An introduction – and a case

Posted on May 7, 2011 by richardfrank

Dear friends and colleagues, after many years of my trusty old website acting as an opportunity for sharing some of the cases I see and the work that I am publishing, the creaks and groans of the old site are becoming just a bit too obvious.

So with the help of my great friend Richard Frank, who designed the first site back in 2004, I am starting a blog of sorts to continue a site that I hope will be of interest to those of you just starting out in veterinary medicine and thus needing to see examples of eye diseases, and also those of you with experience in the field, who I hope can help me with some of these less standard cases.

Here is one to start you off.
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A five year old guinea pig with this weird deposit around the limbus in both eyes. What is happening here and does it matter to the animal?

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This is heterotopic bone formation, occurring because of vitamin C entering the eye with the aqueous humour at the ciliary body, which stimulates this abnormal bone formation. Some consider that this leads to glaucoma, though this eye had a subnormal intraocular pressure of 9mmHg.

The key paper on this condition is Dennis Brook’s report (Heterotopic bone formation in the ciliary body of an aged guinea pig. Laboratory Animal Science 1990;40:88-90) though the prevalence of the condition is low in the pet population, with a figure of only eight animals having the condition in the thousand normal cavies we examined for our recent report (Williams D, Sullivan A. Ocular disease in the guinea pig (Cavia porcellus): a survey of 1000 animals.Vet Ophthalmol. 2010;13 Suppl:54-62) and these generally having a much less severe manifestation of the disease, as seen below.

Note also that the guinea pig above has a white cataract dorsally, this time a condition seen very commonly in our survey.

Do these ocular changes mater to the guinea pig? Most seem to cope very well with visual disturbance and pain does not seem evident, although of course these are a prey species, which opens a whole can of worms in understanding how they might show distress or pain!

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A Clinical Case from the Archives : 09/01/2011

Posted on January 9, 2011 by davidwilliams

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I saw this cat, with similar lesions in both eyes but comfortable and visually still, as a “Have a look at this while you are here” freebee examination in a clinic a few days ago. What are you seeing here?
[/tab][tab name=”David’s view”]This is lipid deposition with associated blood vessels probably after a corneal ulcer. We’d call this a lipid keratopathy, though I’ve never seen one in a cat before and can’t find a report of it in the literature. Not enough money, or a calm enough cat, to take a blood sample for lipid analysis I’m afraid, but as the cat is happy no treatment is needed. If it were maybe the driver of this truck I passed on the way home from the consultation would be able to help![/tab][end_tabset] 

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A Clinical Case from the Archives : 03/01/2011

Posted on January 3, 2011 by davidwilliams

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What is wrong with the retina in this 9 year old labrador which has gone slowly blind over the last three years? It died of disease not relaed to its ocular condition.

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[tab name=”David’s view”]There are next to no retinal photoreceptors or their nuclei left, compared to this normal retinal histology, suggesting that the dog has progressive retinal atrophy, an inherited retinal degeneration which has resulted in gradual loss of vision.

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A Clinical Case from the Archives : 14/06/2010

Posted on June 14, 2010 by davidwilliams

[tab name=”The Case”]This middle aged diabetic Golden Retriever was presented with this somewhat alarming ocular appearance. What might your differentials be, how could you test to confirm the diagnosis and is there a link with the diabetes?[/tab][tab name=”David’s view”]The third eyelid protrusion signals an enophthalmos and the pupils were constricted this some anisocoria (though not easily visible here). The upper eyelids were somewhat lowered. This triad of miosis, ptosis and enophthalmos is classic for Horner’s syndrome. Topical 0.5% phenylephrine resolved the signs in less than 10 minutes, suggesting a third order lesion. While common in Golden Retrievers as an idiopathic problem, most of those are second order lesions. It is highly likely that this is a result of a diabetic neuropathy, as previously reported by Holland in 2007 (Bilateral Horner’s syndrome in a dog with diabetes mellitus. Veterinary Record 160:662-4). The owner was given a supply of phenylephrine to use before taking the dog for a walk, to improve vision which was otherwise compromised by the protruding third eyelids.[/tab][end_tabset] 

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A Clinical Case from the Archives : 15/01/2009

Posted on January 15, 2009 by davidwilliams

[tab name=”The Case”]This Springer Spaniel has had an irritated eye for some time. What can you see that might be causing this?[/tab][tab name=”David’s view”]This is a chalazion or a lipogranuloma of the Meibomian gland. It has become hard and concreted given substantial irritation, and needs to be resolved with hot compresses which make the lipids more fluid and allow them to exit the gland. In unresponsive cases curretage or resection might be required but this is rare.[/tab][end_tabset] 

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A Clinical Case from the Archives : 14/01/2009

Posted on January 14, 2009 by davidwilliams

[tab name=”The Case”]While I was examining this Cavalier King Charles Spaniel for a corneal problem, I thought I’d cast my new Optibrand ClearView digital fundus camera over its other eye and look at its retina. This lesion jumped out at me! What is it and is it a problem?[/tab][tab name=”David’s view”]This circle is a geographic retinal dysplasia, common in this breed. It isn’t a problem for this dog, causing neither visual problems now or in the future but it won’t pass a BVA Kennel Club or American CERF examination and so won’t be able to be bred from, which will be a problem for its owner!![/tab][end_tabset] 

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A Clinical Case from the Archives : 30/10/2008

Posted on October 30, 2008 by davidwilliams

[tab name=”The Case”]This three month old Cavalier King Charles Spaniel is presented as the onwers want to know if its eye problems are inherited. What would you say?[/tab][tab name=”David’s view”]There is a substantial cortical cataract in one eye and a small posterior subcapsular cortical circle in the other as you can see here. In this breed the two cataracts known to be inherited are a congenital cataract with multiple ocular defects (ultrasonographic biometry here showed the eyes not to be microphthalmic) and a progressive opacity occuring at two years of age. So neither of these eyes show opacities recognised as inherited ones, but my feeling is that until proven otherwise any cataract in a young animal should be considered potentially heritable. What do you think?[/tab][end_tabset] 

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A Clinical Case from the Archives : 19/10/2008

Posted on October 19, 2008 by davidwilliams

[tab name=”The Case”]What is happening – or rather has happened – in this dog’s retina?[/tab][tab name=”David’s view”]The yellow area, which appeared highly reflective on fundoscopy, is a post-inflammatory retinopathy where retina has died with resulting tapetal hyper-reflectivity. This may well be caused by a migrating Toxocara larval challenge as the dog was not wormed as a pup. Incidentally this lovely indirect view was taken with Optibrand’s Clearview system, a great new device for those of you who are gadget-mad like me![/tab][end_tabset] 

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A Clinical Case from the Archives : 17/10/2008

Posted on October 17, 2008 by davidwilliams

[tab name=”The Case”]This poor little Jack Russell seems to have everything wrong with it – a weird neurological gait abnormality, probably Cushings, definite hypercholesterolaemia and now when we look in its eye this! What are we seeing – does it affect vision?[/tab][tab name=”David’s view”]This is asteroid hyalosis – bright stars in a degenerate vitreous. They are composed of calcium hydroxyapatite and lipid and rarely cause a visual problem in people, so we assume the same for dogs! They occur in older individuals and those with diabetes or hyperlipidaemia, which fits with this dog. Have a look at Wang, Kador and Wyman’s recent paper in www.molvis.org/molvis/v12/a30/ for a really nice study of them in galactose fed dogs.[/tab][end_tabset] 

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A Clinical Case from the Archives : 26/09/2008

Posted on September 26, 2008 by davidwilliams

[tab name=”The Case”]What might you expect to see if you looked at the retina of this sweet little kitten, blind since the day it was rescued from the side of the road?[/tab][tab name=”David’s view”]Here is the retina – really hyper-reflective, showing an early retinal degeneration, most probably inherited, like progressive retinal atrophy in the dog. We see this in Abyssinian cats both as a dominant early-onset disease (Curtis et al (1987) An early-onset retinal dystrophy with dominant inheritance in the Abyssinian cat. Clinical and pathological findings.
Invest Ophthalmol Vis Sci. 28:131-9) and a recessive mutation in somewhat older animals (Narfstrom and Nillson (1987) Hereditary rod-cone degeneration in a strain of Abyssinian cats. Prog Clin Biol Res. 247:349-68) but also in Persians (Rah et al (2005) Early-onset, autosomal recessive, progressive retinal atrophy in Persian cats. Invest Ophthalmol Vis Sci. 46:1742-7) and Siamese cats. Also from time to time it occurs sponteneously as in this kitten. Little Jasper will grow up used to its blindness and not, we presume, having many welfare implications of the disease.[/tab][end_tabset] 

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