Jun 10, 2015 Wednesday
Jack Russell, Female, spayed 13 years old, 13.7kg, 40.3 degrees C
Complaint - left eye swollen
Overweight, skin disease ventral area as she sleeps a lot
Lethargy for around past 5 years
The workmen was still installing a new operating light past 7.30 pm on this warm night. Dr Daniel had gone to play football while my assistant Naing finished work at around 7 pm.
I was available in the clinic to answer the phone call about the old Jack Russell having a sore right eye. The mother and adult daughter were worried that the right eyeball was protruding or swollen. There was a red spot in the depressed cornea of the right eye at the 3 o'oclock. This would be a descemetocoele. The eye white was reddish with blood vessel congestion. What was the cause of this swollen eyeball? Was it glaucoma?
"The good news is that it is not a recent corneal ulcer," I had applied fluorescein eye stain test onto the cornea and there was no green ulcer spots. "It is a descemetocoele or a bulging of the inner basement membrane of the cornea. In other words, it is an old eye ulcer.
"Jack Russells rarely get corneal ulcers and so this may be due to rubbing of the eye," I saw that the overweight dog was panting and black tartar encrusted teeth glinted in the white light of the consultation room. "It is possible that his cherry eye at the medial canthus was much irritating to him or he has tooth ache. So he had to rub his face and eye, clawing his right cornea."
"I did see him rubbing his eyes," the mother said.
"His cherry eye is inflamed and irritating," I explained. "In fact, he has another cherry eye on the left eye too. Why didn't you get them treated when he was younger?"
"The vet said that the cherry eyes would pop out after putting them inside the eyelid and therefore, no pointing in operating," the mother said.
"Yes, there is a risk of poor outcome in tacking the cherry eye into the 3rd eyelid and extra medical costs," I said. "The reason for tacking is that the dog will have adequate tear production during old age. An alternative is to remove the cherry eyes, relieving the dog of pain and irritation. Decayed loose teeth need to be extracted at the same time."
Now the dog is obese, the anaesthetic risk of dying on the operating table is very high. So, the mother and daughter will need to think about anaesthesia in the next 3 days as regards dental treatment.
Otherwise, the dog had a poor quality of life and his right eye might be scratched till it ruptured. In that case, anaesthesia to remove the eyeball is required." The dog can wear an Elizabeth collar for the time being to prevent eye scratching and antibiotics for the oral infections.
Sleeps a lot. Lethargic. Is this Jack Russell obese, suffering from hypothyroidism or being less active at her old age ? More investigation is needed to check the blood for hypothyroidism but the need to reduce medical costs is a factor in not ordering such tests.
The dog was treated for fever and given antibiotics.
FOLLOW UP ON JUNE 12, 2015
"The right eye is still swollen but not much," the mother was happy that the dog was much better and not scratcing. In practice, evidence-based medicine is best but there will be increased medical costs. The priority is to remove the bacterial infections from the black teeth and excise the two cherry eyes to let this old dog have a better quality of life. I will do the anaesthesia and dental this Saturday morning.