A Clinical Case from the Archives : 26/11/2005

Posted on November 26, 2005 by davidwilliams

[tab name=”The Case”]This 3 year old alpaca has had a corneal problem for nearly a year now. Today was the first time I saw it but I admit I can understand why the other ophthalmologists who have examined the eye have been mystified – the lesion had the same effect on me! Can you help?[/tab][tab name=”David’s view”]Here is the lesion as it appeared ten months ago – stained by the owner who is an optometrist. Subsequent viral, bacterial and fungal culture have proved negative and histopathology revealed only epithelial hyperkeratosis and dyskeratosis. Having used upevery other option they scrape the bottom of tyhe barrel and call me in! The alpaca has been on topical antibiotic and steroid for months with no effect. My feeling is that we should stop all treatment for a couple of weeks and then perform a superficial keratectomy and place a contact lens, as if this were a boxer-type ulcer. But if you have a better idea do please e-mail me asap! [/tab][end_tabset] 

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A Clinical Case from the Archives : 16/11/2005

Posted on November 16, 2005 by davidwilliams

[tab name=”The Case”]Don’t you think this is quite the most beautiful lens pathology you’ve seen for a long time?! I’m kicking myself now that I didn’t dilate the pupil to get a full view and I will in a few months when I reassess the horse. Will it have progressed by then do you think? What effect do you think it has on the animal’s vision?[/tab][tab name=”David’s view”]Here is the other eye a bit closer up. This is cataract in some sense, but as much change of refraction in the anterior cortex as an overt lens opacity. It seems to have little or no obvious effect on the horse’s vision and I have a sneaky feeling that it won’t progress much, if at all, at least in the short to medium term.[/tab][end_tabset] 

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A Clinical Case from the Archives : 13/11/2005

Posted on November 13, 2005 by davidwilliams

[tab name=”The Case”]This three month old cross-bred puppy is presented with eyes that seem, according to the owner, to have been irritating the dog almost from day one. What is the cause and how would you treat it?[/tab][tab name=”David’s view”]There is a forest of aberrant hairs arising from the Meibomian gland orifices all along the eyelid edge – distichiasis. Too many to perform electrolysis on, the other options are to exise the hair follicles by sharp knife surgery along the inner eyelid or, as is seen here use cryotherapy. Two rapid freeze slow thaw cycles, aided by the use of the chlazion clamp here, kills the hair follicle which is more sensitive to cold than the surounding eyelid tissue. Potential side effects are post-operative inflamation and swelling which should be treated prophylactically with systemic anti-inflammatories, and possible hair depigmentation if the probe is applied too enthusiastically.[/tab][end_tabset] 

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A Clinical Case from the Archives : 13/11/2005

Posted on November 13, 2005 by davidwilliams

[tab name=”The Case”]This cat has been presented by the owner saying that, having been awol for a few days, the animal arrives back home with her eyes looking like this. What is your provisional diagnosis and what test would you perform to confirm it. I know we only have the eyes to see here, but would it be worth looking at the rest of the animal too?![/tab][tab name=”David’s view”]The narrower eyelid in the right eye and the narrower pupil, together with the protrusing third eyelid showing an enophthalmos with the globe sunken back in the orbit, are pathognomonic of Horner’s syndrome. But to be sure, and to localise the site of the nerve lesion, topical phenylephrine gave this amelioration of signs in 28 minutes. That shows that the second order neuron between the spinal cord and the cranial cervical ganlion is affected. Actually you’ld have to be very remiss not to notice that the cat had an elbow flexion ipsilaterally too, showing a radial nerve palsy suggesting that the sympathetic denevation is related to trauma to the brachial plexus. This must have resulted only in neuropraxia, for over the next two months the radial and sympathetic nerve dysfunction gradually resolved.[/tab][end_tabset] 

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A Clinical Case from the Archives : 08/11/2005

Posted on November 8, 2005 by davidwilliams

[tab name=”The Case”]This horse presented with a painful lacrimating eye. What might be happening here – extrapolate from other species maybe to give you a clue! What diagnostic steps would you take and what treatment might be appropriate?[/tab][tab name=”David’s view”]Well this looked similar to a dendritic ulcer you might see in a cat, so we took swabs for equine herpesvirus PCV but to no avail. Treatment with penciclovir was not sufficient but with topical steroid added in as well as antiviral the lesions resolved. Make of that what you will! The photograph here shows a different horse where a corneal sample was positive for EHV-5 on PCR but the scarring seen here needed surgery to remove it.[/tab][end_tabset] 

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A Clinical Case from the Archives : 05/11/2005

Posted on November 5, 2005 by davidwilliams

[tab name=”The Case”]A cocker spaniel turns up this morning with an eye characterised by corneal oedema, episcleral congestion, a vascular fringe at its limbus, a dilated pupil and visual impairment. What is the likely diagnosis?[/tab][tab name=”David’s view”]Well the likely diagnosis, as most of you will have guessed, is glaucoma. The only trouble is that the intraocular pressure was 16mmHg. I took the pressure again and again with a tonopen and tonovet tonometer but couldn’t get the pressure any higher! I guess it could be that there is uveitis as well as glaucoma, bringing down the pressure, but would it normalise it? And would the pupil still be widely dilated? I must admit the case has got me somewhat stumped! E-mail me if you know what’s happening, please![/tab][end_tabset] 

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A Clinical Case from the Archives : 05/11/2005

Posted on November 5, 2005 by davidwilliams

[tab name=”The Case”]The dog in the previous qustion has a problem in its right eye as well. Persistent copious discharge and a red eye but one that is visual are seen here. What might be going on?[/tab][tab name=”David’s view”]The Schirmer tear test here is 5mm compared with 15mm in the other eye. So KCS is the diagnosis in this eye. The corneal oedema here is likely to be because of ocular surface microtrauma from dryness, not endothelial damage from glaucoma. I know you might say that I’ve put quite a few dry eye cases on the website, but it just shows its always something to look for – a Schirmer test test is so easy to do. All too many dogs go through several different topical antibiotics before someone realises that infection isn’t the problem and that KCS is a more likely diagnosis.[/tab][end_tabset] 

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A Clinical Case from the Archives : 05/11/2005

Posted on November 5, 2005 by davidwilliams

[tab name=”The Case”]This 9 month almost completely white harlequin great dane is deaf and unilaterally blind too. What is happening here and why has it got these problems?[/tab][tab name=”David’s view”]It looks as if there is no eye here at all – we might call it anophthalmic. But a bit more investigation shows a microphthalmic globe underneath the third eyelid. Removal of this should give some vision in this eye, if not very much. Pigment is essential in showing developing cells where to go in the embryo, and this, at a very most basic level, is what makes white animals defective. In fact the Harlequin gene and the Merle gene cause sufficient problems when homozygous that HH embryos never survive and MM is a semi-lethal trait.[/tab][end_tabset] 

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A Clinical Case from the Archives : 30/10/2005

Posted on October 30, 2005 by davidwilliams

[tab name=”The Case”]This two year old Irish Wolfhound is presented with a gradual loss of vision in this eye. What is wrong and what might you do to investigate and treat?[/tab][tab name=”David’s view”]The dog has almost complete medial strabismus with the eye so inturned that vision is no longer possible. A forced duction test (ophthalmic jargon for trying to tug the eye around after judicious use of local anaesthetic!) showed the strabismus to be restrictive, rather like stranismus fixus in people. An orbital ultrasound (sorry its not the best in the world!) showed a substantial mass of fibrous tissue fixating the globe medially. We resected this and plicated the lateral rectus to bring the eye around, as you will see in the next question…..[/tab][end_tabset] 

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A Clinical Case from the Archives : 30/10/2005

Posted on October 30, 2005 by davidwilliams

[tab name=”The Case”]The treatment in the Irish Wolfhound from the preceeding question has involved pleating the lateral rectus muscle to turn the eye, but has had the effect of bringing across the third eyelid. Why is that?[/tab][tab name=”David’s view”]Our surgery has also pulled the globe inwards making it enophthalmic. Interestingly either enophthalmos or exophthalmos as in this dog with an orbital tumour, cause third eyelid protruision. In the case of the Irish wolfhound, removal of the third eyelid restored vision.[/tab][end_tabset] 

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