Please come visit us at our office on Danbury Road in Wilton:

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It is Dripping Wet!

Tired of the rain yet? The grass is soaked, basements are flooded, rivers are swollen. Where is the summer sun? And the humidity hasn’t been much fun either. With the non-stop rain here in Connecticut, everything seems to be dripping. That includes lots of our canine patients as they run in from the parking lot! We also see lots of “weepy” eyes where the complaint is primarily a clear, sometimes colored, discharge. Let’s take a look to see what may be behind the scenes with this presentation.

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When our patients present with clear discharge, my first question is whether we are making too much tear in response to irritation or whether the outflow pathway, or tear ducts, are compromised. One could presume that in the former instance discomfort would be a feature. This will be manifest as squinting, pawing, rubbing and/or redness to the eye or around the eye. In the latter, discomfort may not be a big feature even with lots of moisture pouring out of the eye.

Diseases with discomfort that present with tearing are many as this is a non-specific sign. However, the nature of the discharge would suggest that infection is not playing a big role otherwise we would see yellow-green discharge. Similarly, significant irritation with marked inflammation my have more mucus or a grey-white discharge. For example, the hallmark of conjunctivitis is discharge but usually one with color. Irritation from foreign bodies or offending hairs may create corneal erosions that are irritating but not infected and thus a clear discharge along with discomfort will be the result. Issues where the lid conformation is abnormal create surface irritation due to the adjacent fur rubbing on the eye. Tearing can then occur during this process which can spill onto the face either directly from the irritation or from a wicking effecting where the tear spills over the lid margin onto the side of the face adjacent to where the lid rolls in. Entropion is the technical name for lids that roll in as a result of genetics (primary entropion) or secondary to globe retraction from surface irritation like a corneal ulcer (spastic entropion). Resolution of the primary entropion by surgery to roll out the lids or appropriate medical or surgery treatment to cure the irritant that causes the spastic entropion will stop the tearing. It’s all connected! Typically a good ophthalmologic exam will reveal the problem.

If upon inspection and testing we rule out surface disease then investigating the outflow system is warranted. Tears are produced by glands that exit through the conjunctiva onto the surface of the eye. These tears then need to be “removed” either by evaporative drying or out through the ducts that are located in the inner aspect of the lids and pass under the surface of the conjunctiva and skin, shortly through bone and into the nose. Most of our patients, except the rabbit, have an upper and lower duct that then join together before exiting the nose. The opening to the duct is called the puncta. Obstruction or narrowing anywhere along this pathway may make the path of least resistance to go over the lid margin and onto the face. This is commonly seen at the inner aspect of the eyelids rather than the outer aspect by the ear. The length of this duct varies with species and breed and thus different issues can affect its passage depending on the type of animal.

nasolacrimal illustration

The lower puncta is easily viewed here as the small non-pigmented circle just inside the pigmented lid margin.

The lower puncta is easily viewed here as the small non-pigmented circle just inside the pigmented lid margin.

Two tests are used in the exam room to evaluate the patency, or intact nature, of the duct system. The first is a passive test, called a Jones Test, where fluorescein dye is placed on the eyeball to see if this dye flows into the nostril region. This dye glows with a blue light and can be easily seen. This test is easy to perform and will tell you if the “plumbing” is working. However, a negative tests does not necessarily tell you that the duct is not patent since flow rate can be slow or the duct may be narrowed which affects the time it takes for the dye to get to the nose. Also, it does not tell if the flow is going through both ducts near the globe initially. Another benefit of the test is that the dye may wick onto the face quickly in some dogs with hair issues that draw the tears onto the face before they get into the puncta.

The second test is more active called nasolacrimal flushing. In this test, a small cannula or catheter connected to a syringe of flush is placed in the upper or lower puncta and gently pressed. The fluid should come out the other puncta and, when obstructed with a finger, out the nose. This should occur with minimal resistance. Most dogs and some cats are amenable to this with just a topical anesthetic. We get information as to whether the openings are intact, if flow out the nose is present, if there is any resistance to outflow and potentially release of a loose blockage.

Fluorescein dye wicking onto the face instead of going into the puncta due to hair and lid anatomy.

Fluorescein dye wicking onto the face instead of going into the puncta due to hair and lid anatomy.

A common entity we see in young dogs is an abnormal development of the lower opening or puncta. An imperforate puncta is when a sheet of tissue is present over the opening due to improper formation at birth. The duct is typically present just under the surface. This is much more common to be seen with the lower puncta. Opening this puncta under a short anesthetic event can improve and sometimes resolve the overflow of tear in the affected eye.

Cats rarely get imperforate puncta but commonly get herpes infections. One manifestation of herpes when acquired as a neonate is the development of adhesions of the conjunctiva to the cornea, third eyelid or itself called symblepharon. Tearing can be noted if these adhesions are associated with the puncta or tear ducts even if the infection is cleared or inactive. Basically these adhesions are scars from the infection. Surgical resolution is typically unrewarding since they recur, however, this is usually good news if all we are left with is tearing. A full discussion of herpes is not necessary here.

Obstruction downsteam of the puncta is less common. Dental or sinus disease can theoretically present with tearing due to the proximity of these structures and the tear duct as it passes into the nose. Mucus plugs are occasionally flushed out but are not too common. Other symptoms may be present if there is trouble downstream of the puncta.

A result of the tearing that bothers many owners, but rarely the dog or cat, is the brownish-red staining of the fur in the wet region as seen in the first photo above. A pigment called porphyrin in the tears reacts with the fur and creates a brown tinge that is very obvious on our white dogs such as Poodles, Bichons and Maltese. This discoloration can happen at any time and is not indicative of any disease process. There is no specific product, diet or medication that resolves this issue much to the chagrin of many. The good news is that this is a cosmetic issue rather than a medical one. The degree of staining may decrease if there is a primary issue when can address that will minimize the overflow.

That’s a wash here! Maybe by the time you have read this the sun will be out!

WINTER FASHION AWARDS!

After a long and cold winter (is it over yet?), the verdicts are back for our winter fashion award winners here at the Animal Eye Clinic. Contestants included any dog that came in wearing anything to keep them warm and chic! This spontaneously concocted event was prompted by all the different clothes we saw this year along with our endless supply of cold days. Award winners will get extra scratches at their next visit. Many owners of these fashion forward critters commented on the numerous choices they had at home, be it costume or functional in nature, that they could have had their dog wear if they had known about the judging. Hmmm, maybe a Halloween theme is coming?!!

We love to see all your pets, clothed or not, and appreciate you trusting us with their ocular care. See ya on the runway and enjoy the winners!

IN THE EVENING FORMAL WEAR CATEGORY, EDDIE IS SHOWING OFF HIS THREADS ALONG WITH HIS RESTORED VISION AFTER CATARACT SURGERY…CONGRATS, EDDIE!!!!

Fiorletti,Eddie 1-31-18

IN THE SLEEPWEAR CATEGORY, DAISY SHOWS OFF HER FULL BODY PJs IN SEASONAL RED!

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THE TEAM COMPETITION WAS WON BY THIS SNAPPY PAIR, LUCE AND DEZZIE!

Dimiceli,Luce and Dezzie 1-31-18

THE CLASSIC PLAID DIVISION WAS TAKEN BY BENNY!

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THE OUTDOORSMAN AWARD WAS GIVEN TO BO WITH HIS EARTH TONES PLAID!

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IN AN ANTICIPATION OF A SUMMER THEME, LUCY IS SPORTING A FLAMINGO LOOK!

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LASTLY, FOR ALL AROUND GOOD LOOKS, WHEATIE, AKA THE MAYOR, SHOWS OFF HIS YEAR-ROUND PANACHE!

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DON’T BE SAD, BEAN, YOU WON THE PARKA DIVISION!

Alves,Bean 2-7-18

The Pressure is Rising

Glaucoma is a painful, blinding disease that by definition is an increase in the pressure inside the eye. It is a bummer of a disease, probably the worst one we see. Why? Because no matter what approach is taken to attack this disease, our goal is usually to delay, not prevent, vision loss. This doesn’t paint a real rosy picture. But as long as this is understood, then together we can make educated decisions on how we want to manage the problem. Let’s talk a little about this entity and see if I can make it a little easier to

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New technology, old fashioned service

Email! Tweets! Snapchat! Instagram! Facebook! Yikes!!!

We have so many ways to communicate with each other and yet the art of communication seems to be getting lost in the chaos.

Multitasking, usually in the form of a downward stare at a cell phone, occurs constantly in our society even if the action is right in front of our face. We try to stay one step ahead of our day, knocking out an errand while doing another, getting a jump on the next event all while staying in time with the constant deluge of emails and texts that raid our devices. Not

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A Change in the Season

I must confess, I have been remiss at updating my post here at the Animal Eye Clinic. Part of this was intentional, as the last post describes the new cataract surgery machine we purchased last year that is working like a charm. Changes in technology are fascinating and very rewarding when we, as veterinarians, find one that applies to our patients and is cost effective in this ever-changing world of health care. Part of my delay was unintentional, as changes of the kids’ school, health of relatives, staffing and life in general often reworks our life and schedule when we

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Technology Upgrade for Cataract Surgery at the AEC

Cataract surgery in the dog is a highly successful procedure that many owners have chosen for their four-legged friends to regain or improve vision. Cataracts in general and a brief discussion of the preoperative workup and surgery is presented in a prior post that you can peruse if interested titled Cataracts in the Dog. (You can find this older post if you scroll to the bottom of this page and click on Older Entries.) Removal of an opaque, cataractous lens is an elective procedure that is chosen if we feel we can improve our dog’s quality of life by returning

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Summertime Blues!

Summer is here in New England and hopefully all are out and about doing what they like to do when the weather is warm. If anyone complains of heat and humidity I am going to send them right back to February so they remember what cold feels like! I am a sun and fun lover so you won’t hear me complain…no summertime blues for me!

Blue shows up in veterinary medicine in a handful of different ways. We have blue-eyed dogs and Russian Blue cats, blue merle coloring and Blue Amazon parrots. When the eye is blue, that usually refers to

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ACVO Diplomates Giving Back

I am always in awe of how animals enhance and improve our daily life. Whether it is the friendly greeting every day when I come downstairs in the morning or the benefit of the evening walk that I do even if I am not in the mood, to see that unrestrained, unconditional love regardless of the day or mood is priceless. The warm body on a lap during a cold day, the cat rubbing up on your legs awaiting some attention, the look of earnest when you are feeling down, pets of all types fill a very important niche in

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Those darned corneal erosions that won’t heal!

I frequently get asked “what is the most common problem you see?”. The long answer is “depends!” as different species get different diseases, different breeds get different problems, and some problems are seasonal and others are year round. So the allergic conjunctivitis may be absent in winter but cataracts occur at any time and at any age. But one of the problems that shows up on our doorstep on a regular basis is the non-healing corneal erosion in the dog. Your poor friend may be squinting and pawing for weeks in spite of repeated attempts to heal with various

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Losing an eye; it is not a bad as you think…

I was stunned to see the last posted picture on the front page here had snow all over the building and I was talking about our wonderful warm environment that is present year round. Now the warmth of summer is waning and we are all holding on to those last few days with green trees and sunny skies. A beautiful summer was our just reward after such a harsh winter! And September was equally nice!

Our pets have survived as well, and do through many adverse conditions and illnesses that would knock us for a loop. We can learn a lot

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