Observations in Ophthalmology , Ophthalmology

Diagnosing Acute Blindness in Dogs

Diagnosing Acute Blindness in Dogs



Caryn E. Plummer, DVM, Diplomate ACVO
University of Florida

Vision loss can occur gradually or manifest acutely in dogs, but acute and complete blindness can be particularly devastating. The abrupt nature of this blindness is very disconcerting for all involved and pet owners may make hasty conclusions and decisions.

The diagnostic approach to these patients should include:

  1. Ophthalmic history identifying the onset and duration of blindness, degree of blindness (as perceived by the owner), other signs of disease, and medication regimen
  2. Vision assessments, including menace response, visual placing, and “maze” tests, that confirm whether the patient is blind
  3. Causative lesion localization by pupillary light reflex examination of the eye, potentially with ocular ultrasound, blood pressure measurement, electrophysiologic testing, specifically electroretinogram.

An Eye Toward Anxiety

When a dog is presented for acute blindness, or what is perceived as acute blindness, it is important to proceed with patience and care because the patient is likely anxious and upset, while its owner is often distraught. Slow movements, accompanied by a calm voice, facilitate the examination, may soothe or allay some anxiety, and make the clinician’s presence known to the dog at all times.


A thorough general and ophthalmic history is crucially important to the investigation of blindness because differential diagnoses can be quite different depending upon the onset and duration of the deficits.

The history should determine:

  • Whether vision loss is partial or complete.
  • Whether vision loss is acute or has been developing gradually: Did the dog have functional vision yesterday, but blindness today or has it been gradually losing vision and now is completely blind?
  • When signs of vision loss developed: Did signs of vision loss manifest yesterday or 2 months ago?
  • Whether the appearance of the eye has changed. If so, when was this change noted? This information is important because, in many instances, the physical appearance of the eye may change over time.
  • Systemic signs of disease are present, or whether a systemic problem has been previously diagnosed. Note that many systemic diseases (eg, infectious disease, lymphoma, hypertension) may initially be recognized by their ophthalmic manifestations.1,2
  • What medications the patient receives/has received, both chronically and more recently, including inadvertent administration/ingestion. For example, has the dog recently received or ingested ivermectin?


As the history is being gathered, confirmation of vision—or the lack thereof—should be performed. Note that some patients—those with neurologic disease and aged animals with cognitive dysfunction—may behave as if they are visually impaired even though their visual systems are functional.

Menace Response

Vision requires functioning central and peripheral ophthalmic systems, and may be roughly assessed with a menace response. The menace response test is performed by making a menacing gesture with the hand toward the patient’s eye. Take care not to touch the vibrissae or cause excessive air currents, both of which stimulate the sensation of touch rather than sight, potentially inducing a false-positive result.2 If the animal can see, it should blink or move its head away from the stimulus.

Cotton Ball Test

The patient’s vision can be further evaluated by noting its response to cotton balls (or some such noiseless, scentless object) tossed into the visual field or observing the visual placing reaction.

Visual Placing Reaction

Visual placing is assessed most easily in small patients that are able to be held. For this test, the patient is held in the examiner’s arms so that the forelimbs dangle freely. The dog is moved slowly toward a table or other elevated flat surface. As the limbs approach the edge of the table/flat surface, if visual and able to respond, the dog will raise its limbs in order to step onto the table.2 If the dog does not see the table, it will not raise its limbs, allowing them to bump into the edge.

Maze Test

In patients with suspected blindness, an obstacle course or “maze test” may be used to determine whether vision is present.

Traffic cones, foam cylinders, or even examination room furniture, such as chairs and waste cans, suffice, although elaborate mazes may be constructed for standardized testing. The dog should be placed at the opposite end of the maze from its human companion, who is asked to call the dog’s name only once, which keeps the dog from following voice cues in order to maneuver.

Vision should be evaluated in normal light and then dim light (after dark adaption) and obstacles should be adjusted between tests to avoid memorization and mapping. To assess night vision, dim the ambient illumination until you can barely distinguish the room furniture and maze course obstacles. Normally sighted dogs have better developed night vision than humans; therefore, the patient should be able to see the maze obstacles better than the examiner.3

Eye Evaluation

For the menace response, cotton ball test, and visual placing reaction, each eye should be evaluated separately by covering each in turn and testing the exposed eye.

Dark adaption

is the adjustment of the eye to low light intensities, involving reflex dilation of the pupil and activation of the rod cells in preference to the cone cells.


The next step in the evaluation of the blind patient is to determine where the causative lesion is located. Is the patient blind because something is obscuring the visual axis, such as pigmentary keratitis, corneal edema, or a cataract? Or is the patient blind because the retina or central nervous system is at fault?

Pupillary Light Reflex

The size of the pupils and the direct and consensual (response in the fellow, non-stimulated eye) pupillary light reflexes (PLRs) are very important for lesion localization (Figure 1).2 These assessments should be performed with a bright light in a dimly lit room.


FIGURE 1. Complete resting mydriasis in a young Chihuahua with bilateral optic neuritis. Both direct and consensual PLRs were absent.

The PLR evaluates:

  • Rapidity of pupillary light response
  • Extent of miosis
  • Ability to maintain miosis to constant light stimulation.

The consensual pupillary reflex is normally equal to the direct.

The PLRs require integrity of retinal neural cells, optic nerves, optic chiasm, optic tracts, midbrain (Edinger-Westphal nucleus), and parasympathetic fibers via the oculomotor nerve, ciliary ganglia, and the iridal sphincter musculature, but integrity of the cerebral cortex is not required (Figure 2). The reflex is, therefore, subcortical and should be considered an evaluation of the integrity of the retina and optic tracts, not of vision.2


FIGURE 2. The pathway of the pupillary light reflex.

In general, in dogs with vision impairment, when PLRs are (Table 1):

  • Absent or diminished: The lesion is likely located in the retina or optic nerve.
  • Intact: The lesion often obscures the visual axis or interferes with the cortical processing of visual information.


Examination of the Eye

Because the eye can often be visualized to the level of the posterior segment (in its normal state), a complete ophthalmic examination can provide a rapid and accurate diagnosis for many ophthalmic diseases (Table 2).


During the ophthalmic examination, keep in mind the general causes of vision loss:

Lesions that prevent light from reaching the retina in a focused (non-scattered) manner

  • Lack of response by the retina to light stimulation
  • Inability of the optic nerve and tracts to transmit the electrical response of the retina
  • Inability of the occipital cortex to process the information supplied by the eyes and optic pathways.

Lesions obscuring the visual axis are often relatively easy to diagnose and may develop slowly or rapidly. Table 3, provides a list of ocular lesions that may present as an acute onset of vision loss.


Because vision can potentially be restored with appropriate management, rapidly developing cataracts, corneal ulcers, severe uveitis, intraocular hemorrhage, and anterior lens luxation should be considered urgent or emergent depending on severity. Acute glaucoma should always be considered an emergency.

A thorough fundic examination is the next step if the:

  • Anterior segment (ie, cornea, anterior chamber, and lens) appears normal
  • Anterior segment abnormalities found are not severe enough to account for the degree of vision loss noted.

Often, if the retina or optic nerve is affected, the pupil is dilated, making pharmacologic mydriasis unnecessary.

Optic Nerve

The optic nerve should be thoroughly examined for evidence of disease or inflammation.

If the optic nerve is raised, swollen, or hemorrhagic, optic neuritis is a likely diagnosis. A variety of infectious or inflammatory diseases and neoplastic processes may result in optic neuritis, which usually manifests with an acute onset of marked vision loss. Once diagnosed, neurologic evaluation should be pursued as other neurologic deficits often are present concurrently.

Conversely, if the optic nerve is recessed or atrophic, the changes present are chronic. This condition can occur due to damage from chronic glaucoma, retinal degeneration, or chronic optic neuritis. Optic nerve disease carries a guarded to poor prognosis for vision return.


Examination of the retina should include both the tapetal and non-tapetal regions and the retinal vasculature. The appearance of the tapetal fundus should be carefully evaluated, particularly its reflectivity.

Generalized tapetal hyperreflectivity (excessively shiny tapetal appearance) indicates retinal thinning and degeneration, which can be associated with:

  • Gradual onset of vision loss, as found with progressive retinal atrophy (PRA)
  • Acute onset of vision loss, as found with sudden acquired retinal degeneration syndrome (SARDS).

Dogs with PRA generally lose night vision first, followed by decreasing day vision and then complete blindness. In both advanced PRA and SARDS, vascular attenuation and diffuse tapetal hypereflectivity develop; a dog with SARDS, though, has a normal fundus initially and becomes acutely blind. Physical evidence of retinal degeneration (tapetal hyperreflectivity and vascular attenuation) develops over time in SARDS patients.

Tapetal hyporeflectivity (dull tapetal appearance) is seen with chorioretinal inflammation. Since much of the retina must be inflamed for obvious vision loss to be present, diagnosis is often easily made by fundus examination.

Keep in Mind During PLR

Remember, PLRs are affected by the psychological state of the animal, room illumination, age, many topical and systemic drugs, and the intensity of the light stimulus.

If an animal is highly nervous or frightened, the pupils may be dilated and respond poorly to low-intensity light. However, with acclimation or a strong light source, this effect is minimized.

Older animals may exhibit slow and incomplete PLRs resulting from atrophy of the iris sphincter muscle. This response is common in small dogs, especially poodles. The pupil margin may have an irregular or scalloped appearance or an irregular pupil shape, referred to as dyscoria (Figure 3).


FIGURE 3. Iris atrophy in a Yorkshire terrier has resulted in mydriasis and an incomplete pupillary light reflex. Note the scalloping of the pupil margin and the holes in the temporal iris stroma. This aged individual also has an immature cataract.

Ocular Ultrasound

If the fundus cannot be visualized due to vitreal hemorrhage or inflammation, an ocular ultrasound should be performed to assess for conditions that result in ocular hemorrhage: retinal detachment and ocular neoplasia.

Blood Pressure Measurement

If retinal detachment is identified—either by fundus examination or by ultrasound—or if posterior segment hemorrhage is present, systemic blood pressure should be measured. As a result of increased hydrostatic pressure in the vasculature, systemic hypertension can cause fluid accumulation in the subretinal space, which displaces the retina into the vitreal chamber, resulting in retinal detachment.1,4

Retinal detachments can also occur:

  • With congenital or developmental disorders (eg, collie eye anomaly)
  • Secondary to inflammatory disease (eg, chorioretinal inflammation), vitreal degeneration, cataracts, or lens luxation
  • As a complication of intraocular surgery (eg, following cataract surgery).

Electrophysiologic Testing

If the fundus appears normal and the animal is avisual, especially if vision loss was acute, consider the following retinal conditions:

  • SARDS (as hyperreflectivity occurs over time)
  • Retinitis (typically immune-mediated)
  • Cortical disease
  • Retrobulbar optic neuritis (optic disc appears normal but retrobulbar optic nerve is affected).

These conditions can usually be differentiated with PLRs and electrophysiologic testing. Abnormal PLRs are typically associated with retinal or optic nerve disease and normal PLRs with cerebral cortical disease.


Sometimes a normal PLR is present with retina and optic nerve disease, even if the animal is avisual. An electroretinogram (ERG) can be used to differentiate vision loss due to retinal disease (abnormal ERG result) from vision loss due to disease of the optic nerve or cerebral cortex (normal ERG result).3

Further Diagnostic Testing

Animals with cortical or optic nerve blindness should be evaluated with:

  • Magnetic resonance imaging or computed tomography
  • Cerebrospinal fluid analysis
  • Generalized workup for systemic inflammatory or neoplastic diseases.

In addition, a normal ophthalmic examination should prompt consideration of the central nervous system as the primary site of disease, especially when the PLRs are normal.


Acute vision loss in the dog is generally considered an emergency and warrants prompt evaluation by a veterinarian to confirm vision loss, localize the causative lesion, and institute therapy. In some cases, prompt medical treatment will result in return of vision. Delayed care carries a poor prognosis for sight and may delay diagnosis of a significant systemic condition.

ERG = electroretinogram; PLR = pupillary light reflex; PRA = progressive retinal atrophy; SARDS = sudden acquired retinal degeneration syndrome


  1. Webb AA, Cullen CL. Neuro-ophthalmology. In Gelatt KN (ed): Veterinary Ophthalmology, 5th ed. Ames, IA: Wiley-Blackwell, 2013, pp 1820-1896.
  2. Webb AA, Cullen CL. Ocular manifestations of systemic disease: The dog. In Gelatt KN (ed): Veterinary Ophthalmology, 5th ed. Ames, IA: Wiley-Blackwell, 2013, pp 1897-1977.
  3. Ekesten B. Ophthalmic examination and diagnostics: Electrodiagnostic evaluation of vision. In Gelatt KN (ed): Veterinary Ophthalmology, 5th ed. Ames, IA: Wiley-Blackwell, 2013, pp 684-702.
  4. Ofri R. Retina. In Maggs DJ, Miller PE, Ofri R (eds): Slatter’s Fundamentals of Veterinary Ophthalmology, 4th ed. St. Louis: Saunders, 2008, pp 285-317.

author_c-plummerCaryn E. Plummer, DVM, Diplomate ACVO, is an associate professor in comparative ophthalmology at University of Florida College of Veterinary Medicine, where she also serves as chief of the comparative ophthalmology service. Her research interests include corneal wound healing and glaucoma, and she has lectured extensively—both nationally and internationally—on many topics associated with clinical veterinary ophthalmology and animal models of ophthalmic disease, especially glaucoma. Dr. Plummer received her DVM from University of Florida; then she completed an internship in small animal medicine and surgery at Michigan State University and a residency in comparative ophthalmology at University of Florida.


DMCA.com Protection Status
[gravityform id="6" title="false" description="false"]
<div class='gf_browser_safari gf_browser_iphone gform_wrapper' id='gform_wrapper_6' style='display:none'><form method='post' enctype='multipart/form-data' id='gform_6' action='/diagnosing-acute-blindness-dogs/'> <div class='gform_body'><ul id='gform_fields_6' class='gform_fields top_label form_sublabel_below description_below'><li id='field_6_1' class='gfield gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible' ><label class='gfield_label gfield_label_before_complex' >Name<span class='gfield_required'>*</span></label><div class='ginput_complex ginput_container no_prefix has_first_name no_middle_name has_last_name no_suffix gf_name_has_2 ginput_container_name' id='input_6_1'> <span id='input_6_1_3_container' class='name_first' > <input type='text' name='input_1.3' id='input_6_1_3' value='' aria-label='First name' aria-required="true" aria-invalid="false" /> <label for='input_6_1_3' >First</label> </span> <span id='input_6_1_6_container' class='name_last' > <input type='text' name='input_1.6' id='input_6_1_6' value='' aria-label='Last name' aria-required="true" aria-invalid="false" /> <label for='input_6_1_6' >Last</label> </span> </div></li><li id='field_6_2' class='gfield gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible' ><label class='gfield_label' for='input_6_2' >Email<span class='gfield_required'>*</span></label><div class='ginput_container ginput_container_email'> <input name='input_2' id='input_6_2' type='text' value='' class='medium' aria-required="true" aria-invalid="false" /> </div></li><li id='field_6_7' class='gfield gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible' ><label class='gfield_label' for='input_6_7' >Profession / Role<span class='gfield_required'>*</span></label><div class='ginput_container ginput_container_select'><select name='input_7' id='input_6_7' class='medium gfield_select' aria-required="true" aria-invalid="false"><option value='Veterinarian' >Veterinarian</option><option value='Veterinary Nurse / Technician' >Veterinary Nurse / Technician</option><option value='Practice Manager / Veterinary Assistant / Support Staff' >Practice Manager / Veterinary Assistant / Support Staff</option><option value='Student (Veterinarian or Veterinary Nurse)' >Student (Veterinarian or Veterinary Nurse)</option><option value='Other' >Other</option></select></div></li><li id='field_6_20' class='gfield gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below field_description_below gfield_visibility_visible' ><br></li><li id='field_6_15' class='gfield field_sublabel_below field_description_above gfield_visibility_visible' ><label class='gfield_label' >Inbox Preferences</label><div class='gfield_description' id='gfield_description_6_15'>Customize your inbox by selecting the areas you are most interested in. </div><div class='ginput_container ginput_container_checkbox'><ul class='gfield_checkbox' id='input_6_15'><li class='gchoice_6_15_1'> <input name='input_15.1' type='checkbox' value='NAVC Better Care Weekly&lt;br&gt;&lt;div style=&quot;font-size: 12px;color: #808080&quot;&gt;A weekly roundup of the new and noteworthy innovations and educational opportunities in the veterinary industry.&lt;/div&gt;' checked='checked' id='choice_6_15_1' /> <label for='choice_6_15_1' id='label_6_15_1'>NAVC Better Care Weekly<br><div style="font-size: 12px; color: #808080;">A weekly roundup of the new and noteworthy innovations and educational opportunities in the veterinary industry.</div></label> </li><li class='gchoice_6_15_2'> <input name='input_15.2' type='checkbox' value='Today&#039;s Veterinary Business eNewsletter&lt;br&gt;&lt;div style=&quot;font-size: 12px;color: #808080&quot;&gt;Covers topics relating to practice management, financial metrics, marketing, retailing and merchandising, and industry news.&lt;/div&gt;' id='choice_6_15_2' /> <label for='choice_6_15_2' id='label_6_15_2'>Today's Veterinary Business eNewsletter<br><div style="font-size: 12px; color: #808080;">Covers topics relating to practice management, financial metrics, marketing, retailing and merchandising, and industry news.</div></label> </li><li class='gchoice_6_15_3'> <input name='input_15.3' type='checkbox' value='Today&#039;s Veterinary Nurse eNewsletter&lt;br&gt;&lt;div style=&quot;font-size: 12px;color: #808080&quot;&gt;Provides practical, peer-reviewed companion animal educational CE for veterinary nurses, technicians and assistants.&lt;/div&gt;' id='choice_6_15_3' /> <label for='choice_6_15_3' id='label_6_15_3'>Today's Veterinary Nurse eNewsletter<br><div style="font-size: 12px; color: #808080;">Provides practical, peer-reviewed companion animal educational CE for veterinary nurses, technicians and assistants.</div></label> </li><li class='gchoice_6_15_4'> <input name='input_15.4' type='checkbox' value='Today&#039;s Veterinary Practice eNewsletter&lt;br&gt;&lt;div style=&quot;font-size: 12px;color: #808080&quot;&gt;Provides practical, peer-reviewed articles focused on the latest diagnostic and treatment techniques to enhance your knowledge and confidence.&lt;/div&gt;' id='choice_6_15_4' /> <label for='choice_6_15_4' id='label_6_15_4'>Today's Veterinary Practice eNewsletter<br><div style="font-size: 12px; color: #808080;">Provides practical, peer-reviewed articles focused on the latest diagnostic and treatment techniques to enhance your knowledge and confidence.</div></label> </li><li class='gchoice_6_15_5'> <input name='input_15.5' type='checkbox' value='VetFolio eNewsletter&lt;br&gt;&lt;div style=&quot;font-size: 12px;color: #808080&quot;&gt;Discover online CE resources offered in a variety of formats including videos, podcasts, webinars and more.&lt;/div&gt;' id='choice_6_15_5' /> <label for='choice_6_15_5' id='label_6_15_5'>VetFolio eNewsletter<br><div style="font-size: 12px; color: #808080;">Discover online CE resources offered in a variety of formats including videos, podcasts, webinars and more.</div></label> </li><li class='gchoice_6_15_6'> <input name='input_15.6' type='checkbox' value='Partner Emails&lt;br&gt;&lt;div style=&quot;font-size: 12px;color: #808080&quot;&gt;Exclusive deals and information from our partners.&lt;/div&gt;' id='choice_6_15_6' /> <label for='choice_6_15_6' id='label_6_15_6'>Partner Emails<br><div style="font-size: 12px; color: #808080;">Exclusive deals and information from our partners.</div></label> </li></ul></div></li><li id='field_6_19' class='gfield gfield_html gfield_html_formatted field_sublabel_below field_description_below gfield_visibility_visible' ><br></li><li id='field_6_22' class='gfield field_sublabel_below field_description_below gfield_visibility_visible' ><label class='gfield_label' >Do you want to be added to our postal mailing list?</label><div class='ginput_container ginput_container_checkbox'><ul class='gfield_checkbox' id='input_6_22'><li class='gchoice_6_22_1'> <input name='input_22.1' type='checkbox' value='Yes, I love mail!' id='choice_6_22_1' /> <label for='choice_6_22_1' id='label_6_22_1'>Yes, I love mail!</label> </li><li class='gchoice_6_22_2'> <input name='input_22.2' type='checkbox' value='No thank you.' id='choice_6_22_2' /> <label for='choice_6_22_2' id='label_6_22_2'>No thank you.</label> </li></ul></div></li><li id='field_6_10' class='gfield gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible' ><label class='gfield_label gfield_label_before_complex' >Please provide your mailing address below.<span class='gfield_required'>*</span></label> <div class='ginput_complex ginput_container has_street has_street2 has_city has_state has_zip has_country ginput_container_address' id='input_6_10' > <span class='ginput_full address_line_1' id='input_6_10_1_container' > <input type='text' name='input_10.1' id='input_6_10_1' value='' aria-required="true"/> <label for='input_6_10_1' id='input_6_10_1_label' >Street Address</label> </span><span class='ginput_full address_line_2' id='input_6_10_2_container' > <input type='text' name='input_10.2' id='input_6_10_2' value='' /> <label for='input_6_10_2' id='input_6_10_2_label' >Address Line 2</label> </span><span class='ginput_left address_city' id='input_6_10_3_container' > <input type='text' name='input_10.3' id='input_6_10_3' value='' aria-required="true"/> <label for='input_6_10_3' id='input_6_10_3_label' >City</label> </span><span class='ginput_right address_state' id='input_6_10_4_container' > <input type='text' name='input_10.4' id='input_6_10_4' value='' aria-required="true"/> <label for='input_6_10_4' id='input_6_10_4_label' >State / Province / Region</label> </span><span class='ginput_left address_zip' id='input_6_10_5_container' > <input type='text' name='input_10.5' id='input_6_10_5' value='' aria-required="true"/> <label for='input_6_10_5' id='input_6_10_5_label' >ZIP / Postal Code</label> </span><span class='ginput_right address_country' id='input_6_10_6_container' > <select name='input_10.6' id='input_6_10_6' aria-required="true"><option value='' selected='selected'></option><option value='Afghanistan' >Afghanistan</option><option value='Åland Islands' >Åland Islands</option><option value='Albania' >Albania</option><option value='Algeria' >Algeria</option><option value='American Samoa' >American Samoa</option><option value='Andorra' >Andorra</option><option value='Angola' >Angola</option><option value='Anguilla' >Anguilla</option><option value='Antarctica' >Antarctica</option><option value='Antigua and Barbuda' >Antigua and Barbuda</option><option value='Argentina' >Argentina</option><option value='Armenia' >Armenia</option><option value='Aruba' >Aruba</option><option value='Australia' >Australia</option><option value='Austria' >Austria</option><option value='Azerbaijan' >Azerbaijan</option><option value='Bahamas' >Bahamas</option><option value='Bahrain' >Bahrain</option><option value='Bangladesh' >Bangladesh</option><option value='Barbados' >Barbados</option><option value='Belarus' >Belarus</option><option value='Belgium' >Belgium</option><option value='Belize' >Belize</option><option value='Benin' >Benin</option><option value='Bermuda' >Bermuda</option><option value='Bhutan' >Bhutan</option><option value='Bolivia' >Bolivia</option><option value='Bonaire, Sint Eustatius and Saba' >Bonaire, Sint Eustatius and Saba</option><option value='Bosnia and Herzegovina' >Bosnia and Herzegovina</option><option value='Botswana' >Botswana</option><option value='Bouvet Island' >Bouvet Island</option><option value='Brazil' >Brazil</option><option value='British Indian Ocean Territory' >British Indian Ocean Territory</option><option value='Brunei Darussalam' >Brunei Darussalam</option><option value='Bulgaria' >Bulgaria</option><option value='Burkina Faso' >Burkina Faso</option><option value='Burundi' >Burundi</option><option value='Cambodia' >Cambodia</option><option value='Cameroon' >Cameroon</option><option value='Canada' >Canada</option><option value='Cape Verde' >Cape Verde</option><option value='Cayman Islands' >Cayman Islands</option><option value='Central African Republic' >Central African Republic</option><option value='Chad' >Chad</option><option value='Chile' >Chile</option><option value='China' >China</option><option value='Christmas Island' >Christmas Island</option><option value='Cocos Islands' >Cocos Islands</option><option value='Colombia' >Colombia</option><option value='Comoros' >Comoros</option><option value='Congo, Democratic Republic of the' >Congo, Democratic Republic of the</option><option value='Congo, Republic of the' >Congo, Republic of the</option><option value='Cook Islands' >Cook Islands</option><option value='Costa Rica' >Costa Rica</option><option value='Côte d&#039;Ivoire' >Côte d&#039;Ivoire</option><option value='Croatia' >Croatia</option><option value='Cuba' >Cuba</option><option value='Curaçao' >Curaçao</option><option value='Cyprus' >Cyprus</option><option value='Czech Republic' >Czech Republic</option><option value='Denmark' >Denmark</option><option value='Djibouti' >Djibouti</option><option value='Dominica' >Dominica</option><option value='Dominican Republic' >Dominican Republic</option><option value='Ecuador' >Ecuador</option><option value='Egypt' >Egypt</option><option value='El Salvador' >El Salvador</option><option value='Equatorial Guinea' >Equatorial Guinea</option><option value='Eritrea' >Eritrea</option><option value='Estonia' >Estonia</option><option value='Eswatini (Swaziland)' >Eswatini (Swaziland)</option><option value='Ethiopia' >Ethiopia</option><option value='Falkland Islands' >Falkland Islands</option><option value='Faroe Islands' >Faroe Islands</option><option value='Fiji' >Fiji</option><option value='Finland' >Finland</option><option value='France' >France</option><option value='French Guiana' >French Guiana</option><option value='French Polynesia' >French Polynesia</option><option value='French Southern Territories' >French Southern Territories</option><option value='Gabon' >Gabon</option><option value='Gambia' >Gambia</option><option value='Georgia' >Georgia</option><option value='Germany' >Germany</option><option value='Ghana' >Ghana</option><option value='Gibraltar' >Gibraltar</option><option value='Greece' >Greece</option><option value='Greenland' >Greenland</option><option value='Grenada' >Grenada</option><option value='Guadeloupe' >Guadeloupe</option><option value='Guam' >Guam</option><option value='Guatemala' >Guatemala</option><option value='Guernsey' >Guernsey</option><option value='Guinea' >Guinea</option><option value='Guinea-Bissau' >Guinea-Bissau</option><option value='Guyana' >Guyana</option><option value='Haiti' >Haiti</option><option value='Heard and McDonald Islands' >Heard and McDonald Islands</option><option value='Holy See' >Holy See</option><option value='Honduras' >Honduras</option><option value='Hong Kong' >Hong Kong</option><option value='Hungary' >Hungary</option><option value='Iceland' >Iceland</option><option value='India' >India</option><option value='Indonesia' >Indonesia</option><option value='Iran' >Iran</option><option value='Iraq' >Iraq</option><option value='Ireland' >Ireland</option><option value='Isle of Man' >Isle of Man</option><option value='Israel' >Israel</option><option value='Italy' >Italy</option><option value='Jamaica' >Jamaica</option><option value='Japan' >Japan</option><option value='Jersey' >Jersey</option><option value='Jordan' >Jordan</option><option value='Kazakhstan' >Kazakhstan</option><option value='Kenya' >Kenya</option><option value='Kiribati' >Kiribati</option><option value='Kuwait' >Kuwait</option><option value='Kyrgyzstan' >Kyrgyzstan</option><option value='Lao People&#039;s Democratic Republic' >Lao People&#039;s Democratic Republic</option><option value='Latvia' >Latvia</option><option value='Lebanon' >Lebanon</option><option value='Lesotho' >Lesotho</option><option value='Liberia' >Liberia</option><option value='Libya' >Libya</option><option value='Liechtenstein' >Liechtenstein</option><option value='Lithuania' >Lithuania</option><option value='Luxembourg' >Luxembourg</option><option value='Macau' >Macau</option><option value='Macedonia' >Macedonia</option><option value='Madagascar' >Madagascar</option><option value='Malawi' >Malawi</option><option value='Malaysia' >Malaysia</option><option value='Maldives' >Maldives</option><option value='Mali' >Mali</option><option value='Malta' >Malta</option><option value='Marshall Islands' >Marshall Islands</option><option value='Martinique' >Martinique</option><option value='Mauritania' >Mauritania</option><option value='Mauritius' >Mauritius</option><option value='Mayotte' >Mayotte</option><option value='Mexico' >Mexico</option><option value='Micronesia' >Micronesia</option><option value='Moldova' >Moldova</option><option value='Monaco' >Monaco</option><option value='Mongolia' >Mongolia</option><option value='Montenegro' >Montenegro</option><option value='Montserrat' >Montserrat</option><option value='Morocco' >Morocco</option><option value='Mozambique' >Mozambique</option><option value='Myanmar' >Myanmar</option><option value='Namibia' >Namibia</option><option value='Nauru' >Nauru</option><option value='Nepal' >Nepal</option><option value='Netherlands' >Netherlands</option><option value='New Caledonia' >New Caledonia</option><option value='New Zealand' >New Zealand</option><option value='Nicaragua' >Nicaragua</option><option value='Niger' >Niger</option><option value='Nigeria' >Nigeria</option><option value='Niue' >Niue</option><option value='Norfolk Island' >Norfolk Island</option><option value='North Korea' >North Korea</option><option value='Northern Mariana Islands' >Northern Mariana Islands</option><option value='Norway' >Norway</option><option value='Oman' >Oman</option><option value='Pakistan' >Pakistan</option><option value='Palau' >Palau</option><option value='Palestine, State of' >Palestine, State of</option><option value='Panama' >Panama</option><option value='Papua New Guinea' >Papua New Guinea</option><option value='Paraguay' >Paraguay</option><option value='Peru' >Peru</option><option value='Philippines' >Philippines</option><option value='Pitcairn' >Pitcairn</option><option value='Poland' >Poland</option><option value='Portugal' >Portugal</option><option value='Puerto Rico' >Puerto Rico</option><option value='Qatar' >Qatar</option><option value='Réunion' >Réunion</option><option value='Romania' >Romania</option><option value='Russia' >Russia</option><option value='Rwanda' >Rwanda</option><option value='Saint Barthélemy' >Saint Barthélemy</option><option value='Saint Helena' >Saint Helena</option><option value='Saint Kitts and Nevis' >Saint Kitts and Nevis</option><option value='Saint Lucia' >Saint Lucia</option><option value='Saint Martin' >Saint Martin</option><option value='Saint Pierre and Miquelon' >Saint Pierre and Miquelon</option><option value='Saint Vincent and the Grenadines' >Saint Vincent and the Grenadines</option><option value='Samoa' >Samoa</option><option value='San Marino' >San Marino</option><option value='Sao Tome and Principe' >Sao Tome and Principe</option><option value='Saudi Arabia' >Saudi Arabia</option><option value='Senegal' >Senegal</option><option value='Serbia' >Serbia</option><option value='Seychelles' >Seychelles</option><option value='Sierra Leone' >Sierra Leone</option><option value='Singapore' >Singapore</option><option value='Sint Maarten' >Sint Maarten</option><option value='Slovakia' >Slovakia</option><option value='Slovenia' >Slovenia</option><option value='Solomon Islands' >Solomon Islands</option><option value='Somalia' >Somalia</option><option value='South Africa' >South Africa</option><option value='South Georgia' >South Georgia</option><option value='South Korea' >South Korea</option><option value='South Sudan' >South Sudan</option><option value='Spain' >Spain</option><option value='Sri Lanka' >Sri Lanka</option><option value='Sudan' >Sudan</option><option value='Suriname' >Suriname</option><option value='Svalbard and Jan Mayen Islands' >Svalbard and Jan Mayen Islands</option><option value='Sweden' >Sweden</option><option value='Switzerland' >Switzerland</option><option value='Syria' >Syria</option><option value='Taiwan' >Taiwan</option><option value='Tajikistan' >Tajikistan</option><option value='Tanzania' >Tanzania</option><option value='Thailand' >Thailand</option><option value='Timor-Leste' >Timor-Leste</option><option value='Togo' >Togo</option><option value='Tokelau' >Tokelau</option><option value='Tonga' >Tonga</option><option value='Trinidad and Tobago' >Trinidad and Tobago</option><option value='Tunisia' >Tunisia</option><option value='Turkey' >Turkey</option><option value='Turkmenistan' >Turkmenistan</option><option value='Turks and Caicos Islands' >Turks and Caicos Islands</option><option value='Tuvalu' >Tuvalu</option><option value='Uganda' >Uganda</option><option value='Ukraine' >Ukraine</option><option value='United Arab Emirates' >United Arab Emirates</option><option value='United Kingdom' >United Kingdom</option><option value='United States' >United States</option><option value='Uruguay' >Uruguay</option><option value='US Minor Outlying Islands' >US Minor Outlying Islands</option><option value='Uzbekistan' >Uzbekistan</option><option value='Vanuatu' >Vanuatu</option><option value='Venezuela' >Venezuela</option><option value='Vietnam' >Vietnam</option><option value='Virgin Islands, British' >Virgin Islands, British</option><option value='Virgin Islands, U.S.' >Virgin Islands, U.S.</option><option value='Wallis and Futuna' >Wallis and Futuna</option><option value='Western Sahara' >Western Sahara</option><option value='Yemen' >Yemen</option><option value='Zambia' >Zambia</option><option value='Zimbabwe' >Zimbabwe</option></select> <label for='input_6_10_6' id='input_6_10_6_label' >Country</label> </span> <div class='gf_clear gf_clear_complex'></div> </div></li> </ul></div> <div class='gform_footer top_label'> <input type='submit' id='gform_submit_button_6' class='gform_button button' value='Sign Up' onclick='if(window["gf_submitting_6"]){return false;} window["gf_submitting_6"]=true; ' onkeypress='if( event.keyCode == 13 ){ if(window["gf_submitting_6"]){return false;} window["gf_submitting_6"]=true; jQuery("#gform_6").trigger("submit",[true]); }' /> <input type='hidden' class='gform_hidden' name='is_submit_6' value='1' /> <input type='hidden' class='gform_hidden' name='gform_submit' value='6' /> <input type='hidden' class='gform_hidden' name='gform_unique_id' value='' /> <input type='hidden' class='gform_hidden' name='state_6' value='WyJbXSIsIjNkNTNhNjhlOThlOGY4N2JlZWZiNTRmZDhlZDQ5OWI3Il0=' /> <input type='hidden' class='gform_hidden' name='gform_target_page_number_6' id='gform_target_page_number_6' value='0' /> <input type='hidden' class='gform_hidden' name='gform_source_page_number_6' id='gform_source_page_number_6' value='1' /> <input type='hidden' name='gform_field_values' value='' /> </div> </form> </div><script type='text/javascript'> jQuery(document).bind('gform_post_render', function(event, formId, currentPage){if(formId == 6) {gf_global["number_formats"][6] = {"1":{"price":false,"value":false},"2":{"price":false,"value":false},"7":{"price":false,"value":false},"20":{"price":false,"value":false},"15":{"price":false,"value":false},"19":{"price":false,"value":false},"22":{"price":false,"value":false},"10":{"price":false,"value":false}};if(window['jQuery']){if(!window['gf_form_conditional_logic'])window['gf_form_conditional_logic'] = new Array();window['gf_form_conditional_logic'][6] = { logic: { 10: {"field":{"actionType":"show","logicType":"any","rules":[{"fieldId":"22","operator":"is","value":"Yes, I love mail!"}]},"nextButton":null,"section":null} }, dependents: { 10: [10] }, animation: 1, defaults: {"1":{"1.2":"","1.3":"","1.4":"","1.6":"","1.8":""},"15":["choice_6_15_1"],"10":{"10.1":"","10.2":"","10.3":"","10.4":"","10.5":"","10.6":""}}, fields: {"1":[],"2":[],"7":[],"20":[],"15":[],"19":[],"22":[10],"10":[]} }; if(!window['gf_number_format'])window['gf_number_format'] = 'decimal_dot';jQuery(document).ready(function(){gf_apply_rules(6, [10], true);jQuery('#gform_wrapper_6').show();jQuery(document).trigger('gform_post_conditional_logic', [6, null, true]);} );} gformInitChosenFields('#input_6_7','No results matched');} } );jQuery(document).bind('gform_post_conditional_logic', function(event, formId, fields, isInit){gformInitChosenFields('#input_6_7','No results matched');} );</script><script type='text/javascript'> jQuery(document).ready(function(){jQuery(document).trigger('gform_post_render', [6, 1]) } ); </script>