A Clinical Case from the Archives : 28/06/2007

Posted on June 28, 2007 by davidwilliams

[tab name=”The Case”]I looked at this diabetic terrier today to see if it had any lens changes and came across this appearance. What do you see here?[/tab][tab name=”David’s view”]Here is a picture at a different exposure showing these multiple concentric rings. In nuclear sclerosis you see one ring where the nucleus and cortex meet, but I’ve never seen changes in the lens like these. In fact I think in retrospect (and with help from Peter Renwick -many thanks to him!) that the dog has had a classic diabetic cataract and phaco surgery with a replcament lens, which is what we are seeing here![/tab][end_tabset] 

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A Clinical Case from the Archives : 23/06/2007

Posted on June 23, 2007 by davidwilliams

[tab name=”The Case”]This duck has sustained an injury some time previously and now has an eye like this. What should be done for this bird, unilaterally affecetd?[/tab][tab name=”David’s view”]The obvious answer would be to resect some of the conjunctiva and form a normal palpebral aperture. But my enthusiasm for this surgical approach is tempered by experience in other birds species such as this cockateil where attempts to correct this cryptophthalmos always met with failure and regrowth of the aberrant inflamed lid tissue. This photograph is courtesy of Ned Buyukmihci who wrote these birds up in 1990(Eyelid malformation in four cockatiels. J Am Vet Med Assoc.196:1490-2)[/tab][end_tabset] 

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A Clinical Case from the Archives : 21/06/2007

Posted on June 21, 2007 by davidwilliams

[tab name=”The Case”]This dog was presented to the vet school with a pyrexia of unknown origin but also this ocular appearance. What is the likely condition and how would you investigate further?[/tab][tab name=”David’s view”]Here is the dog 12 minutes after the administration of 0.5% phenylephrine. The dog has Horner’s syndrome with a lesion in the third order neuron as determined by the speed of resolution of signs. The third order nerve runs from the cranial cervical ganglion through the middle ear and on to the eye. Quite where the lesion is has yet to be determined but most of these are idiopathic and resolve with around 2 months.[/tab][end_tabset] 

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A Clinical Case from the Archives : 18/06/2007

Posted on June 18, 2007 by davidwilliams

[tab name=”The Case”]Jennie my wife thinks that most of the photos I bring home are pretty gruesome but this one, as we would say, takes the biscuit! I guess this tortoise has had a traumatic incident but what other dietary factor may be at play with the defective eyelid healing here?[/tab][tab name=”David’s view”]With dysplastic epithelial pathology in chelonia, as this might well be, one alwsys has to bear in mind hypovitaminosis A. This rather dusty old slide is from the great Dr Edward Elkan who, with Dr Zwart, first recognised low dietary vitamin A as the causative factor back when I was a mere child (Elkan and Zwart: The ocular disease of young terrapins caused by vitamin A deficiency. Pathol Vet. 4:201-22, 1967). It may not be the sole factor in today’s case, but dietary supplementation may be worthwhile, always with concern to ensure that hypervitaminosis A is not produced.[/tab][end_tabset] 

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A Clinical Case from the Archives : 13/06/2007

Posted on June 13, 2007 by davidwilliams

[tab name=”The Case”]Richard, one of the vets out there in the real world who often sends me good e-diagnosis pics , asks of this case, whether I think this is a melanoma or not. What do you think? It’s appeared in the last month, according to the owner.[/tab][tab name=”David’s view”]Well its a bit strange isn’t it – raised and apparently rapidly developing. But the image here is what I’m more used to as an iris melanoma in a cat – slightly raised and with a velvety texture. I vote for waiting on the first case for another month and seeing what happens. But we don’t want to let it get this far, when the literature shows us that , having reached the boundary of the iris, it may well have metastasized.[/tab][end_tabset] 

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A Clinical Case from the Archives : 11/06/2007

Posted on June 11, 2007 by davidwilliams

[tab name=”The Case”]This dog has had keratoconjunctivitis sicca, unresponsive to topical cyclosporine which, as you can see, has a nice wet ocular surface after a parotid duct transposition. It does, however, have some white deposits in the tear film and on the corneal surface. What are these and what might be done to reduce them?[/tab][tab name=”David’s view”]Here’s another picture of the same eye. These are calcium deposits from the saliva now replacing tears on the ocular surface. Treating topically with EDTA can stop them depositing on the cornea but this is a recognised problem after the surgery.[/tab][end_tabset] 

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A Clinical Case from the Archives : 16/05/2007

Posted on May 16, 2007 by davidwilliams

[tab name=”The Case”]Sorry for not putting any images up on the site recently – too many cases, not enough time to put them up. Here’s one for you – a stray cat I saw at a rehoming charity today. What has it got and what would you do?[/tab][tab name=”David’s view”]This cat has a chronic severe keratitis – maybe FHV-1 in the first place but now it has a descmetocoele, protruding out of the ocular surface as shown by this slit-beam image. An ulcer has gone far enough that only the elastic Descemet’s membrane is remaining, and this bulges with intraocular pressure all too easily. If the cat were insured it would have had a corneo-conjunctival graft today, but as it is a stray which has had this problem for ages, we’ll leave it for now. Its sufficiently fibrosed that perforation is unlikely. Having said that it’ll probably pop tomorrow![/tab][end_tabset] 

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A Clinical Case from the Archives : 29/03/2007

Posted on March 29, 2007 by davidwilliams

[tab name=”The Case”]This cat presents with sudden onset bilateral pupil dilation and less sudden deterioration in vision. Its polydipsic and polyuric, also with a bit of diarrhoea too. What is the likely diagnosis?[/tab][tab name=”David’s view”]You don’t have to be a top notch ophthalmologist to have an idea that this is a classic detached retina as part of systemic hypertension in renal failure. But you’ld be wrong! The cat has a flat retina but with these black dots in both fundi. Its blood pressure and intraocular pressure are within normal limits. So what is going on then? The retinas don’t look as if they are part of a blinding condition, which leaves us with a diagnosis of central blindness. In fact the cat had a midbrain lymphoma which explains the loss of sight.[/tab][end_tabset] 

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A Clinical Case from the Archives : 17/03/2007

Posted on March 17, 2007 by davidwilliams

[tab name=”The Case”]This twelve year old Cocker spaniel is presented with both eyes in this sorry state. What do you think is going on?[/tab][tab name=”David’s view”]Well, there is entropion with trichiasis often seen in these dogs. But as this rather over-exposed Schirmer tear test strip suggests, there is also no tear production in either eye. We performed a Stades procedure to remove those irritating eyelashes and started topical cyclosporine and carbomer gel tear replacement. Oh – and we haven’t even mentioned the eyelid dermatopathy the dog has have we? Malassezia infection I guess but we’ll leave that for the dermatologists![/tab][end_tabset] 

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A Clinical Case from the Archives : 17/03/2007

Posted on March 17, 2007 by davidwilliams

[tab name=”The Case”]This kitten has had these grey corneas since birth. Why?[/tab][tab name=”David’s view”]Its most probably got a corneal endothelial dystrophy where the endothelium is improperly formed or not metabolically active, not pumping water out of the cornea as it should. When the excess water causes the regular collagen fibril spacing to be disrupted, as in this electron micrograph, the cornea turns from transparent to translucent. The other differential would be glaucoma but the intraocular pressure was 15mmHg in both eyes and the cat could see, if a bit cloudily![/tab][end_tabset] 

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