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

Posted on October 10, 2005 by davidwilliams

[tab name=”The Case”]This dog is presented with gradually worsening vision and a continuous white discharge. What’s the likely problem, what would your key diagnostic test be and what are the possible therapeutic options?[/tab][tab name=”David’s view”]This dog has keratoconjunctivitis sicca or dry eye with subsequent corneal pigmentation. The low tear production (a Schirmer tear test gave a reading of 2mm/min in the first and 5mm/min in this eye) may be resolved with topical cyclosporine but this is unlikely to resolve the pigmentation completely – a superficial keratectomy may be required for that.[/tab][end_tabset] 

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A Clinical Case from the Archives : 07/10/2005

Posted on October 7, 2005 by davidwilliams

[tab name=”The Case”]This Boa constrictor is presented for an eye problem. What is your diagnosis and what would you suggest is done to correct it?[/tab][tab name=”David’s view”]That was a bit of un unfair question without seeing the other more normal eye perhaps – here is its other eye. The snake has retained its spectacle after a shed. Remember that snakes do not have eyelids but these are fused to form the transparent spectacle. This should be shed with the rest of the skin slough. Normally the problem with dysecdysis is too low an ambient humidity or snake mite damage around the edge of the spectacle. Raising the humidity and applying a damp cotton wool pad to the eye normally alows the spectacle ot the shed well with the next skinn slough. Here the owner knows his stuff and the boa is kept at just the right temperature and humidity. In fact the problem seems not just a simple failure to hed but rather a centripetal growth of skin around the spectacle. Normally we wouldn’t consider trying physically to remove the retained ‘eyecap’ since the underlying cornea is very delicate but here we may be forced to resort to surgery.[/tab][end_tabset] 

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A Clinical Case from the Archives : 07/10/2005

Posted on October 7, 2005 by davidwilliams

[tab name=”The Case”]This circus horse is presented with a two week history of eye problems. My feeling is that this has been going on for a fair bit longer but what can you see as the problem(s) here? What woud you do about them?[/tab][tab name=”David’s view”]There is a mass on the lower eyelid that is most probably a sarcoid while the third eyelid lesion is almost certainly a squamous cell carcinoma. We resected them both but I must say that the prognosis for the squamous cell carcinoma is not good as the surgical margins were poor. Cryotherapy or brachytherapy can be useful in lowering the liklihood of recurrence.[/tab][end_tabset] 

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A Clinical Case from the Archives : 29/09/2005

Posted on September 29, 2005 by davidwilliams

[tab name=”The Case”]This 7 month labrador is presented with this slowly growing excrescence (well I’m not quite sure what word to use for it!) and associated exophthalmos. What might be going on here?[/tab][tab name=”David’s view”]The truth is the dog came in today so I’m not quite sure myself what is going on here. I put the image up for your help please, if you’ve seen something similar! Here is one of a number of ultrasound images of the retrobulbar area. Clearly there are cysts which extend into the retrobulbar space but what could they be? Fluid filled sacs associated with the lacrimal or nasolacrimal system? A zygomatic salivary problem? An echinococcal or similar parasitic cyst? Or a simple but giant set of conjunctival cysts? Please e-mail me if you have an idea![/tab][end_tabset] 

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A Clinical Case from the Archives : 29/09/2005

Posted on September 29, 2005 by davidwilliams

[tab name=”The Case”]This dog is presented with a acutely red painful lacrimating eye. There’s obviously a corneal ulcer here, stained with fluorescein dye and conjunctival hyperaemia. But what has caused the ulcer? Look carefully. Can you see the problem?[/tab][tab name=”David’s view”]A bit of extra history might have been useful I suppose – this all started after the dog had been playing in a meadow in late summer. Nothing very diagnostically taxing here – just a grass awn in the dog’s lower medial conjunctival sac behind its third eyelid (you can just see the ends of the awn poking out or maybe it takes the eye of faith!)and it is this foreign body which is resulting in this superficial ulcer. Removal and a few days topical antibiotic were all that were needed. Thanks to Vicky Peirce who actually whipped the offending article out before I had a chance to![/tab][end_tabset] 

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A Clinical Case from the Archives : 29/09/2005

Posted on September 29, 2005 by davidwilliams

[tab name=”The Case”]This 13 year old dog is brought to you because the owners are concerned about the haziness in his lenses. He doesn’t seem to be having problems at the moment but should he have cataract surgery now to save his sight?[/tab][tab name=”David’s view”]The key thing is not to look at the eye with incident light at an angle, as in that first image – in any older dog this will show scattered light from the ageing lens. Look, however, with an ophthalmoscope through the lens to view the reflected light from the tapetum as in this picture from the same dog. Note that there is no overt cataract here, just a ring marking the edge of the nucleus which has become compressed by the continually growing cortex and so has a higher refractive index but is still transparent. This is nuclear sclerosis which does not require cataract surgery.[/tab][end_tabset] 

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A Clinical Case from the Archives : 29/09/2005

Posted on September 29, 2005 by davidwilliams

[tab name=”The Case”]This 18 month old Golden Retriever presents with these startled-looking eyes. What is going on here? How would you treat it?[/tab][tab name=”David’s view”]The two key things here are first that while the eyes are exophthalmic to some degree, there is no protrusion of the third eyelid, unlike this dog with a retrobulbar sarcoma where the nictitating membrane is all too obviously protruding. The lack of protrusion in the first case means that whatever is pushing the eye forward must be within the muscle cone of the extraocular muscles. The second is that the dog is a young Golden Retriever and I guess there is a third – the condition is bilateral. The dog is fully sighted and not in any pain. This is extraocular myositis, a condition particularly seen in this breed, though who knows why! There isn’t much in the literature about the condition and what is there is tucked away in unlikely places – like the excellent case study ‘Canine bilateral extraocular polymyositis’ hidden in Veterinary Pathology in 1989 (26:510-12). Anti-inflammatory doses of oral steroid resolve the problem but recurrence is all too common in my book.[/tab][end_tabset] 

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A Clinical Case from the Archives : 12/09/2005

Posted on September 12, 2005 by davidwilliams

[tab name=”The Case”]Don’t worry if this one has you completely stumped – it did me! This Elephant in an Algerian zoo has a white hazy appearance to the cornea with blepharospasm and a discharge from the eye. What could be going on and has it a human counterpart?[/tab][tab name=”David’s view”]As I say I really hadn’t a clue and it was Khyne Umar who is an elephant expert currently working on a PhD at London Zoo who helped me out. It is hypovitaminosis A, apparently a common problem in poorly fed elephant in Asia and xerophthalia, as it can be known, is widely seen in people in the Third World too. The elephant in this picture also has corneal trauma from periocular lice infestation.[/tab][end_tabset] 

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A Clinical Case from the Archives : 12/09/2005

Posted on September 12, 2005 by davidwilliams

[tab name=”The Case”]Here’s one to show the wonder of telediagnosis! Rocky is an Atlantic rock cod, kept as a pet on the research base in South Georgia in the Antarctic! What is wrong with himand do we need to do anything?[/tab][tab name=”David’s view”]The exopht5halmos in this fish is probably caused by gas bubble disease where gas bubbles from supersaturated water give cysts which expand in the retrobulbar space pushing the eye out. Other causes can include gas bubble generation in the vasculature of the choroidal rete which naturally produces oxygen to supply the metabolic needs of the retina. In shallow water this can come out of solution as we have noted in farmed halibut (Williams and Brancker (2004) Intraocular oxygen tensions in normal and diseased eyes of farmed halibut. Veterinary Journal 2004 167:81-6) as shown in this picture. In the former case supersaturation must be prevented as bubbles elsewhere can be damaging, but in the latter situation in an individual animal nothing need be done – Rocky is probably fine as long as trauma is avoided. Interestingly this condition was first noted in cod back in the 1966s (Dehadrai PV (1966)Mechanism of gaseous exophthalmia in the Atlantic cod (Gadhua morua). Journalof the Fisheries Research Board of Canada 23: 909-914)[/tab][end_tabset] 

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A Clinical Case from the Archives : 07/09/2005

Posted on September 7, 2005 by davidwilliams

[tab name=”The Case”]This 12 year old cat is brought to you as an emergency with haemorrhage in the eye. What might be the causes for this and how might you elucidate which is responsible?[/tab][tab name=”David’s view”]This could conceivably be trauma or anterior uveitis but notice that the rest of the iris is pretty normal. In a cat of this age I’d be worried about a hypertensive episode. What is the other eye like? Here we can see a detached retina suggestive of hypertensive retinopathy. Blood pressure was 220/180mmHg and treatment with amlodipine at 0.625mg/day orally prevented any further haemorrhage and eventually yielded a relatively normal retina in the fellow eye.[/tab][end_tabset] 

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