A Clinical Case from the Archives : 18/12/2006

Posted on December 18, 2006 by davidwilliams

[tab name=”The Case”]This elderly cat is presented with sore eyes which have been waxing and waning for a time. What might the underlying cause be and what treatment might you use?[/tab][tab name=”David’s view”]Here’s the other eye which isn’t as bad but shows a swollen hyperaemic mucocutaneous junction too. I’ve seen dogs like this with pemphigus and as the cat has been given a number of antibiotics I think that bacterial infection is unlikely to be the main cause. An ideal work-up would have included biopsy and immunohistology looking for autoantibody deposition but in and old cat such as this we have opted for systemic steroid (a short course of topical treatment hadn’t worked) hopefully to alleviate the chronic inflammation, whatever its underlying pathology.[/tab][end_tabset] 

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

Posted on December 12, 2006 by davidwilliams

[tab name=”The Case”]This bay minature shetland pony has a rather unusual piebald lesion in her eye! What might it be and what treatment should be employed?[/tab][tab name=”David’s view”]Well, coming out of the cornea and limbus as it was I really suspected this would be a squamous cell carcinoma. But after we resected it and performed cryosurgery on the underlying tissue, our pathologists read it out as a papilloma as you can see here. So what’s the difference histopathologically between the SCC and papilloma then? Being a simple chap I liked the explanation from Kathy, one of our pathologists: the SCC grows into the corneal tissue while the papilloma grows out! I’m sure its more complicated than that but an easy answer like that was fine for me![/tab][end_tabset] 

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A Clinical Case from the Archives : 08/12/2006

Posted on December 8, 2006 by davidwilliams

[tab name=”The Case”]How would you describe this fundus? To which species might it belong?[/tab][tab name=”David’s view”]Its a paurangiotic fundus, indeed verging on anangiotic, with only very sparse vessels arising form the disc. It comes from an African elephant and is taken from the ground-breaking monograph by this chap, Gordon Lindsay Johnson, back in the Philosophical Transactions of the Zoological Society of London of 1901![/tab][end_tabset] 

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A Clinical Case from the Archives : 03/12/2006

Posted on December 3, 2006 by davidwilliams

[tab name=”The Case”]This poor guinea pig always seems to have one eye somewhat closed. What might be the reasons for this?[/tab][tab name=”David’s view”]Well lots of guinea pigs get hay awns in their conjunctival sacs as foreign bodies, or allergic or infectious conjunctivitis. But look at this eye in a bit more detail and see the dull lustreless cornea with deposits on its surface. The animal has dry eye and a Schirmer tear test of 0mm/min in this eye and 4mm/min in the other (a pretty normal level for these animals). We’re trying topical cyclosporine out which might seem a bit pricey but hopefully the pain relief will be worth it![/tab][end_tabset] 

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A Clinical Case from the Archives : 23/11/2006

Posted on November 23, 2006 by davidwilliams

[tab name=”The Case”]This picture was sent to me by a concerned colleague – what do you think is going on in this cat’s upper eyelid and what can be done to ameliorate the condition?[/tab][tab name=”David’s view”]Simon, the referring vet is more worried and so am I! A few days has resulted in this substantial worsening in the situation. I thought these looked a little like the pyogranulomas we sometimes see in dog’s eyelids, maybe crossed with the lipogranulomatous lesions in cat associated with Meibomian gland distention. But this is far more severe – what should we do? I’ve started the cat on hot compresses as well as the antibiotics and anti-inflammatories its already being given.[/tab][end_tabset] 

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A Clinical Case from the Archives : 23/11/2006

Posted on November 23, 2006 by davidwilliams

[tab name=”The Case”]The persian cat is presented with this weird mass at its medial canthus, one on the eyelid and a couple on its chin. What are they are what needs to be done with them?[/tab][tab name=”David’s view”]These are hidrocystomas, or if you want to be more eponymous, cysts of Moll (here he is – an anatomist from Utrecht in the 1800’s! A poor picture but at least it shows he wore a bowtie!!) They are cysts derived from apocrine sebaceous glands to be morte precise and need to be removed with sharp knife surgery, which we did with difficulty. When I have the histopath back I’ll pop it onto the website here! There is a recent paper on these – Cantaloube et al 2004 Multiple eyelid apocrine hidrocystomas in two Persian cats. Veterinary Ophthalmology 7(2):121-5 but their cysts didn’t look quite as spectacular as this one to my mind![/tab][end_tabset] 

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A Clinical Case from the Archives : 20/11/2006

Posted on November 20, 2006 by davidwilliams

[tab name=”The Case”]This poor horse whacked (a technical term meaning ‘to hit very hard’ for those of you web-browsing from overseas) its head on the lintel of the stable door two weeks ago. Does this explain what you see here?[/tab][tab name=”David’s view”]Here is its normal eye. Note the pale optic disc on the affted side and the lack of optic nerve or retinal vasculature. There is also retinal detachment dorsal to the disc. The ischaemic optic neuropathy and detachment are both likely to be results of the trauma and are not going to improve, but the horse will adapt fairly quickly to its visual compromise on this side.[/tab][end_tabset] 

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A Clinical Case from the Archives : 10/11/2006

Posted on November 10, 2006 by davidwilliams

[tab name=”The Case”]This eight week puppy comes to you with really sore eyes. What are you going to do?[/tab][tab name=”David’s view”]The answer is a tacking procedure placing vertical mattress sutures to evert the inturned eyelids in which the entropion has resulted in trchiasis with eyelid hairs rubbing against the cornea with the possibility of severe ulceration. Here is the pleasing result (for surgeon, owner and above all the patient!)[/tab][end_tabset] 

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A Clinical Case from the Archives : 10/11/2006

Posted on November 10, 2006 by davidwilliams

[tab name=”The Case”]What has this ten year old West Highland White Terrier got wrong with its eyes? And what can we do – topical cyclosporine doesn’t work at 0.2% or 2%, tacrolimus does no better and tear replacement (whoops I’ve given the game away with regard to my first question haven’t I?!) aren’t having much success either. Where next?[/tab][tab name=”David’s view”]The dog needs a parotid duct transposition – allowing it to salivate onto its ocular surface. Think about it – apart from an enzyme or two there’s little difference between the secretion of the salivary gland and the lacrimal gland. Here’s the result an hour and a half after surgery with a lovely moist ocular surface. A real success after months of faffing around (if you’ll excuse the phrase!) with medical therapy. We should have operated much sooner![/tab][end_tabset] 

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A Clinical Case from the Archives : 03/11/2006

Posted on November 3, 2006 by davidwilliams

[tab name=”The Case”]Sorry this isn’t the best picture in the world but it shows what I saw well enough. This nine year old cross-bred has a positive swinging light test into its right eye (a Marcus-Gunn pupil for those of you liking eponyms!). The pupil in the right eye dilates as the light is directed into it showing that there is less ipsilateral stimulation than from the contralateral eye. The dog has had GME with involvement of the prechiasmal optic nerve and now has an optic nerve head looking like this. What can you see and can you work out what has happened?[/tab][tab name=”David’s view”]Here is the normal optic nerve head on the contralateral side. Note how the entire cribriform plate is taken up by myelinated nerve fibres unlike the affected eye. I presume that the smaller size of the affected nerve has been caused by optic nerve degeneration. But is that right? Have you seen something similar?[/tab][end_tabset] 

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