This may be one of the more common cocktail party questions that veterinary ophthalmologists get asked! Not that eyes in any species are not cool, but a little exotic flavor can spice up the conversation. Fortunately for us veterinary ophthalmologists, the anatomy of the eye is very similar from species to species. There are significant changes when going from mammal to bird to fish since the anatomy is altered to maximize performance depending on the environment in which an animal lives, however, the main structures are present in most eyes. Disease states will also be different based on these living conditions and expectations of performance since these conditions are varied. Thus, understanding the species variations is important to help one in coming up with a list of differential diagnoses for a given lesion in a given species. Alas, this part is interesting to the ophthalomogist but the attentive crowd at the cocktail party may start to thin! And so, we stick with the coolest creature answer and go from there!
Fortunately, the instrumentation used to examine the dog, cat and horse will also work for the mouse, elephant and eagle. As shown in a prior posting, the slit lamp biomicroscope and the binocular indirect ophthalmoscope are mobile instruments that, if one can get close enough, will allow a good view of the eye in dry conditions. Yes, sedation is occasionally needed for uncooperative animals, but most creatures can be evaluated without much in the way of heavy restraint. Dare I say, even with angry dogs and cats, trauma to the doctor or technician is usually limited to the occasional scratch with proper positioning and respect.
At this juncture, my caseload is mostly limited to the animals that can walk, fly, swim or get carried into the clinic. Large animals, including the exotics, require a field visit which are done on a selective basis. Some of my colleagues specialize in horses or farm animals and some of us may have a relationship with a local zoo, for example, to assist in those needs. We have helped with the Norwalk Aquarium on occasion as well as with numerous wildlife rescue agencies in the area. I will admit, it spices up the day for us, too, to get a break from the dogs and cats that make up 95% of what I see. Therefore, most of our exotics come from these realms as well as second opinions from local boarded exotic specialists.
Enough chatter! Here are some pictures of some patients that have graced our practice. Some we can help and others have sustained too much damage to repair. But most are attached to someone who cares and is willing to treat them with the hope of making their life better!
Grumpy the monitor
Nile Monitor in the exam room
Grumpy above is a Nile Monitor that presented for evaluation of a hazy eye. All animals with a crystalline lens can get cataracts and Grumpy was no exception. Fortunately for him, it only affected one eye so a performance decline was not evident. As long as he can see his food and amble about his environment, cataract surgery, although a possibility in reptiles, is not needed. He was quite friendly, however, it is always nice to have a handler around to help with restraint!
What is a sugar glider you ask? These cute little creatures are omnivorous gliding possums typically found in Australia. They are marsupials and get their name from there enjoyment of nectar and glide like a flying squirrel. As with many nocturnal animals, sugar gliders have large eyes to help them see in the dark. The one I saw was a pet that developed inflammation and glaucoma which is increased pressure inside the eye. This guy was very sweet, easy to examine due to his large eyes and liked to hide in a pouch the owner strapped around her neck.
Sugar glider with glaucoma
Speaking of marsupials, kangaroos and their cousins are very interesting critters that ophthalmologists will see for cataracts at a very young age. Hand raised orphans fed cow’s milk become affected because of a metabolic inability to convert the galactose in the cow’s milk to lactose. This allows a product called dulcinol to accumulate in the lens which pulls fluid into it, makes the fibers swell and a complete cataract forms. The cataracts can be prevented by the use of a milk substitute used in human infants with inherited galactosemia instead of a standard cow’s milk. Cataract surgery can be performed in these species with limited success because the vitreous, the gelatinous substance between the lens and the retina, becomes opaque as well with an unknown substance. So if surgery is performed, you not only have to remove the opaque lens but the opaque vitreous as well which is rather sticky and handles like old cotton candy. Unfortunately, even if successful with those manipulations, they also have a high tendence to develop glaucoma after surgery presumably from drain obstruction. Prevention is the key here.
Kangaroo in the exam room
Kangaroo with cataracts
The Norwalk Aquarium will call me every once in a while to look at animals there that have ocular changes. Most display fish are exactly that, one of many in a tank used for education. However, survival of the fittest may still hold truth both for large tanks or small. When one cod got bilateral cataracts, the question was whether this would affect the fish to be able to adequately eat and protect itself in the tank. Lens extraction was performed in this cod (the lens was shifted or luxated out of position as well) to assess whether this surgery would positivley effect the fish itself. In addition, we were also assessing the anesthetic regimen and, if successful, would it be a consideration for other more “prized” fish in the future.
Gil the Cod cataract and lens luxation
The seals at the Norwalk Aquarium have had occasional issues associated with trauma or common risks in captive pinnipeds. Cataracts and luxated lenses are occasionally noted in captive seals and we assisted with the followup care after lens surgery was performed in the past by one of my colleagues and her team who specialize in pinniped disease (who knew, right?!). We have also assisted with management in corneal injury or degeneration in the older members. Be careful looking at these critters who can be fast and unwilling to hold still! This poor girl had a degenerate cornea we watched mother nature mend with some supportive care by their great staff to avoid surgery.
Corneal degeneration in a seal
Birds of prey are fascinating creatures with excellent vision and beautiful ocular structures to aid them in hunting prey. Many of the wildlife rescue organizations will see, treat and release these birds if they are not critically injured. Unfortunately, trauma to the head of these birds is not uncommon, usually associated with motor vehicles, and the eye is often involved. Our role is to assess these birds to see if there is vision and if there is any reversible issue that can be improved with medication or surgery. This all factors in to the ultimate decision as to whether the animal can be released back into the wild or used as a display bird. I have seen hawks and owls primarily. We even did cataract surgery in a great horned owl after we designed an intraocular lens to use to get the visual acuity back! The hawk and owl below were not so lucky with significant damage to the left eye (hawk and owl) and central nervous system (owl) that rendered them blind.
Hawk with trauma to left eye
Barred owl with traumatic eye injury
Alas, I am starting to ramble and this digital cocktail party is moving along. I could still tell you about the giraffe, fox, gekko, rooster….hey, wait, here comes the passed hors d’oeurves. Ask me about it at the next party! Waiter!!!!
Welcome back from the holidays! Hope everyone had a wonderful season full of family joy and giving. Our family here at the Animal Eye Clinic had no complaints as apparently all were on the “nice” list and the New Year rang in sweetly. And now that we have weathered the latest series of storms, I guess it means back to work for all full time!
We had last started a discussion about lid disease. We see lots of patients here with a variety of lid maladies that affect its position, function and appearance. Some are genetic in origin, many are acquired problems, and most are succesfully treated. My last post talked about congenital lid changes. Let’s dip into some of the common acquired issues we see in the dog and cat.
Entropion is rolling in of the lids and this presentation comes in two flavors, primary or spastic. With primary entropion, the lid isn’t built quite right with the lid rolling into the eye causing local irritation from hairs rubbing on the corneal or conjunctival surface. This is typically a surgical disease. Many breeds of dog are predisposed to this such as the hunting or large breed dogs. In cats, I see this most often in older cats for the big males with deepset eyes and large jowls. Sometimes this may be a “normally abnormal” finding such as in the Saint Bernard or Newfoundland where the lids are loose and rolling in a little but the dog shows minimal evidence of irritation. In these dogs, a minor mucoid discharge or surface redness from exposure is not uncommon and surgery is often not warranted. In other dogs, squinting and rubbing is obvious and the development of corneal ulceration is not uncommon. These will warrant surgical intervention.
Entropion of the lower lid.
Spastic entropion is a dynamic rolling in of the lid secondary to ulceration, lid swelling or some overt pain. Dog’s and cats can retract their eyeball into the socket as a pain or protective response. When this occurs, the lids may have the tendency to roll in and aggravate the pain. The globe retracts farther, the lid rolls in more, they start to rub, the lid swells, rolls in more….you get the idea! If the pain response is removed or blunted, with topical anesthetic for instance, the lid may return to a normal position as the spastic component relaxes. In this patient, we need to palliate the entropion while the irritation is resolved and hopefully the lid will remain in a normal place at the conclusion. I see this a lot with Bulldogs that have skin allergies where their face swells, for example.
Some cases are a variation on this catergorization as a primary component is worsened by a spastic component. A good example would be the Shar Pei puppy with entropion that is not developed enough to determine if the lids will remain rolled in as they grow. This case may be treated like a spastic entropion initially and then need surgery later once the dog matures. Or the allergic dog with entropion that has made the eye look worse than it is due to inflammation or self trauma. One needs to resolve this features before surgery as overcorrection can ensue.
Repair of primary entropion entails removing skin to evert, shorter or loosen the lid margin. There are many techniques to accomplish this goal. Which technique is employed depends on the features that contribute to the abnormality. The “basic” repair involves removing skin in an ellptical shape away from the lid marging with a width that approximates the amount of roll. The wound is then closed to pull the lid margin away from the cornea. Over correction or under correction are the biggest risks.
Lower lid entropion in a large dog. Note discharge and hair on cornea.
Using my thumb to roll out lid and expose lid margin.
Temporary tacking is the term used to palliate a spastic entropion. Suture or staples can be used to gather the skin and evert the lid without actually removing the skin. Once the irritation is resolved, these are removed to assess the true lid position without the active spastic component. Some may need primary repair after this procedure where others with complete spastic entropion will be fine unless another episode of pain occurs. This procedure is also used in young puppies, like the Shar Pei, to allow them time to “grow into” their lids before determining if primary repair is needed.
Stapling lower lid for a spastic entropion.
Lid tumor development is very common in our patients. Fortunately, 95% of lid tumors are benign. They typically arise from the meibomian glands or the lid skin itself. Ease of removal is proportional to size. If a tumor is less than 1/3 of the total lid length, simple excision can be performed. If it is greater than this, cryosurgery or removal with lid reconstruction may be needed. Many tumors remain small and don’t enlarge significantly over time. Thus, if a mass is noted and it is irritating or obviously enlarging then it will be much easier to remove if it is small. If it is stable then waiting and watching or removing if another anesthetic event is needed would be prudent advice. Many general practitiioners are comfortable removing smaller masses. Larger ones should be addressed by a specialist who may have different options and approaches to maintain good lid function.
Small upper lid tumor.
Large lid tumor that warrants surgery.
Inflammation or infection of the lid is called blepharitis. The lid is just fancy skin with a function to protect the eye and thus reacts like skin anywhere to allergy, trauma, immune-disease, etc., by becoming red and swollen. Organisms, primarily bacteria, can be the source or result of these issues. Similar to skin, oral medications are often used for a number of weeks to try and reverse the problem. Unlike skin, topical medications are typically not used due to ocular irritation to the products in the lotions or salves. Topical eye drops don’t necessarily penetrate well into the lid and may be ineffective. This photo shows a lid with bacterial blepharitis that responded well to oral antibiotics and antiinflammatories. The dreaded Elizabethan collar is oftern needed in these cases as self trauma is usually evident as noted by the concurrent hair loss.
Blepharitis with moderate swelling and hairloss.
These are just a few of the many problems that can be seen in the lids of our patients. If you notice these changes, give us or your veterinarian a call as most times early intervention is best!
From all of us at the Animal Eye Clinic to all of you, may you have a very Merry Christmas, a Happy Hanukkah and a Happy New Year! May your travels be safe and family be healthy and happy. We all hope and pray that the new year will fill us with peace and prosperity after such a trying 2012 especially here in the Northeast. Many thanks to all who visit us here in Wilton as we try our best in our little niche to help you and your furry friends at home stay comfortable and sighted!
Lisamarie, Katie, Christina,
Continue reading Merry Christmas!
The eyelid is involved in many diseases that we see and treat on a regular basis. Its function to protect the eye is an important one, whether it be to act as a barrier to prevent direct trauma, to limit bright light irritation or to distribute the tear over the corneal surface. Some species have an extra lid where others have no lids at all! I’ll take a couple of posts to address the lids and we will concentrate on congenital issues here. So take off your lid and stay awhile as we talk about the eyelid and some of
Continue reading Put a lid on it!
A common comment veterinarians hear is about how our job is so difficult with a patient that cannot tell us what is wrong. Well, sometimes less is more! Our patients talk to us in different ways with clinical signs and symptoms that help us determine what and where the problem is without the confusion of speculation and interpretation and emotional embellishment of those features that we all do as humans. We use our senses and powers of observation along with listening to the heart and lungs and palpation of the body to get most of the answers in general practice.
Continue reading How do you see what you’re doing?
I can’t believe the way time has sped along here in the Northeastern United States. We have gone from storm to storm this year, enduring “hurricanes” in the summer to heavy snow at Halloween which combined for almost 2 weeks of life without power at both my home and the clinic. No good sales on generators this holiday season you can bet! Thanks to battery powered equipment, we were able to cobble together a service for those of you with non-surgical problems that inspection, conversation and medication could provide an answer. Thanks to all who survived these times and even
Continue reading Looking ahead to the New Year
Sassie and Dr. Stuhr
It has been a decade since I became the sole owner of the Animal Eye Clinic in Wilton and it stuns me to think of all that has happened over that time. When Dr. David Covitz gave me the keys and I promptly found the basement in the old clinic had flooded the next morning, it hit me right between the eyes that this was now my baby to care for and shape into the practice I wanted it to be. Ten years later, I can gladly say that the journey so far has been a
Continue reading My Ten Year Anniversary
An ongoing concern for both doctor and patient is the use, accessibility, cost and delivery of medications for ourselves and our patients. You can’t go a day without reading in the newspaper about a recall of a drug, an unexpected side effect or misuse of a medication that created significant complication. Whether a drug is for human or veterinary use or both, there will always be questions as to how to treat, when to treat, where to get, what to expect and how cheap can I get it to make life easier for all involved.
Left me wax poetic a bit
Continue reading The Confusing World of Drugs
Well, finally the snow has cleared and the Northeastern United States is no longer looking like the Arctic. The only snow that remains around here are the frozen remnants of the largest piles of plowed snow with bits and pieces of driveway gravel left in its wake. After a long period of hibernation, out peeks a crocus and the hints of daffodils which harken to warmer days that we strain to remember. And in a flash, people wil be complaining about the humidity and be hunting for shade! The joy of living in a seasonal climate!
As the Spring season begins,
Continue reading Spring has sprung…and with it…
Ok, enough already! I get it, we live here for a reason, get to enjoy all the seasons and the diversity they bring to our lives. I like to ski, go sledding with my kids, build the occasional snowman. I have lived in more temporate and more severe climates so I have a nice barometer on weather variation and I do love the activities that each season allows. But I think we all agree….enough of the white stuff already! We have got nowhere to put it!
In all seriousness, we are trying our best, like most businesses, to keep ourselves
Continue reading Too Much White Stuff!!!