I’ve Got An Eye Problem

This is adorable blind Honey, who had come to us last year from a rural shelter in Maine. Over the Thanksgiving holiday weekend (of course!), she gave us quite a scare.

In late October we had noticed in her right eye that the sclera (the white part of the eyeball) was turning red with lots of blood vessels. This is usually a sign of something amiss. The body is sending out those blood vessels to go deal with something. I took Honey over to our veterinary ophthalmologists in Burlington, who diagnosed her with an indolent ulcer and treated her for it. The ophthalmologist summarized it this way:

The cornea is the transparent window at the front part of the eye that allows light to enter for vision. A corneal ulcer is a break or erosion in the outer surface layer of the cornea. Corneal ulcers typically heal within 3-4 days post trauma. Indolent corneal ulcers are chronic (non-healing) in nature and can be present for several weeks without any healing taking place.

Treatment performed today:

To speed up healing, the indolent ulcer was treated today with a sterile cotton-tipped applicator debridement, followed by a diamond burr debridement and bandage contact lens placement. The debridements remove the abnormal, loose outer layer of cornea (epithelium) and creates a textured scaffolding on the underlying layer to help anchor the healing tissue. A drop of atropine and a bandage contact lens has been placed on this eye in order to decrease pain and promote healing. The atropine will dilate the pupil for 3-5 days.

Approximately 90% of indolent ulcers heal in two weeks following the procedures performed today. A very small percentage of patients may require an additional treatment (re-debridement or superficial keratectomy) or may take several more weeks to heal. Therefore returning for recheck appointments is important.

Why did this happen to my pet?

Indolent ulcers are a result of a primary tissue healing defect: there is a problem with the attachments/anchoring between the cells of your pet’s outer/superficial corneal layer (epithelium) and the underlying layers of the cornea (stroma). A normal attachment and anchoring process between these corneal layers is necessary for an ulcer/wound to heal. Lack of proper adhesion between the two corneal layers results in significantly delayed corneal wound healing time.

Everything had gone well, she had her recheck a few weeks later, and we were to keep administering the usual daily eye medications to her. Honey didn’t need to be seen again for several months. Yay!

And then, on the Saturday after Thanksgiving, I was starting to give her an eye drop that morning and noticed something didn’t look right. I couldn’t quite tell what it was, so Alayne held Honey for me while I used our digital SLR to get high-resolution close-up images. On the computer, this is what we saw:

Can you see those two round holes in her cornea? And the larger bubble looking thing just above them? Something bad was happening.

I emailed that photo to our veterinary ophthalmology team, and then called their emergency number. A short while later one of our two ophthalmologists called and said, “I don’t like what I’m seeing there!”  They were melting ulcers which, if left unchecked, could rupture the eyeball.

She asked if we had another eye medication, ofloxacin, on hand. Fortunately, we did, so she had us start administering that eye drop, let her know if things worsened on Sunday, but otherwise plan to bring Honey in on Monday.

Amazingly, by Monday morning just the addition of the ofloxacin had turned things around, and the cornea was starting to heal. It doesn’t look pretty, but healing is underway. So we are continuing with the ofloxacin along with the terramycin ointment she had already been getting.

How did that initial indolent ulcer get started? Well, when Honey first came to us, the ophthalmologist determined she was blind from progressive retinal atrophy (PRA) or sudden acquired retinal degeneration syndrome (SARDS). But the doctor noted that Honey had cholesterol deposits on the surface of both corneas. This is not very common and is kind of weird, because no one really knows for sure how cholesterol gets there in the first place!  I mean, in arteries, yes, but on the cornea?

Here’s what it looks like … you can see the sheen here in Honey’s left eye:

Usually these cholesterol deposits don’t do much harm, but occasionally pieces can break off. Our ophthalmologists wonder if a shard of that cholesterol didn’t nick the corneal surface on her right eye in the process of sloughing off. There’s no way to know for sure.

For now, though, we seem to have the ulcers under control.

In the meantime, Honey for her part is enjoying the best part of winter … that wood stove in the living room:

Honey joins us in wishing you a very happy holiday season — and hopefully an uneventful one, too!