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

Posted on September 7, 2005 by davidwilliams

[tab name=”The Case”]What lesions do you see in this 13 year old dog’s eye? Is the cataract (there’s a giveaway for a start!) suitable for surgery do you think?[/tab][tab name=”David’s view”]There is a cataract for sure but the key feature to note here are the keratic precipitates – inflammatory cells from the aqueous humour accumulating on the posterior face of the cornea. There is a pretty serious inflammatory reaction here which would not auger well for a successful cataract surgery.[/tab][end_tabset] 

Posted in Cases | Tagged , , | Leave a comment

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

Posted on September 7, 2005 by davidwilliams

[tab name=”The Case”]This six week old kitten showed signs of cat flu three weeks ago and now has this ocular appearance. What has happened and what would you do, if anything can be done, to reverse the changes?[/tab][tab name=”David’s view”]This is symblepharon where conjunctiva has adhered to the cornea after virally mediated necrosis of both tissues. Surgery is relatively straight forward to reveal and relatively healthy cornea underneath, as here, but the problem is keeping the surfaces from readhering. Massage of the eye several time a day with use of an antiviral like acyclovcir (see our recent paper Efficacy of topical aciclovir for the treatment of feline herpetic keratitis: results of a prospective clinical trial and data from in vitro investigations.
Vet Record 2005 157(9):254-7 you can download from the recent publications page of the website although it should say 3% not 0.3%!) and steroid too maybe to reduce the aberrant healing but that’s a bit contraversial.[/tab][end_tabset] 

Posted in Cases | Tagged , | Leave a comment

A Clinical Case from the Archives : 10/08/2005

Posted on August 10, 2005 by davidwilliams

[tab name=”The Case”]This 8 year old thoroughbred has a persistent but shallow corneal ulcer. What might be stopping it healing and how might we treat it?[/tab][tab name=”David’s view”]Look at the edge of the ulcer – there under-running of fluorescein beyond the edge of the epithgelial defect that shows an annulus of non-adherent epithelium just as in this dog with a similar sort of non-healing ulcer. This needs to be removed by debridement before the ulcer will heal. A grid keratotomy may also be needed as may protection of the corneal surface with a contact lens.[/tab][end_tabset] 

Posted in Cases | Tagged , | Leave a comment

A Clinical Case from the Archives : 06/08/2005

Posted on August 6, 2005 by davidwilliams

[tab name=”The Case”]In this owl, rescued from the roadside, there seems to be a black slug causing haemorrhage in the back of the eye. What are we seeing?[/tab][tab name=”David’s view”]The black slug is the pecten, a sheet of vascularised tissue emminating from the choroid, acting to provide oxygen and nutrition to the otherwise avascular retina as it waves from side to side as the eye is moved by small saccadic oscillations, as first beautifully described by John Pettigrew in his seminal paper ‘Saccadic oscillations facilitate ocular perfusion from the avian pecten.’ Nature. 1990 343:362-3. Here’s a more normal pecten – the previous one was persistently haemorrhaging after blunt trauma.[/tab][end_tabset] 

Posted in Cases | Tagged , , | Leave a comment

A Clinical Case from the Archives : 06/08/2005

Posted on August 6, 2005 by davidwilliams

[tab name=”The Case”]This tawny owl was found by the side of the road. What ocular lesions can you see and what might be their cause?[/tab][tab name=”David’s view”]This owl has most probably sustained blunt trauma as a result of a vehicular impact (HBT the American’s would say – hit by truck!) with a persistent corneal ulcer resulting. Did you also see the widely dilated pupil? Looking at the posterior segment of the eye, the fluid shock wave that resulted through the eye has caused a contra-coup injury with retinal tearing and subsequent fibrosis, as seen here. That explains what in technical terms we could call the afferent pupillary defect (i.e. its blind!)[/tab][end_tabset] 

Posted in Cases | Tagged , , | Leave a comment

A Clinical Case from the Archives : 06/08/2005

Posted on August 6, 2005 by davidwilliams

[tab name=”The Case”]The African Eagle Owl has a persistent ptosis (lowered eyelid). What might cause this and what diagnostic test could you use to confirm your diagnosis?[/tab][tab name=”David’s view”]Ptosis can be caused by facial nerve damage or Horner’s syndrome, since the upper eyelid is partially sympathetically innervated. Using 0.1% phenylephrine will imrpove the ptosis as seen here. We might also expect miosis (lack of sympathetically-innervated pupil opening) and enophthalmos (lack of functional innervation of the peribulbar muscle come) but in birds the iris is striated muscle and thus not autonomically innervated and in an owl like this the globe is conical to enophthal;mos does not occur. Read more about Bubo, this owl in our paper ‘Horner’s syndrome in an African spotted eagle owl (Bubo africanus.’ Veterinary Record 134:64-6[/tab][end_tabset] 

Posted in Cases | Tagged , | Leave a comment

A Clinical Case from the Archives : 03/08/2005

Posted on August 3, 2005 by davidwilliams

[tab name=”The Case”]What disease processes are you seeing in the eye of this white 7 year old German Shepherd. What diagnostic tests might you employ and what treatment?[/tab][tab name=”David’s view”]Here’s his other eye – there are conjunctival follicles and third eyelid depigmentation caused by lymphocytic plasmacytic conjunctivitis (you can see another case with some histopathology by using the image search engine on the clinical cases page) and also corneal lipid deposits in each eye. I have asked about diet (he’s on James Wellbeloved) and taken a fasted blood lipid serum sample to assess what’s going on systemically. The dog is already on prednisolone acetate qid which isn’t holding things at the height of summer (a British summer mind you so not that much UV!) so we have moved on to topical cyclosporine in Optimmmune to see what difference that makes.[/tab][end_tabset] 

Posted in Cases | Tagged , , | Leave a comment

A Clinical Case from the Archives : 03/08/2005

Posted on August 3, 2005 by davidwilliams

[tab name=”The Case”]This year old (and 10cm long!)Hermann’s tortoise has eyes that look a lot duller than its brother’s. What is the likely diagnosis here, how might you confirm it and how could you treat it?[/tab][tab name=”David’s view”]Here is its other eye – they both look dry don’t they, though Schirmer tear tests for such tiny eyes aren’t possible to take, even with the phenol red thread test. I’ve suggested using a gel-based tear replacement such as Viscotears but cyclosporine might be an option – have any of you seen KCS in a tortoise? E-mail me if you have please![/tab][end_tabset] 

Posted in Cases | Tagged , , | Leave a comment

A Clinical Case from the Archives : 02/08/2005

Posted on August 2, 2005 by davidwilliams

[tab name=”The Case”]What is this slowly growing eyelid tumour in a 10 year old Gordon Setter likely to be? How would you reconstruct the lid after resection?[/tab][tab name=”David’s view”]Does this histopathology help you? The cells are trying to form glandular structures and the diagnosis is adenoma, most probably from the meibomian glands. A rotational graft is the simplest form of lid reconstruction and worked well in this case.[/tab][end_tabset] 

Posted in Cases | Tagged , | Leave a comment

A Clinical Case from the Archives : 31/07/2005

Posted on July 31, 2005 by davidwilliams

[tab name=”The Case”]This old diabetic dog has had cataracts for four years now – his owner says he gets around well and hasn’t the money for surgery. But over the past week he has developed this red eye – what might be going on?[/tab][tab name=”David’s view”]The dog could have uveitis or glaucome both of which could arise secondarily to the cataract, as lens induced uveitis or as a phacomorphic glaucoma where the enlarged cataractous lens pushes the angle closed as seen on this ultrasound picture. Again the owner says the dog doesn’t seem concerned and she refuses any treatment to reduce the intraocular pressure (42mmHg) which does rather make one wonder why she came to see you in the first place![/tab][end_tabset] 

Posted in Cases | Tagged , , | Leave a comment