Welcome to Dr David Williams website – mostly a record of recent cases he’s been involved in and publications in journals. This is a relatively new version of the site – there are hundreds more cases archived on the previous site…
…but here’s something even older, especially for Freshers!
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Looking at this eye reminded me of the Animals’ glorious hit from 1964 ‘House of the rising sun’ (listen and watch at http://www.youtube.com/watch?v=mmdPQp6Jcdk!) But what are you seeing in the eye?
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This is a lens subluxated but still behind the pupil with the tapetal reflection wonderfully concentrated by the lens. The majority of cases present with an aphakic crescent as in this cat where the lens is in the anterior chamber and the iris behind it:
But in our Yorkie its a rising sun rather than a crescent moon! Incidentally the eye was comfortable and visual with a low intraocular pressure and as the dog was old, we decided not to dive into surgery but warn the owners to call us immediately if the eye ever became painful. Was that the right decision?
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A colleague referred a blind hyperthyroid cat to me saying she expected to see complete retinal detachment, retinal haemorrhages and vessel changes but didn’t – why is it blind? how to describe eyes in writing?
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There isn’t a complete detachment for sure with billowing folds of retinal flapping in the breeze, as it were! But what there is, is a grey haze over what should be a bright tapetal reflection – this is protein insudate giving a flat retinal detachment with resulting blindness. Actually if you look ventrally there is a more severe retinal detachment, as shown below – the same was seen in the other eye.
The blood pressure was over 220mmHg confirming a diagnosis of hypertensive retinopathy and treatment with amlodipine at 0.625mg daily per os should reduce the blood pressure and hopefully reattach the retina. The pathology is probably more in the choroid than the retinal vessels, which explains why the appearance was not as was expected.
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This eye belongs to a English Springer Spaniel which has some visual disturbance but isn’t blind. But it does have a hazy cornea and the owner, having read up on the internet is worried her dog has glaucoma. Is this the case and if not what could the diagnosis be?
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The key feature of the case if that the conjunctiva and sclera are white and not red with episcleral vessel congenstion. That means it is very unlikely to be glaucoma – indeed the intraocular pressures are 8 and 9mmHg. The pupil too is neither widely dilated (as it would be in glaucoma) or constricted (as in uveitis).
In fact this is most likely to be endothelial degeneration, commonly seen in older animals of this breed, where there is corneal oedema which somewhat reduces visual acuity but not glaucoma which is blinding and painful.
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This picture might be a bit blurry as the dog wasn’t prepared to stand perfectly still but I hope you can see what is going on here – a nasty puffy lid swelling probably signalling blepharitis. This case is from my friends Jen Harrison and Joanna Morall at Acorn House Veterinary Clinic in Bedford. What is happening and how should they investigate and treat it?
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My immediate thought took me back to Jane Sansom’s JSAP paper in 2000 (Sansom J et al Pyogranulomatous blepharitis in dog dogs. J Small Anim Pract. 2000;41:80-3). They considered that a Pyrocathus thorn-induced irritation might be the aetiology in the two Dalmatians they reported. Here’s a similar lesion I saw in a labrador puppy with juvenile cellulitis.
But this Doberman has the condition only in one eye but has a similar lesion on its leg as well as you can see here.
What do you think I should advise? Bacteriology and cytology for a start I guess. But maybe we need a dermatologist! Or maybe antibiotics and steroids – the last resort of the diagnostically destitute?!
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A few posts ago I showed you an owl with equal pupils but this poor little Staffie cross puppy has unequal eyes and a certain degree of visual comrpomise. What is happening here do you think?
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Alfie’s right eye is too big and his left eye is too small – megophthalmos and microphthalmos you might say. Many ophthalmologists will argue that I should say buphthalmos (literally ox eye) or hydrophthalmos, but both those terms imply an increased intraocular pressure or congenital glaucoma. In fact neither eye has an increased pressure. In fact what they are also missing is a lens!
I performed an ultrasound scan to measure the size of the globes but blow me down, I couldn’t find a lens in either eye! Aphakia as part of a syndrome of multiple congenital anomalies has been reported in the veterinary literature (Martin and Leipold Aphakia and multiple ocular defects in saint bernard puppies. Veterinary Medicine Small Animal Clinician 69:448-453 and Bergsjo et al Congenital blindness with ocular developmental anomalies including retinal dysplasia in Doberman Pinscher dogs. JAVMA 184:1383-6) but those were in 1974 and 1984 so its not that common!
Aphakia is rare in people too with one recent paper reporting a mutation in a gene central to development of the lens placode (Anjum et al A mutation in the FOXE3 gene causes congenital primary aphakia in a an autosomal recessive consanguineus Pakistani family. Molecular Vision 16: 549-555). Whether a similar gene defect is occuring here awaits out investigations!
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I do enjoy receiving images from you for a quick e-diagnosis but many times one does need to see the animal face to face – maybe I should say eye to eye! Here is a cat where a frontal view gives some idea of what is going on but really a full appreciation only comes when other views of the globe can be assessed. What do you think is happening here?
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There is a corneal opacity here it would seem that obscures a clear view of the anterior segment, but there is marked dyscoria – that’s to say the pupil is all mis-shapen. A side view shows the pathology in a much more striking manner:
The iris is dragged downwards towards the lens by posterior synechiae giving a funnel-like appearance when one is able to see it in 3D. This is the end result of a severe uveitis but the eye is comfortable with an intraocular pressure of 25mmHg, higher than normal but not through the roof! There is obviously still a passageway for aqueous to pass through the pupil and drain in the iridocorneal angle. The cat is blind in this eye but not bothered about it at all – so neither should we be!
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Refereed original work:
Williams DL (2010) Production Animal Ophthalmology (editor) Veterinary Clinics of North America Food Animal Practice 26:427-564
Williams DL. (2010) Congenital abnormalities in production animals. Veterinary Clinics of North America Food Animal Practice 26:477-86
Williams DL. (2010) Welfare issues in farm animal ophthalmology. Veterinary Clinics of North America Food Animal Practice 26:427-35.
Williams DL, Sullivan A. (2010) Ocular disease in the guinea pig (Cavia porcellus): a survey of 1000 animals. Veterinary Ophthalmology 13 Suppl:54-62.
Williams DL. (2010) Lack of effects on lymphocyte function from chronic topical ocular cyclosporine medication: a prospective study. Veterinary Ophthalmology 13:315-20
Williams DL, Kim JY (2009) Feline entropion: a case series of 50 affected animals (2003-2008). Veterinary Ophthalmology;12:221-6.
Kim JY, Choi YM, Jeong SW, Williams DL. (2009) Effect of bovine freeze-dried amniotic membrane (Amnisite-BA) on uncomplicated canine corneal erosion. Veterinary Ophthalmology 12:36-42.
Williams DL (2008) Extraocular myositis in the dog. Veterinary Clinics of North America Small Animal Practice 38:347-59
Williams DL (2008) Immunopathology of canine keratoconjunctivitis sicca. Veterinary Clinics of North America Small Animal Practice 38:251-68
Williams DL (2008) Oxidative Stress and the Eye. Veterinary Clinics of North America Small Animal Practice 38:179-92
Williams DL, Pierce V, Mellor P, Heath MF (2007) Reduced tear production in three canine endocrinopathies. Journal of Small Animal Practice 48: 252-256
Williams DL, Goddard PJ, Brancker WM (2007) Ultrasonographic examination of ocular lesions in farmed halibut. Veterinary Journal 173:456-8
Williams DL (2007) Fighting tooth and CLAW for more monoclonal antibodies against canine leucocyte antigens. Veterinary Journal 173:20-1
Williams DL, Heath MF (2006) Prevalence of feline cataract: results of a cross-sectional study of 2000 normal animals, 50 cats with diabetes and one hundred cats following dehydrational crises. Veterinary Ophthalmology 9:341-9
Willams DL, Munday P (2006) The effect of a topical antioxidant formulation including N-acetyl carnosine on canine cataract: a preliminary study. Veterinary Ophthalmology 9:311-6
Williams DL (2006) Oxidation, antioxidants and cataract formation: a literature review.
Veterinary Ophthalmology 9:292-8
Williams DL, Gonzalez-Villavincencio CM, Wilson S (2006) Chronic ocular lesions in tawny owls (Strix aluco) injured by road traffic. Veterinary Record 159:148-53
Williams DL, Haggett E (2006) Surgical removal of a canine orbital lipoma. Journal of Small Animal Practice 47: 35-7
Hartley C, Williams DL, Adams VJ (2006) Effect of age, gender, weight, and time of day on tear production in normal dogs. Veterinary Ophthalmology 9: 53-7
Williams DL, Brancker WM (2006) Aggravating factors in the development of ocular abnormalities in farmed Atlantic halibut (Hippoglossus hippoglossus). Veterinary Journal 172: 501-5
Mellor PJ, Fetz K, Maggi RG, Haugland S, Dunning M, Villiers EJ, Mellanby RJ, Williams D, Breitschwerdt E, Herrtage ME (2006) Alpha1-proteinase inhibitor deficiency and Bartonella infection in association with panniculitis, polyarthritis, and meningitis in a dog. Journal of Veterinary Internal Medicine 20: 1023-8
Williams DL (2005) Major histocompatibility class II expression in the normal canine cornea and in canine chronic superficial keratitis. Veterinary Ophthalmology 8: 395-400
Williams DL (2005) Analysis of tear uptake by the Schirmer tear test strip in the canine eye. Veterinary Ophthalmology 8: 325-30
Williams DL, Robinson JC, Lay EL, Field H (2005) Efficacy of topical aciclovir for the treatment of feline herpetic keratitis: results of a prospective clinical trial and data from in vitro investigations. Veterinary Record 157: 254-7
Williams DL, Fitzmaurice T, Lay L, Forster K, Hefford J, Budge C, Blackmore K, Robinson JC, Field HF (2004) Efficacy of antiviral agents in feline herpetic keratitis: results of an in vitro study. Current Eye Research 29: 215-8
Williams DL (2004) Entropion correction by fornix-based suture placement: use of the Quickert-Rathbun technique in ten dogs. Veterinary Ophthalmology 7: 343-7
Williams DL, Simpson VR, Flindall A (2004) Retinal dysplasia in wild otters (Lutra lutra). Veterinary Record 155: 52-6
Williams DL (2004) Lens morphometry determined by B-mode ultrasonography of the normal and cataractous canine lens. Veterinary Ophthalmolology 7: 91-5
Williams DL, Heath MF, Wallis C (2004) Prevalence of canine cataract: preliminary results of a cross-sectional study Veterinary Ophthalmology 7: 29-35
Williams DL, Brancker WM (2004) Intraocular oxygen tensions in normal and diseased eyes of farmed halibut. Veterinary Journal 167: 81-6
Williams DL, Flach E (2003) Symblepharon with aberrant protrusion of the nictitating membrane in the snowy owl (Nyctea scandiaca). Veterinary Ophthalmology 6: 11-3
Williams DL (2002) Use of punctal occlusion in the treatment of canine keratconjunctivitis sicca. Journal of Small Animal Practice 43: 478-481
Williams DL (2002) Ocular disease in rats: a review. Veterinary Ophthalmology 5: 183-91
Williams DL, Newman JL (2001) Antibiotic resistance in avian bacteriological isolates. Veterinary Record 148: 748-750
Williams DL, S Macgregor, AW Sainsbury (2000) Evaluation of organisms responsible for infectious ocular disease in a group of captive non-domestic animals. Veterinary Record 146: 515-518
Williams DL (1999) Histological and immunocytochemical analysis of canine chronic superficial keratitis. Research in Veterinary Science 67:191-195
Williams DL, Pantel U, Brancker WM (1998) Levels of choroidal body carbonic anhydrase activity and glycogen in farmed halibut. The Veterinary Journal 156: 223-229
Williams DL, Long R Barnett KC (1998) Lacrimal pseudotumour in a young bull terrier. Journal of Small Animal Practice 39: 30-32
Rament L, Williams DL (1995) Glaucoma in a captive-bred great horned owl (Bubo virginianus virginanus). Veterinary Record 140: 481-483
Williams DL, AJ Hoey and PJ Smitherman: (1995) The use of topical cyclosporine and dexamethasone in the treatment of canine chronic superficial keratitis: a comparison of therapeutic effects. Veterinary Record 137: 635-639
Williams DL, Wall AE, Branson E, Hopcroft T, Poole A, Brancker WM (1995) Preliminary findings of ophthalmological abnormalities in farmed halibut. Veterinary Record 136:610-2.
Williams DL, Cooper JE (1994) Horner’s syndrome in an African spotted eagle owl (Bubo africanus). Veterinary Record 134:64-6
Williams DL, Barnett KC (1993) Bilateral optic disc colobomas and microphthalmos in a thoroughbred horse. Veterinary Record 132:101-3.
Williams DL (1993) A comparative approach to anterior segment dysgenesis. Eye 7: 607-16
Books and book chapters
Williams DL (2010) Ocular rehabilitation and supportive care. In: Lindley S, Watson P (eds) BSAVA Manual of Canine and Feline Rehabilitation, Supportive and Palliative Care: Case Studies in Patient Management
Williams DL (2009) Animal Rights, Human Responsibilities. Grove Book Publications, Cambridge
Williams DL (2007) In: Gelatt KN (ed) Veterinary Ophthalmology 4th edition. Blackwell Science Pp 1336-1369
Williams DL (2003) Rabbit ophthalmology. In Manual of Ophthalmology, 2nd edition British Small Animal Veterinary Association, Cheltenham.
Williams DL, K Barrie, TF Evans (2002) Veterinary Ocular Emergencies, Butterworth Heinmann, Oxford.
Williams DL (2002) Amphibians. In Manual of Exotic Pets, 4th Edition British Small Animal Veterinary Association, Cheltenham
Williams DL (2002) Invertebrates. In Manual of Exotic Pets, 4th Edition British Small Animal Veterinary Association, Cheltenham.
Williams DL(2000) Ophthalomology. In Manual of Rabbit Medicine and Surgery, British Small Animal Veterinary Association, Cheltenham, 2000
Williams DL (1999) Laboratory Animal Ophthalmology. In: Gelatt KN (ed) Veterinary Ophthalmology 3rd edition Williams & Wilkins, New York, Pp 1209-1236
Williams DL: Animal Models for Ophthalmic Diseases in Humans. In: Gelatt KN (ed) Veterinary Ophthalmology 3rd edition Williams & Wilkins, New York, Pp 1237-1272, 1999
Williams DL (1998) Ask the Vet: Exotic Pets, Lifelearn, Newmarket
DL Wiliams (1997) Ocular pharmacology and therapeutics: Current Equine Therapy IV 339-344
Williams DL (1995) Reptile Ophthalmology. In: Reptile Medicine and Surgery. (ed. D Mader), WB Saunders, Pp175-185.
Frey FL and Williams DL (1995) Colour Review of Reptile and Amphibian Medicine and Surgery, Manson Publications.
Williams DL (1995) Amphibian Dermatology. In: Kirk’s Current Veterinary Therapy XIII. (ed. EM Miller) WB Saunders, Pp 1375-1379.
Cooper JE and Williams DL (1995) Veterinary perspectives and techniques in reptile husbandry and research. In: Health and Welfare in Captive Reptiles. Eds C Warwick, FL Frye and JB Murphy, Chapman and Hall, Pp. 98-112.
Williams DL (1994) Ophthalmology. In: Avian Medicine: Principles and Application (eds W B Ritchie, G J Harrison and L R Harrison), Wingers Publishing Inc, Lake Worth, Florida. Pp 673-694.
Williams DL and Crispin SM (1992) Sclera, episclera and limbus. In Manual of Ophthalmology, British Small Animal Veterinary Association, Cheltenham.
Carrington SD, Crispin SM and Williams DL (1992) Characteristic conditions of the feline cornea. Veterinary Annual 32: 83-94.
Williams DL (1992) Cardiovascular disease. In Manual of Reptiles, British Small Animal Veterinary Association, Cheltenham.
Williams DL (1991) Oncology of exotic animals. In Manual of Small Animal Oncology, British Small Animal Veterinary Association, Cheltenham.
Williams DL (1991) Amphibians. In Manual of Exotic Pets, British Small Animal Veterinary Association, Cheltenham.
Williams DL: Animal rights. In New Dictionary of Theology, IVP, Leicester 1988.
Cooper JE, Pearce-Kelly P and Williams DL (1987) (eds) Proceedings, Arachnida ’87, Symposium, Zoological Society of London, November 1987
Williams DL (1987) Studies in arachnid disease. In Proceedings, Arachnida ’87, Symposium, Zoological Society of London, November.
