A Clinical Case from the Archives : 11/06/2005

Posted on June 11, 2005 by davidwilliams

[tab name=”The Case”]What is this lesion, slowly growing over the past six months in this 18 year old horse? How should it be removed?[/tab][tab name=”David’s view”]You don’t need to be an expert equine clinician or an ace oncologic pathologist to know that a black mass anywhere on a grey horse is a melanoma! But here complete resection might be difficult. The bleached section here shows few mitotic figures: this is a relatively benign melanocytoma, but with poor surgical margins obtained after resection from the canthus. Had it been in the third eyelid complete removal would have been easy but at the canthus we performed cryotherapy on the tissue following resection to prevent recurrence.[/tab][end_tabset] 

Posted in Cases | Tagged , | Leave a comment

A Clinical Case from the Archives : 11/06/2005

Posted on June 11, 2005 by davidwilliams

[tab name=”The Case”]This eyelid mass has been slowly growing for the past 4 months in this 10 year old Doberman-cross bitch. What might it be and what surgical margins do you think should be taken?[/tab][tab name=”David’s view”]Histology shows this to be a relatively benign pedunculated melanocytoma requiring narrow surgical margins only necessitating a simple wedge excision.[/tab][end_tabset] 

Posted in Cases | Tagged , | Leave a comment

A Clinical Case from the Archives : 03/06/2005

Posted on June 3, 2005 by davidwilliams

[tab name=”The Case”]What might be the cause of this dog’s third eyelid protrusion? The change has come on slowly and does not seem to bother the animal. The dog seems somewhat to resent mouth opening but not to the extent of showing it to be painful. There is a mild serosanginous nasal discharge on this side.[/tab][tab name=”David’s view”]The eye is somewhat exophthalmic, explaining the protrusion of the third eyelid. It always seems strange to me that both exophthalmos and enophthalmos (for instance in Horner’s syndrome) give rise to a third eyelid protrusion. If you can explain that to me please do send me an e-mail! The slow development of this and the relatively painfree mouth opening are omminous signs suggestive of tumour rather than inflammatory changes. The nasal discharge is worrying to isn’t it? Sure enough an MRI, as shown here, demonstrates amazingly profound infiltration of the orbit by a nasal tumour for the limited exophthalmos. Dealing with a tumour which has developed this far without giving the dog a severely compromised end to its life is very difficult in my mind. I’ll let you know when we have the biopsy results obtained through a nasal endoscopy. Thanks to the oncology team at Cambridge for a chance to look at this interesting but rather sad case. At least the dog is happy and feeling well at present.[/tab][end_tabset] 

Posted in Cases | Tagged , , | Leave a comment

A Clinical Case from the Archives : 03/06/2005

Posted on June 3, 2005 by davidwilliams

[tab name=”The Case”]This cat has sustained major mandibular and maxilliary trauma after a road traffic accident. There is no menace response or pupillary light response although visual placing reflexes using this eye seem intact. What is the problem with its left eye and how would you resolve it?[/tab][tab name=”David’s view”]The major problem for the eye is lagophthalmos – a failure of eyelid closure – probably caused by facial nerve neuropraxia. The lack of reflexes in the presence of vision suggests that these defects are efferent rather than afferent. There is an internal ophthalmoplegia with oculomotor dysfunction and a facial nerve deficit also. The lagophthalmos is resoluting in a corneal ulcer and the key ocular treatment is a temporary tarsoraphy as shown here with a matress suture with stents of drip tubing. After one week the corneal lesions had resolved and ocular reflexes had returned.[/tab][end_tabset] 

Posted in Cases | Tagged | Leave a comment

A Clinical Case from the Archives : 03/06/2005

Posted on June 3, 2005 by davidwilliams

[tab name=”The Case”]What is amiss with the eyes of this young Bulldog puppy? Can it be corrected?[/tab][tab name=”David’s view”]This animal has bilateral congenital exotropic strabismus. Here the defect appears to be in the orbital bone structure although without a high resolution ultrasound examination investigation of extraocular muscle anatomy is very difficult. Strabismus, though common in children, is very rare in dogs. The Bichon shownin this second picture developed a unilateral strabismus after injury, a far more common cause than the congenital problem seenin the puppy.[/tab][end_tabset] 

Posted in Cases | Tagged , , | Leave a comment

A Clinical Case from the Archives : 27/05/2005

Posted on May 27, 2005 by davidwilliams

[tab name=”The Case”]This rabbit has a rapidly developing (over a week or less) blindness. What is the ocular cause and what might be the systemic cause?[/tab][tab name=”David’s view”]If this were a dog we would say for sure it was a diabetic catarct, given its mature appearance and rapid onset. But in a rabbit things aren’t quite so simple; the animal has no other signs of diabetes and most importantly the other eye still has a clear lens! Not all diagnoses are as straight forward as we would like them to be! More importantly the animal is behaviourally unaffected and needs no treatment. It is always possible that Encephalitozoan cuniculi is involved in cataractogenesis here, but here the owner was not concerned enough to warrant serological confirmation of this.[/tab][end_tabset] 

Posted in Cases | Tagged , | Leave a comment

A Clinical Case from the Archives : 27/05/2005

Posted on May 27, 2005 by davidwilliams

[tab name=”The Case”]What changes are you seeing in the eye of this 7 year old American cocker spaniel? What might you suggest should be done about them?[/tab][tab name=”David’s view”]The dog has cataract for sure, but one with areas giving a crystalline whiteness which suggests resorption and areas of visual axis clarity suggesting that resorption has occured. The iris is dark as well showing some lens-induced uveitis. Also note the iris cyst which has exploded onto the posterior face of the cornea as a black star. All these changes in my mind would argue against cataract surgery – the eye is inflammed to some degree and the cataract may well resorb further restoring some sight if we are lucky![/tab][end_tabset] 

Posted in Cases | Tagged , , | Leave a comment

A Clinical Case from the Archives : 27/05/2005

Posted on May 27, 2005 by davidwilliams

[tab name=”The Case”]What is causing the blindness in this youg calf? What might the underlying cause be? The animal also has spastic paresis of its hindlimbs which may or may not help you with the diagnosis![/tab][tab name=”David’s view”]The calf has a cataract with asociated iritis – notice how the iris is adherant to the lens capsule dorally and ventrally with the lateral and medial areas of the pupil ballooning out giving this strange erythrocyte-in-crossection appearance! I’m not sure which can first, the uvetis or the cataract, but I guess the latter. This may well be associated with BVD – the calf is BVD-antibody negative but that may mean little and we await the BVD antigen test. Incidentally, compare the iris with the contralateral eye shown here and see how much darker it is, a sure sign of uveitisas well as the synechiae top and bottom.[/tab][end_tabset] 

Posted in Cases | Tagged , , | Leave a comment

A Clinical Case from the Archives : 07/05/2005

Posted on May 7, 2005 by davidwilliams

[tab name=”The Case”]This 7 year old German Shepherd dog was referred for the unusual appearance of the right eye. This occured rapidly, over the course of a few days and worried the owner (and the referring vet!)but apparantly not the dog. What might be happening here and what might your diagnostic plan include?[/tab][tab name=”David’s view”]Here is a closer look at the affected eye with the depigmentation very obvious but no iris swelling, pathological vascularisation or flare. I must admit that I haven’t an immediate diagnosis here but intraocular inflammation sprang to mind. Vogt-Koyanagi-Harada-like syndrome (isn’t that just a great name!!) is manifest with periocular depigmentation – vitiligo and poliosis – and then posterior segment inflammation often with retinal detachment and blindness. But here the depigmentation is iridal and there is a mild iridocyclitis (anterior segment uveitis) not choroiditis in the posterior segment. I know that because the intraocular pressure was 11mmHg compared with 17mmHg in the normal left eye and the posterior segment is unremarkable. There were some tiny foci of cataract in the lens of this eye and not the left eye. A full work-up would include a blood screen including a serum electrophoresis, titres for all sorts of unusual infectious agents (except that the dog had not been out of the country) and maybe even an aspirate of aqueous and cells from the iris surface. Given that the dog is not in any discomfort of visual impairment however, we decided against such a drastic diagnostic plan and merely tried topical steroid….and phototherapy of course, the results of which you can see displayed here![/tab][end_tabset] 

Posted in Cases | Tagged , , | Leave a comment

A Clinical Case from the Archives : 07/05/2005

Posted on May 7, 2005 by davidwilliams

[tab name=”The Case”]What disease process could be causing the abnormal appearance in this 12 year old cat’s iris? What systemic implications could this have and what might your treatment be?[/tab][tab name=”David’s view”]These large iris masses are highly likely to be neoplastic. It is conceivable that they could be metastases from a distant neoplasm such as a mammary carcinoma but lymphoma is the top of my differentials list. In fact as you can see here there were smaller lesions in the iris of the other eye and cutaneous masses too. They didn’t look anything like as spectacular as the eye signs to me (or maybe that’s just an ophthalmologist’s biased perspective!) but if you wanted to have a look at one of them send me an e-mail by clicking on the button on the homepage and I’d be happy to send you a jpeg of a fairly non-descript skin mass! Incidentally the cat was FeLV/FIV negative. The COP protocol was effective in resolving the iris lesions but obviously not the generalised disease as on cessation of treatment the iridal lesions recurred and a more aggressive regime including doxyrubicin has been initiated.[/tab][end_tabset] 

Posted in Cases | Tagged , | Leave a comment