This twelve week old Cavalier King Charles Puppy is presented with these eyelid lesions. What is the likely diagnosis, what steps would you take to confirm it and what treatment should be implemented?
These irregularly thickened lids are typical of pyogranuloamtous inflammationcentred around the meibomian glands and associated with juvenile cellulitis or ‘head-gland’ disease. The question and the image were a little unfair, as in real life you would see the whole head of the animal with the classical dermatological lesions. Although the lesions suggest an infectious problem no agents were cultured from samples taken from the dog. Cytology from a fine needle aspirate showed a mixed inflammatory cell reaction with no agents visible on Gram stain. Systemic steroid is the recommended treatment, although I am always concerned enough that infection might possibly be present to give a cephalosporin antibiotic concurrently. The two most useful reviews are Reimann et al: Clinicopathologic characterization of canine juvenile cellulitis. Vet Pathol. 1989 26(6):499-504 from a pathological perspective and White SD et al: Juvenile cellulitis in dogs: 15 cases (1979-1988). J Am Vet Med Assoc. 1989 Dec 1;195(11):1609-11 as a significant case series.