Saturday, June 23, 2012

Use your tools of the trade - opthalmoscope

Yesterday, Friday, Jun 22, 12, I allocated cases to Dr V and Dr D so that waiting times don't drag on as most Singaporean pet owners hate to wait at the Surgery. This is a common trait and many vets and doctors at Clinics don't realise that trait. So, I install this system.

The new client went to Dr V.

"I just want a second opinion," the lady in her 40s said to me. "My vet (many years of experience and consulted by this owner for around past 20 years) said my dog's blindness is due to brain problem and not cataracts. He said there is no cure. MRI may detect where the problem occurs in the brain."

I went into the consultation room to particpate.  After fluorescein stain showed negative corneal ulcers. The dog banged his head when he walked and so there was blindness in both eyes.

WHAT TO DO?
"Did your vet do an eye check with this opthalmoscope?" I asked the lady who came with her brother-in-law whom I mistook for her husband.

"No," she said. I guess her regular vet finds that it is not necessary to use the opthalmoscope or there are other reasons as each vet approaches a consultation differently from others.


NOTES: This may be a case of SARD
Sudden acquired retinal degeneration (SARD)
Bilateral. Middle aged. Older dogs females predisposed. All breeds affected.
Complete blindness
Cause unknown
No treatment
Bilateral absence of the menace and dazzle response
Resting mydriasis
Retina degeneration
Hyper-reflectivity of tapetum
Vascular attenuation
Differential diagnosis:  Central (neurologic) blindness or peptic neuritis
Test: Electroretinogram


This case is a female Maltese, 8 years old, completely blind. Will wait for blood test report. From the opthalmoscopy, I saw in both eyes, the lower half of the fundus being very shiny reddish brown (hyper-reflectivity) like semi-circles. The upper half is greyish white with bigger blood vessels (Vascular attenuation) seen. The optic disc appears swollen (oedematous) - optic neuritis?

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