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David Williams

@bow_teye

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What ophthalmic condition might you expect to see in a German shepherd dog? The most common things I see are lymphocytic plasmacytic conjunctivitis and associated keratitis. Thankfully this dog just has the conjunctivitis. Topical steroid will resolve this but will need to be given for ever - will this give cushingoid symptoms I wonder? A drop of Pred Forte or Maxitrol will overflow down the nasolacrimal duct and be absorbed systemically so I’ve given Maxitrol ointment that is much more likely to stay in the eye. OK so that’s also got antibiotics in it which isn’t ideal from an antibiotic stewardship perspective but you can’t have everything can you?! #germanshepherddog #conjunctivitis #eye #steroid #veterinaryophthalmology by @bow_teye

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2 days ago

Again I just happened to walk past this guinea pig in a practice a few days ago and noticed a white ring in the cavy’s eye - what is this? It’s a classic case of heterotopic bone formation. What?! Vitamin C is concentrated in the aqueous humour as it’s produced at the ciliary body and this ascorbic acid promotes bone formation in the cornea. Some suggest that this leads to glaucoma but in a paper we wrote years ago on eye disease on a thousand otherwise normal piggies we found the iop was actually lower than normal in affected eyes. The right eye in this animal has some haemorrhage but as the case wasn’t in the vets for its eyes I don’t know any more about it I’m afraid. #guineapig #veterinary #heterotopicboneformation #ophthalmology by @bow_teye

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3 days ago

Yesterday I showed you a young beagle with congenital anophthalmos I’d been asked to see in a practice ‘while you’re here’ - here’s another incidental case, this time an elderly lurcher. He’s a great case of nuclear sclerosis - from straight ahead in the second image you can see the hazy centre of the lens with a ring of clear cortex around the outside, while in the third picture from an angle you can see the edge of the lens nucleus but also that the reflection from the tapetum is visible throughout the lens - it’s not cataract. Look into the fundus and there are two areas of tapetal hyper-reflectivity, most probably focal retinal degeneration associated with ocular larva migrans from Toxocara nematodes. And right at the front of the eye there are some benign meibomian gland adenoma - but not causing any problem so not needing any surgery given the dog’s age. #dog #nuclearsclerosis #ocularlarvamigrans #meibomianadenoma #veterinaryophthalmology by @bow_teye

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4 days ago

This beagle was a ‘while you’re here’ at a lovely practice I was visiting with cases Ive already shown you. What are you seeing - or maybe I should say not seeing! The dog is unilaterally anophthalmic with no right eye. Or perhaps we should say probably with extreme microphthalmos - there is most likely a tiny eye somewhere in the orbit but nothing that can see or that we can see. With children in the same situation the big problem is facial asymmetry as you can see here - the eye plays a big part in cranial development. No such worries here though as the dog will never worry how he looks! #dog #eye #anophthalmos #veterinaryophthalmology by @bow_teye

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5 days ago

Every rabbit needs a companion and Coco here is Fudge from Saturday’s friend. Or who knows, it may be a well aimed kick that caused Fudge’s cataract?! But Coco has a non-healing ulcer. The haze of dye uptake around the edge of the ulcer shows the rim of non-adherent devitalised epithelium that is stopping the epithelial erosion from healing. Just as in a SCEED (spontaneous corneal epithelial erosion defect - I think I’ve got that acronym right!) in a dog this needs a diamond burr debridement. Sadly the photo I took after performing that was all out of focus so you’ll just have to imagine what a bigger area of ulcer post-debridement looked like! Lubricant and antibiotic drops for a week should aid healing. #rabbit #cornealulcer #veterinaryophthalmology by @bow_teye

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6 days ago

I met Zoe one of our wonderful gardeners at St John’s while wearing this bow tie last week and she remarked how much she liked it - I hope you do too and like the beautiful flowers in one of the beds that are Zoe’s pride and joy! by @bow_teye

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7 days ago

A few days ago I showed you a cat with aqueous misdirection glaucoma where aqueous pooling in the vitreous pushed the lens forward. Here’s a rabbit with what looks like the same thing but actually this is a mature cataract where the lens has become intumescent, massively swollen, so again pushing the iris forward with a really shallow anterior chamber. I expected a high pressure but actually the iop was only 12mmHg, if anything a bit low for a rabbit. The bunny is really old and not bothered by being blind in this eye. There was an ulcer in the eye - hence those blood vessels - but this has now healed so I’m just suggesting some lubricant to protect any exposed ocular surface. Now I know that you might say rabbits as prey species hide any discomfort but this animal’s owner has had her pet since he was young so as I always say, I may be the eye ‘expert’ but the owner is the expert on their charge, so if she said all is well I’m likely to agree! #rabbit #cataract #eye #veterinaryophthalmology by @bow_teye

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8 days ago

I’m not expecting you to be able get a diagnosis from this first image but what about the close up images - what test might give us a clue? The pigment across the cornea might suggest dry eye and interestingly a schirmer tear test shows slightly low readings in both eyes but not dramatically low tear production. Intraocular pressure was within normal limits in both eyes. The hairs rubbing on the eyes might be causing some pathology but not this much surely?! Maybe they show that it’s reduced corneal sensation that is leading to reduced blinking and thus ocular surface exposure - the tear film breakup time was really fast at 4 seconds so this is an evaporative dry eye. We need Remend back on the market to solve this problem I think but until that happens another tear replacement gel will have to do! #dog #veterinaryophthalmology #dryeye #keratopathy by @bow_teye

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9 days ago

This sweet little chihuahua lost one eye when she autoenucleated it jumping off a bed 😩 and has a weird multiple cranial nerve neuropathy that has both given a paresis of her facial nerve and a lack of ocular surface sensation through a trigeminal neuropathy 😢. All of which means she has no palpebral reflex at all 😳. How are we going to protect her eye and cure this corneal ulcer? The practice where her owner/carer works had some contact lenses so, although I’ve never been much of a fan of them we popped one in. It stayed in slightly less than a day 🥴 but as they are cheap day-use lenses maybe just keeping on putting them in is the answer - with a lateral tarsorhaphy too to hold it in place maybe 😉. What would you do? #dog #cornealulcer #eye #trigeminalneuropathy #veterinaryophthalmology by @bow_teye

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10 days ago

Pattern recognition strikes again! This elderly cat has a strange right eye with a really narrowed anterior chamber and if you haven’t seen this before you’ll be really perplexed. The slit beam pictures aren’t brilliant I’ll grant you but they do show that in this eye compared with the other the iris and lens are pushed right forward. Why? If you’ve seen this before though you’ll immediately recognise that this is aqueous misdirection glaucoma. Instead of passing through the pupil and out through the iridocorneal angle the aqueous has made its way into the degenerate vitreous thus pushing the lens and iris forward and compromising aqueous drainage. The intraocular pressure was actually only 28mmHg with no ocular discomfort evident, so we’ve left things be unless the pressure goes up and causes any pain at which point we’ll use a topical carbonic anhydrase inhibitor to reduce aqueous production. #cat #glaucoma #aqueousmisdirectionglaucoma #ophthalmology #veterinaryophthalmology by @bow_teye

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11 days ago

What’s going on in this elderly dog’s eye? Does a closer look help? What about a view with a slit beam? There’s an anterior lens luxation here with the lens trapped between the iris and the cornea. Normally that spells emergency with a pupil-block glaucoma but here the pressure is actually low at 9mmHg and the eye isn’t at all painful. What’s that central haziness? The lens is pushing up against the corneal endothelium stopping those cells pumping fluid out of the cornea hence giving this corneal oedema. So what should we do? Surgery to remove the lens? At attempt to couch the lens back into the vitreous? If you know me through previous posts here you might not be surprised to know that I said ‘if the dog’s not bothered neither should we be!’ Let’s leave well alone unless at any point the eye becomes uncomfortable in which case we could act. #dog #lensluxation #veterinaryophthalmology by @bow_teye

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12 days ago

What might be causing the opacity in this pigeon’s cornea? Try extrapolating from what it might be in a dog or cat - lipid, calcium, oedema, scarring… a closer look shows the lesions is made up of individual foci which to my mind puts scarring down the list of possible diagnoses and calcium higher up but I think it’s really difficult to be sure if it’s calcium or lipid - the crystalline whiteness makes me veer towards calcium so we’re going to use EDTA topically to see if we can reduce it but I’m not holding out much hope that we can. The medics call this band keratopathy as it forms a band of opacity across the cornea. This looks more like a blob to me but blob keratopathy doesn’t very scientific does it?! And what’s caused it? Any ideas?! Thanks to Aithghen for the pictures and the question regarding how to help the bird - sorry not to be much help Aithghen! #pigeon #bird ##veterinaryophthalmology #cornealopacity bandkeratopathy by @bow_teye

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13 days ago