Diagnostics, Canovanas, Puerto Rico) staining was negative and stain passage into the nostrils within 2 min. The intraocular pressures measurement with Schiotz tonometer (Reister, Jungingen, Germany) were 26 mm Hg in both eyes. Direct ophthalmic examinations (Welch Allyn, Inc., USA) were limited to the right eye and showed moderate conjunctivitis, localized swelling and thickening of the episclera in dorsal cornea with mild corneal oedema (Fig. 1a, b).

The swelling on episclera was biopsied for histopathological evaluation under general anesthesia. No infectious agents or foreign bodies were present.

Fig. 1(a-b):	Right eye of the patient in different views

RESULTS AND DISCUSSION

Our clinical diagnosis was nodular granulomatous episcleritis of the right eye. Differential diagnoses for episcleralitis include secondary episcleritis occurring due to other ocular diseases such as uveitis, glaucoma, keratitis and/or orbital disease and ophthalmic neoplasia^1,3. Secondary episcleritis was ruled outbased on a complete ophthalmic examination. Histopathological evaluation of the biopsy revealed a mixed population of lymphocytes, plasma cells and macrophages. These findings were confirmed NGE.

Primary episcleritisis divided to simple (diffuse) or nodular forms. Diffuse episcleritis may be unilateral or bilateral. Its clinical manifestation usually is an elevated sector lesion, posterior to the limbus with episcleral and conjunctival vascular congestion. Cocker spaniels and golden retrievers are predisposed to diffuse episcleritis. Although the nodular form is the most commonly diagnosed in Rough Collie and Shetland sheep dog breeds but in this case report nodular form was diagnosed in a Golden Retriever. Nodular episcleritisis commonly referred to as nodular granulomatous episclerokeratitis which is presented alternatively with other titles such as nodular fasciitis, fibrous histiocytoma, proliferative conjunctivitis and collie granuloma^1,3,7.

The NGE is usually bilateral and manifests clinically as a raised pink mass affecting the temporal limbus, cornea and the nictitating membrane but this report included a unilateral mass which affected superior limbus³.

The immunopathogenesis of the primary episcleritis likely involving primary type IV hypersensitivity with a probable underlying type III. Literature did not show any association with a local infectious process or systemic immune-mediated disease^1,3.

Although, medical therapy including topical corticosteroids such as prednisolone, triamsinolone and dexamethasone can usually improve clinical signs but systemic corticosteroids or other immunosuppressive agents such as azathioprine and cyclosporine A may be necessary in some cases^3,5,6. Treatment may be complicated due to the necessity of long-term maintenance therapy and underlying side effects of the systemic immunosuppressive medicines⁸. The frequency of administration can be gradually tapered in case of remission³. The more recent medications are niacinamide and tetracycline but the efficacy of these treatments has not been completely proven and need more trialsyet¹.

The above mentioned patient treatment was initiated with ciprofloxacin 0.3% ophthalmic drop (Ciplex; Sina Darou, Tehran, Iran) q8 h and prednisolone 1% (Precord; Sina Darou, Tehran, Iran) q12 h to prevent infection and inflammation of the biopsy site. Reevaluation was performed 2 weeks following biopsy and initiation of therapy. The biopsy site had healed completely, therefore the treatment protocols was changed to oral prednisolone tablet (Biosynthesis, Penza, Russia), 2 mg kg^–1, q12 h tapered to 1 mg kg^–1, q12 h for 2 months and two subconjunctival injections of triamcinolone (Kenalog-40; Bristol-Myers Squibb, Spain), 6 mg with 1 month interval⁸. No recurrent lesion was detected 2 month after the treatment period and periodically check-up, once in a month was suggested for this patient.

This communication is the first report of diagnosis and different management of NGE in Republic of Azerbaijan.

ACKNOWLEDGMENT

The authors are many thankful to the sponsorship of Azerbaijan Animal Rescue Center, Milla dairy Co. (AZFP Ltd) for providing facilities for the presence report.