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

Posted on February 23, 2008 by davidwilliams

[tab name=”The Case”]This horse is presented because of an unusual ocular appearance, though the animal doesn’t seem particularly bothered by it. What is happening and what might your treatment be?[/tab][tab name=”David’s view”]There is a dense grey-white opacity which is deep in the cornea – note the stromal oedema overlying it – a presumptive diagnosis of immune mediated endothelitis, with a somewhat lower iop (13mmHg compared with 18mmHg in the other eye). We used topical Pred Forte through a lavage system which worked to a degree, so moved to cyclosporine in corn oil again through the lavage, which has amleiorated the condition completely.[/tab][end_tabset] 

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A Clinical Case from the Archives : 21/01/2008

Posted on January 21, 2008 by davidwilliams

[tab name=”The Case”]My colleague Mark Ames e-mailed to ask if I was OK as I hadn’t put any pics on for quite a time! The answer is I’ve been editing a new ophthalmic issue of the Veterinary Clinics of North America which should come out in the spring – all immune-mediated eye disease with some excellent cutting edge papers and some brilliant reviews – but that has taken up all my time! Mark’s beautiful picture of this equine eye was an abolsute must to upload though, I hope you’ll agree – what is going on do you think?[/tab][tab name=”David’s view”]Well thanks for a fantastic image Mark – the black sphere is a wonderful iris cyst and there are persistent pupillary membranes too, though they are small and insignificant in my view – not so the keratic precipitates ventrally looking like big blobs of fat (hence their name mutton fat KPs – they signal intraocular inflammation) There is some corneal oedema around them which has apparently worsened recently. This might be a recrudescence of past uveitis, except that the KPs look old and not at all active and the rest of the iris looks crisp and clear. Compare with this recurrent uveitis case where the iris is dull and dark brown. Maybe there’s been some recent trauma to cause the increase in corneal haze – who can tell![/tab][end_tabset] 

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A Clinical Case from the Archives : 15/10/2007

Posted on October 15, 2007 by davidwilliams

[tab name=”The Case”]This nine year old cat presented with lethargy, innappetance and was weak and tachycardic on examination. Ophthalmic examination showed these lesions in his retina. What other tests would you perform and what diagnosis might be made?[/tab][tab name=”David’s view”]We ran a haematology and biochemistry panel and found a potassium of 2.mmol/l (reference range 3.7-4.5) and abdominal radiography which showed a mass close to the left kidney. The retinal lesions suggested hypertension and indeed the cat has a mean blood pressure of well above 180mmHg. This is secondary to hyperaldosteronism associated with an adrenal mass. Surgery is planned soon.[/tab][end_tabset] 

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A Clinical Case from the Archives : 12/08/2007

Posted on August 12, 2007 by davidwilliams

[tab name=”The Case”]This old donkey is presented with ocular lesions. What do you see here and what might be causing it?[/tab][tab name=”David’s view”]There is central corneal oedema without ulceration but with epiphora. Its difficult to be sure what’s going on but in a dog one might think of an endothelial degeneration. The surprising thing is that an unrelated donkey in the same stables has the same condition as shown here. I’d be glad of any good ideas on what is going on![/tab][end_tabset] 

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A Clinical Case from the Archives : 12/08/2007

Posted on August 12, 2007 by davidwilliams

[tab name=”The Case”]What is happening in this aged grey pony’s eye? The clue is in the ‘aged’ and the ‘grey’![/tab][tab name=”David’s view”]There is some dorsal corneal neovascularisation but also a darker arae underlying that in the iris. Its difficult to see on that picture and my photo-slit-lamp wasn’t playing ball, so here is an ultrasonogram showing the coropra nicra at the pupil margin nicely but also a mass more peripherally in the iris – an intraocular melanoma I’m sure. Not causing a problem so we’ll just leave it be I think![/tab][end_tabset] 

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A Clinical Case from the Archives : 03/08/2007

Posted on August 3, 2007 by davidwilliams

[tab name=”The Case”]What are these strange lesions in a 12 year old West Highland White Terrier?[/tab][tab name=”David’s view”]These are oedematous ‘rafts’ of non-adherent cornea as an unusual manifestation of corneal epithelial basement membrane dystrophy normally giving recurrent corneal erosion or ‘boxer ulcer’ where the epithelium loses its adherance to underlying basement membrane as seen here histologically.[/tab][end_tabset] 

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A Clinical Case from the Archives : 24/07/2007

Posted on July 24, 2007 by davidwilliams

[tab name=”The Case”]This Springer spaniel is presented with this rather gruesome eye – what do you see, where else would you look and what would your treatment be?[/tab][tab name=”David’s view”]There is exophthalmos with gross third eyelid protrusion suggestive of a retrobulbar space-occupying lesion. The mouth was painful to open suggesting infcetion and inflammation rather than tumour and here, behind the last molar, was a draining tract. This needs to be further opened with antibiotics and anti-inflammatories until the abscess resolves.[/tab][end_tabset] 

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A Clinical Case from the Archives : 21/07/2007

Posted on July 21, 2007 by davidwilliams

[tab name=”The Case”]This cat has been AWOL for three days and comes back with a slightly irritated eye. What do you see and what would you do about it?[/tab][tab name=”David’s view”]Here’s an intraoperative image showing that this is a penetrating foreign body resting between the posterior cornea and the anterior iris. It needed removing not through the entrance wound but by easing it out through a paralimbal incision, as shown in the next question – how would you premedicate the eye before attempting surgery?[/tab][end_tabset] 

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A Clinical Case from the Archives : 21/07/2007

Posted on July 21, 2007 by davidwilliams

[tab name=”The Case”]Here is the offending article and while I couldn’t get a picture of its removal, the diagram I’ve included in the answer shows the way to remove these![/tab][tab name=”David’s view”]These two pictures show the ways to remove a superficial and a penetrating foreign body from the eye, but each need magnification and also pre-medication of the eye with topical nonsteroiidal to prevent production of fibrinoid secondary aqueous with breakdown of the blood aqueous barrier as the foreign body is removed with concurrent aqueous leakage.[/tab][end_tabset] 

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A Clinical Case from the Archives : 21/07/2007

Posted on July 21, 2007 by davidwilliams

[tab name=”The Case”]This border collie is presented with a lesion in one eye – what is it likely to be, what more might you expect to see and what might your treatment be?[/tab][tab name=”David’s view”]This could quite easily be a healed corneal ulcer couldn’t it? But in fact its a focal vascular keratitis – just like chronic superficial keratitis in the German Shepherd dog which is sometimes also seen in border collies. The key factor showing its not an old corneal ulcer is that there is bilateral disease. Its always worth looking closely at the other eye – and hey presto here is a tiny lesion hiding away until you look closely for it! Topical steroid tid or cyclosporine bid work equally well to resolve the pathology (Williams et al: Comparison of topical cyclosporin and dexamethasone for the treatment of chronic superficial keratitis in dogs.
Vet Rec 137:635-9 – not available online as I haven’t a pdf file of it I’m afraid but e-mail me if you want a print copy!) but some prefer to start with a more frequent dose regime and treatment will need to be lifelong.[/tab][end_tabset] 

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