632. Corneal degeneration in an old Miniature Pinscher, FS, 9 years

SUNDAY'S INTERESTING CASE

The owner wanted a diagnosis from me. She went to Vet 1 who referred her to Vet 1, but she said she still had to pay Vet 1 for a non-diagnosis. I showed her that Vet 1 did diagnose "lipid" deposits in the right eye and referred her to Vet 2.

"It must have been a long time since I usually keep older records stored outside the Surgery," I said. She showed me my 2006 Toa Payoh Vets receipt with my pen illustration of "left eye white central scarred ulcer - 3mm diameter". I was impressed that she kept records. That was 5 years ago! "It was the left eye affected," she said. "The spot disappeared after a while."

"Did you use the eye ointment?" I asked.
"No," she said. "My dog disliked it".

EXAMINATION
1. To check whether the right eye had corneal ulcers or not in addition to the lipid deposits.
I showed my assistant Min how I used the fluorets paper strip. I placed it onto the lower fornix and closed the eyelid. The dog blinked many times. Green dye gathered below the lower conjunctiva.
"Is it dangerous to my dog's eye?" the owner asked. "No," I showed her the seller was Bausch and Lomb which she had instant knowledge but said that there was a lawsuit against this company for the contact lens solution.

Results: No green ulcers in the right eye but there were 11 to 1 o'clock ulcers in the left eye!

2. Digital photography useful esp. side views of corneal degeneration. Axial central corneal degeneration 4x3 mmx3mm. It looks like it is going to bulge out and ulcerate. Owner had said the swelling suddenly appeared in the last month.

3. Blood tests for thyroid and cholesterol not done yet due to financial considerations. Hypothryoid and high cholesterol are said to be important in this degeneration where aqueous fluid enters the endothelium, causing edema and whiteness and swelling (side view of image).

DIAGNOSIS
Right eye - corneal endothelial dystrophy. No definite cure as this is due to aging. Blood tests for thyroid hormones and cholesterol levels advised.
Left eye - corneal ulcers due to eye rubbing of the 3 upper eyelid "melanomas". Excision of the melanomas will prevent ulcerations.

TREATMENT
Usually not curative. Low fat diet 8% fat? Check thyroid hormones and cholesterol levels.
Prevent further corneal degeneration? What drug?
E-collar and antibiotics to prevent left eye rubbing although the owner said she never saw actual rubbing.


Website with more photos
http://www.sinpets.com/F5/20110928corneal-ulcer-eyelid-melanoma-miniature-pinscher-singapore_ToaPayohVets.htm