A Clinical Case from the Archives : 03/03/2007

Posted on March 3, 2007 by davidwilliams

[tab name=”The Case”]Here’s a picture taken with my new Dioptrix Hawkeye photoslit-lamp! What do these signs in a Welsh Springer Spaniel suggest to you? What steps should be taken in diagnosis and treatment?[/tab][tab name=”David’s view”]The episcleral engorgement, the perilimbal vascular fringe and the corneal oedema all spell glaucoma. The intraocular pressure was 68mmHg and 15mmHg in the fellow eye. Topical prostaglandin latanoprost reduced the pressure to 45mmHg in half an hour but not much lower unfortunately. The dog is blind in this eye but quite comfortable, so the key therapeutic step is prophylactic – Trusopt (dorzolamide) as an anti-glaucoma medication in the other eye to keep the pressure normal in this eye. Here’s a supplementary question – why do we get this corneal vascular fringe in acute glaucoma?[/tab][end_tabset] 

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A Clinical Case from the Archives : 21/02/2007

Posted on February 21, 2007 by davidwilliams

[tab name=”The Case”]What is the white haze the owner is worried about in this Cocker spaniel’s eyes? The bitch is in season and the owner wants to breed from her – will the offspring be similarly affected and will it alter their vision?[/tab][tab name=”David’s view”]Questions questions questions! Well this is a stromal lipid deposit and as it is in both eyes to varying degrees in an otherwise normal animal, the likelihood is that its a stromal lipid dystrophy. Which I guess means that it is an inherited problem, though the mode of inheritance is, to my knowledge, not known. Should the bitch be bred from? Still rather a tricky question I fear – in all other respects the animal is, as we might say here, ‘cute as heck’![/tab][end_tabset] 

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A Clinical Case from the Archives : 04/02/2007

Posted on February 4, 2007 by davidwilliams

[tab name=”The Case”]What is causing the red eye and ocular irritation in this Cocker Spaniel?[/tab][tab name=”David’s view”]Now some of you will have noticed the tell-tale aphakic crescent on that first picture with diffuse illumination, but here on this one, taken as you might see it with distant direct ophthalmoscopy, its much more obvious. The lens has slipped down, allowing a crescent of bright light shining through where there is no lens to absorb any of it. This dog has a lens luxation with a cataractous lens and lens-induced uveitis (note the dark iris more obvious on the first picture) which have all conspired together to give an intraocular presure of 48mmHg. Treatment was difficult as the dog was old and thus we chose a medical rather than surgical option in this case and lowered the pressure successfully with Trusopt. The case shows, I hope, the value of the simple technique of distant direct ophthalmoscopy to view the lens against the tapetal reflection rather than just with incident light.[/tab][end_tabset] 

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A Clinical Case from the Archives : 28/01/2007

Posted on January 28, 2007 by davidwilliams

[tab name=”The Case”]This six year old Newfoundland is presented to you with gradually failing eyesight, worse at night. Here is its retina. What might be a possible diagnosis?[/tab][tab name=”David’s view”]Well although it doesn’t show brilliantly here there is increased tapetal reflectivity, narrowing of the retinal vessels and a rather pallid optic disc. This, together with the developing night-blindness, signals progressive retinal atrophy to me. There’s only one problem – as far as I know Newfies don’t get this. If you know different do e-mail me![/tab][end_tabset] 

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A Clinical Case from the Archives : 17/01/2007

Posted on January 17, 2007 by davidwilliams

[tab name=”The Case”]This bearded dragon is referred because of possible cataracts. Is that what it has wrong with its eyes? This is a bilaterally symmetrical condition and otherwise the animal seems in good condition.[/tab][tab name=”David’s view”]OK that was a bit far away wasn’t it!? Here is a closer photo. Get any nearer and the animal closes its eyes tight shut but otherwise he’s a harmless creature unlike the snake with a cataract I saw next which had enough sight left to give me a quick but painful bite! Anyway to get back to this dragon, I think that these may be lipid deposits – what do you think? There were no cataracts here by the way.[/tab][end_tabset] 

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A Clinical Case from the Archives : 16/01/2007

Posted on January 16, 2007 by davidwilliams

[tab name=”The Case”]I was asked to examine the eyes of a dog today with a weird history of lethargy and breathlessness. Can you see anything unusual about this retina? What might it suggest to you?[/tab][tab name=”David’s view”]Those retinal veins have a very wide calibre don’t you think? Look at the other eye with an area of bullous retinal detachment very similar to cats with hypertension. In fact this dog is polycythaemic, probably as a result of respiratory compromise – its P02 is only 30mmHg! The increased PCV (70 in this dog!)gives those dilated venules while hyperviscocity gives the bullous detachments. This just shows how valuable it is looking at the retina if you want a detailed examination of a vascular bed.[/tab][end_tabset] 

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A Clinical Case from the Archives : 29/12/2006

Posted on December 29, 2006 by davidwilliams

[tab name=”The Case”]Here’s my last case for 2006! Just what you need in that slack period between Christmas and New Year! Frankie, a 3 year old Tibetan terrier, had a sore eye on Christmas day, so his vet referred him to me two days later. What is the problem and what’s the solution?[/tab][tab name=”David’s view”]Did you see the bright arc of reflection showing the edge of the lens in the anterior chamber? Have a look again if you missed it. This is a lens luxation, classic in this breed at this age. Here is the lens on its way out via a simple lendectomy. Case solved and back home well before the new year celebrations begin! Have a great 2007 won’t you![/tab][end_tabset] 

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A Clinical Case from the Archives : 21/12/2006

Posted on December 21, 2006 by davidwilliams

[tab name=”The Case”]This cat presents with a brown deposit in its anterior chamber. It looks as if it might be in the cornea here, like a corneal sequestrum doesn’t it, but believe me it was lying in the aqueous behind the cornea. What is it? How might it have got there?[/tab][tab name=”David’s view”]Here’s a slightly burred picture of the same thing in the other eye. Its fibrin, which might have come from an anterior uveitis, but the eye is quiet and not inflamed at all. The cat was however hypertensive and this fibrin clot has probably come from leaky iris vesels….not that I can find a reference to this happening in the literature![/tab][end_tabset] 

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A Clinical Case from the Archives : 19/12/2006

Posted on December 19, 2006 by davidwilliams

[tab name=”The Case”]This otherwise healthy 13 year old Golden Retriever is presented to you because of sudden visual loss. Both eyes look like this. What is happening here, why might this have occurred and what diagnostic tests would be necessary?[/tab][tab name=”David’s view”]The dog has bilateral serous retinal detachments with foci of haemorrhage within the retina. Intraocular pressure was normal as was systemic blood pressure so, unusually for me, I asked for an extended blood profile. I felt something was very wrong somewhere inside this dog! It was indeed the case with a panleucopaenia and a raised plasma protein with this globulin spike suggestive of multiple myeloma with retinal detachment occuring because of hyperviscocity syndrome. Ehrlichiosis and Leishmaniosis can give a similar picture but the dog had not been out of the UK. The next images tell what we did next…..[/tab][end_tabset] 

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A Clinical Case from the Archives : 19/12/2006

Posted on December 19, 2006 by davidwilliams

[tab name=”The Case”]Here is a closer view of the retina, showing the haemorrhagic foci in more detail. What other tests would you do, more invasive than a simple blood count?[/tab][tab name=”David’s view”]A bone marrow aspirate showed these nasty neoplastic cells, confirming the diagnosis of multiple myeloma. The dog has done well on cytotoxic drugs, although the internists have had quite a job to curtail his neoplastic disease without making him more myelosuppressed. As an ophthalmologist I’m more than happy to have flagged up his disease status by examining his retina and leave them to the tricky therapeutic decisions![/tab][end_tabset] 

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