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

Posted on September 26, 2008 by davidwilliams

[tab name=”The Case”]What has happened to this poor little pug and how would you correct it?[/tab][tab name=”David’s view”]Some might say that the dog is exophthalmic which is certanly the case but I think that the underlying problem is more lagophthalmos – his eyelids just can’t close! This results in a severe exposure keratitis with pigmentation, oedema and quite possibly corneal ulceration. The answer is a canthoplasty as we have done here. We removed a small length of eyelid margin at the medial and lateral canthus and suture the lids together to reduce the length of the eyelid apereture. This reduces the exposure with all its related problems, including the pain and discomfort the dog must be in![/tab][end_tabset] 

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A Clinical Case from the Archives : 24/09/2008

Posted on September 24, 2008 by davidwilliams

[tab name=”The Case”]What do you see as the abnormality in this horse’s eye? Every summer it has gone somewhat opaque but this year it is much more irritated than before. What would you do?[/tab][tab name=”David’s view”]There is a central ulcer associated with a congenitally defective upper eyelid margin. This will need repair in the long term but in the short term a contact lens, as here, will reduce the ocular surface pain and allow ulcer healing.[/tab][end_tabset] 

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A Clinical Case from the Archives : 24/09/2008

Posted on September 24, 2008 by davidwilliams

[tab name=”The Case”]This quarterhorse has been referred after its retinal health was, quite rightly, questioned in a pre-purchase examination. What do you see and is it part of normal variation or something abnormal?[/tab][tab name=”David’s view”]The little white dots around the optic nerve and in the non-tapetal fundus here are, in my book, abnormal as are these little ‘doughnuts’ of hypopigmentation seen in the other eye. They may be the result of a herpesvirus infection ages ago (we saw the same thing in horses experimentally infected with EHV-1 in a study with Josh (now Professor!) Slater years ago) but the key thing for the vetting is that the retinas are quiet and the changes should have no effect on vision now or in the future.[/tab][end_tabset] 

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A Clinical Case from the Archives : 10/07/2008

Posted on July 10, 2008 by davidwilliams

[tab name=”The Case”]What is causing the lesions in this poor horse – they happened over a day or two first in the left eye and then in the right. There appears nothing else wrong with the horse, at least at present.[/tab][tab name=”David’s view”]Here is the chemosis close-up. My initial thoughts are possibly African Horse Sickness or lymphoma – see the next question for a confirmed case of the latter with a similar presentation.[/tab][end_tabset] 

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A Clinical Case from the Archives : 10/07/2008

Posted on July 10, 2008 by davidwilliams

[tab name=”The Case”]Here is a similar case where the diagnosis was confirmed at post-mortem. Whar could be causing the conjunctival swelling and exophthalmos in this ten year old thoroughbred?[/tab][tab name=”David’s view”]Infection or tumour could be causing this, but the most likely diagnosis is that of lymphoma – neoplastic lymphocytes fill the orbit giving rise to a rapid presentation just like this. The reference here is Rebhun and Del Piero (1998) Ocular lesions in horses with lymphosarcoma: 21 cases (1977-1997) J Am Vet Med Assoc 212:852-4.[/tab][end_tabset] 

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A Clinical Case from the Archives : 17/04/2008

Posted on April 17, 2008 by davidwilliams

[tab name=”The Case”]This 8 year old Staffordshire Bull Terrier has a slowly growing mass making itself visible in the pupil. What is it and how would you treat it? What tests might you use to assess the status of the eye?[/tab][tab name=”David’s view”]Is is a ciliary body adenoma. The intraocular pressure is 28mmHg so glaucoma is not a big worry at present. In the past we would have left this as the eye is painfree and visual, enuicleating when uncontrollable glaucoma supervened. These days intraocular surgery could be used to remove it. My worry is that we might convert a sighted painless globe into a blood-filled blind painful one. What do you think?[/tab][end_tabset] 

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A Clinical Case from the Archives : 14/04/2008

Posted on April 14, 2008 by davidwilliams

[tab name=”The Case”]What is happening in this eight year old cat’s eye? How would you treat it?[/tab][tab name=”David’s view”]This cat has a corneal sequestrum – not a difficult diagnosis if you’ve seen one before. But also it has entropion in both eyes, as is seen here where there is a milder sequestrum and a corneal ulcer in the other eye. Quite which came first is a bit tricky to judge – did the hair abrading the cornea lead to the ulcer and the sequestrum, or did ocular surface irritation result in blepharospasm and lid in-turning? Which ever is was, both need surgical correction.[/tab][end_tabset] 

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A Clinical Case from the Archives : 12/03/2008

Posted on March 12, 2008 by davidwilliams

[tab name=”The Case”]What is happening in this 9 year old cat’s eyes?[/tab][tab name=”David’s view”]This could be a complete clouding of the cornea couldn’t it, but actually the opacity is within the eye – its what we term lipid laden aqueous. Quite why its happening is less than clear. Uveitis might break down the blood aqueous barrier letting lipid in from the blood but the cat has mid sized reactive pupils and normotensive eyes (14 and 15mmHg). It isn’t fed a fatty diet and is somewhat pyrexic but otherwise not systemically ill so we have sent off bloods for a fasting blood lipid analysis. Olin et al back in 1976 published two dogs with this – ‘Lipid-laden aqueous humor associated with anterior uveitis and concurrent hyperlipemia in two dogs. JAVMA 168:861) but that’s the only reference in the peer reviewed literature I can find.[/tab][end_tabset] 

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A Clinical Case from the Archives : 01/03/2008

Posted on March 1, 2008 by davidwilliams

[tab name=”The Case”]This twenty year old Hanoverian cross horse was presented with a history of gradually worsening night vision but otherwise no ophthalmioc abnormalities. Pupillary light reflex was somewhat slow and the retina appeared as shown here. What might be occuring here?[/tab][tab name=”David’s view”]There is an unusual ‘lunar landscape’ appearance to the retina in the left eye, which may be a normal variant in an older horse, but in the right eye, shown here, there is mild tapetal hyper-reflectivity with focal areas of markedly increased reflectivity suggestive of retinal degeneration. In one study by Chadler et al (Ophthalmic lesions in 83 geriatric horses and ponies.
Vet Rec. 2003 153:319-22.) 35 of 83 older horses had senile retinal degeneration but this was generally manifest as pigmentary changes and not hyper-reflectivity with photoreceptor degeneration. The retinal appearance here ties in with the clinical signs but quite what the prognosis is for future retention or loss of vision is unclear.[/tab][end_tabset] 

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A Clinical Case from the Archives : 23/02/2008

Posted on February 23, 2008 by davidwilliams

[tab name=”The Case”]What is wrong with this poor little ferret (its intense smell and tendency to bite excluded!!) What diagnostic tests and treatment might you use?[/tab][tab name=”David’s view”]There is bilateral nicitating membrane protrusion which might make you think it had nictitans gland prolapse, but actually this is associated with exophthalmos. At the time of first presentation these were the only signs of disease in the ferret but within a week multiple lymphadenopathy, splenomagaly and hepatomegaly supervened, confirming our initial concern that this was associated with lymphosarcoma.[/tab][end_tabset] 

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