Vetinfoindex
Vetinfo4cats
Catindex
Subscriber Area (members only)
Zoonotic disease
Becoming A Veterinarian
Your Turn
Search vetinfo4dogs
Support Vetinfo and Subscribe toVetinfo Digest
Eye Problems and Disorders of Dogs
Corneal endothelial degeneration
Blood transfusion in dog treated with large amounts of eye medication
Giving Bulldogs Tums for tear stains on face
Herbal supplements for eye problem in Pug
Collapsing of the eye - phthisis bulbi
Horner's and Hypothyroidism - is there a connection
Nuclear sclerosis
Nuclear lenticular sclerosis
Rusty color around eyes and mouth of Dalmatian
Retinal folds and PPM's in Belgian
Eye problem in Pug litter
Discharge from eye of German Shepherd
Button's update - not blind
Blindness with Cushing's
Horners Syndrome
Eye removal surgery - calcinosis cutis
Retrobulbar abscess possible
Anisocoria
Optic nerve hypoplasia/micropapilla
Sudden blindness
Sudden cloudy eyes
Chronic conjunctivitis in Bullmastiff
Swollen, cloudy eye
CERF testing
Uveitis and generally poor condition
Sudden Acquired Retinal Degeneration
Dilated Pupils
also see Entropion
also see Cataracts
also see CIKS
also see Cushing's
also see Distichiasis
also see Vision - How Dogs See
Corneal endothelial degenerationQuestion: Dear Dr. Richards
Let m first thank you for a very insightful site on Cushing's disease.
My dog's symptoms and initial blood tests strongly indicated Cushing's.
After reading your material, I became convinced that the cause was
cortisoids in eye drops. I stopped all medication and she started to get
better, and the "resistance" (I forgot the name) came back negative.
Now the question.
I have a 7-year old Boston Terrier called Missy.
A Veterinary Ophthalmologist diagnosed her condition as
corneal endothelial degeneration and gave the following medication:
Indomethacin and 5% saline.
I would be very grateful if you could give me a broad walk around on
your views and experiences with this condition.
Thank you once again
Riitta
Answer: Riitta-
The cornea is the clear portion of the eye. In order to be clear, it has to be very specialized. It can't contain blood vessels, for instance --- because then it would be red or the vessels would at least be visible in it. If you think of it as clear skin without blood vessels it might be helpful. The endothelium is the innermost layer of the cornea. It is a very thin layer that has the major task of keeping the fluid in the eye from entering into the clear cornea. The reason for this is that any water that gets into the corneal layers tends to make them swell. When they swell they get cloudy or develop a bluish haze. This can be focal, occurring in discrete spots, or it can be generalized and the cornea can become cloudy or blue instead of clear. In some dogs this will lead to corneal ulcers or a condition that is referred to as bullous keratopathy (blistering of the cornea).
In Boston terriers there is an inherited form of endothelial degeneration that is referred to as endothelial dystrophy. It usually starts out as haziness or cloudiness of the cornea towards the outside side of the eye and then gradually over time spreads towards the nasal side of the eye. It can lead to blindness. Older dogs of all breeds can have a degeneration of the endothelium that is just a function of age and perhaps some underlying weakness (since it doesn't occur in a lot of dogs it can't be just age). I'm not sure how to tell these conditions apart since the problem in Boston terriers tends to start in middle age (or older). The inherited condition is more common in females, though.
There is a surgical treatment for endothelial degeneration, thermokeratoplasty, but I do not know if it is useful in the inherited form of this disease in Boston terriers.
5% Sodium chloride drops are used because they are hyperosmotic (more salt in the drops than in the cornea) which causes fluid to move out of the cornea. This is beneficial in reducing the accumulation of fluid in the cornea.
I was not aware that there was evidence that anti-inflammatory drops were helpful but I'm absolutely certain that your ophthalmologist knows more about this condition that I do so I'm going to remember this for future reference. Indomethacin is a non-steroidal anti-inflammatory medication and I'm assuming it is being used to reduce pain and/or inflammation in the cornea.
My experiences with this condition are actually pretty limited. I think we have had less than five patients with this condition over the years in our practice. Unfortunately, most of them have eventually had to have either permanent conjunctival flaps (where the pink conjunctiva is undermined and then pulled over the cornea to act as kind of a permanent bandage) or their owners eventually decided the situation was hopeless and just ignored it -- even though this is not really an acceptable option if you are thinking about the dog's comfort. I can't recall having a patient with this since the advent of thermokeratoplasty but this is reported to work well. This is a URL for an article on this: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=12619840I am hoping that the ophthalmologist has seen lots more cases of this than we have and has had good luck with treatment. This is entirely possible because we may have treated patients thinking they just had corneal ulcers or keratopathy and just missed the underlying condition. If that has happened we may have treated some of these guys with good success without even knowing it.
Mike Richards, DVM
11/19/2004
Blood transfusion in dog treated with large amounts of eye medication
Question: My dog Thor recently became quite passive and didn't eat normally. He is a 9 year old diabetic that takes 14 units of insulin twice a day. I get worried easily so I took him to the vet.
The vet determined he needed a blood transfusion as
his red blood count was 21. I hope this is a valid number. He also said his previous tests showed 43.
Thor did get the transfusion and a drug baytrol 60 #14
because the vet does not know what is wrong.
It has only been one day....but Thor is still very quiet and
doesn't eat as normal...but he does eat something.
He goes back to the vet tomorrow to do more tests for his diabetes, red blood counts, etc.
Let me say one more thing. Thor recently had cataract surgery at a surgical center for this type of work and was on a massive amount of eye drugs because one eye was not responding to the drugs.
It has been several months of the massive drugs. As of
now he only gets prednisone acetate. Could these drugs be the problem?
Can you recommend anything to try to help Thor?
I recently lost my beloved 14 year old german shepherd and I don't want to lose Thor.
thank you so much for being there.
SherrieAnswer: Sherrie-
I think that it is possible that the medications for the eye may be linked to the anemia. Many medications can induce either immune mediated thrombocytopenia (platelet deficiency) or immune mediated hemolytic anemia (IMHA). If one of these diseases is present, there should be recognizable clinical signs pretty quickly. In the case of the immune mediated thrombocytopenia a platelet count is often all that is necessary to confirm the presence of this problem. This is often done as part of the complete blood count but may have to be specifically requested at some laboratories. If would be a good idea to ask if a platelet count has been done and if so, what the results were. Immune mediated hemolytic anemia is a little harder to diagnose as this diagnosis is often based on the appearance of red blood cells in a blood smear and the presence or absence of reticulocytes, or developing red blood cells. Reticulocyte counts almost always have to be requested separately from complete blood counts because they require different staining techniques. If there are high numbers of reticulocytes and unusually shaped red blood cells referred to as spherocytes, it is very likely that IMHA is present.
The reason that I started with those two diseases is simply that they are sometimes involved in drug reactions. The diagnosis of the cause of anemia can be a little complicated because there are a number of disorders that can lead to anemia, including intestinal parasites, blood loss from undetected trauma, gastric or intestinal ulcers, kidney failure, liver failure, cancers (several), chronic illness (including diabetes) and probably at least a hundred other known causes. This makes it necessary to make a pretty thorough diagnostic effort to determine the cause of anemia.
I'm not sure that I understand why a blood transfusion was given prior to making at least a tentative diagnosis with a hematocrit of 21 unless it was clear that there was a serious ongoing loss of blood. This may complicate making a diagnosis slightly. Things like this are always a judgment call and your vet was able to see your dog's overall condition so it is possible that this was the best option at the time. The hematocrit is the percentage of the blood which is made up of red blood cells. The normal range varies from lab to lab but generally runs around 32 to 50. If the last hematocrit of 43 was recent this may give you some idea why your vet felt that a transfusion was necessary first.
The first step in making a diagnosis when anemia is present is to determine if the anemia is regenerative or not. A regenerative anemia is one in which the body is attempting to respond to the loss of blood by releasing young red blood cells (reticulocytes) and/or making new blood. A non-regenerative anemia is one in which there is no apparent effort by the body to respond to the blood loss. In general, regenerative anemias tend to be more of a crisis situation and non-regenerative anemias tend to cause slow loss of red blood cells over a long period of time. There is a three day (minimum) period of time in which the body can't respond to blood loss very well. It takes about this length of time to start making new red blood cells and for high numbers of reticulocytes to make it into the blood stream from the bone marrow. This time period can confuse the differentiation between regenerative and non-regenerative anemias -- but only for a few days.
The most common cause of regenerative anemia in older dogs is probably IMHA. Sometimes the IMHA is secondary to another disease process like ehrlichiosis or cancer, though. Hookworms, severe flea infestation, severe tick infestation, gastric ulcers, traumatic blood loss, toxic damage to blood (onion poisoning, zinc poisoning, acetaminophen toxicity, others) and damage to red blood cells from diseases such as heartworms, other heart diseases, cancer and vasculitis.
Non-regenerative anemia occurs when something is stopping or inhibiting the production of red blood cells. Because there is no way for the body to respond to this problem a slowly developing anemia occurs as the red blood cells are used up. The average red blood cell in dogs probably lives a little more than 100 days but due to the continuous overlap of red blood cell production it may only take 60 days or so for anemia to develop with even small amounts of continuous blood loss that the body can not respond to. Unfortunately, there are hundreds of causes of non-regenerative anemia because almost any chronic disease can inhibit red blood cell production if it goes on long enough. Vitamin B deficiencies and iron deficiencies can cause failure to produce red blood cells. Kidney failure causes anemia because the kidneys produce the hormone that stimulates red blood cell production (erythropoietin) and because red blood cells don't live as long when the kidneys aren't doing their job of removing blood toxins well. Anemia occurs with hormonal diseases such as hyperadrenocorticism and hypothyroidism. Some drugs directly suppress bone marrow, including sulfa-trimethoprim antibiotics, chloramphenicol, toxic levels of estrogen and chemotherapeutic agents. Cancer can cause non-regenerative anemia by suppressing red blood cell production, robbing the body of essential nutrients, causing organ damage and in several other ways. We have seen anemia in several of our patients with diabetes, especially when we have trouble getting good regulation of their insulin dosage. So far this has always been non-regenerative anemia that has improved as we gained better control over the diabetes management or at least reached a point where the anemia became stabilized even though we couldn't make it go away completely, as long as there weren't other complicating factors like kidney failure.
Hopefully it is apparent why it is so important to know which type of anemia is present. Once this is known, it is possible to narrow the search for a cause in a more systematic way. It also helps in planning appropriate therapy, including the timing of treatments such as blood transfusions. There is a big difference between giving a blood transfusion for a one-time blood loss with a normally functioning bone marrow and giving blood transfusions to patients who are not making blood, where multiple transfusions may be necessary and careful cross-matching of the blood as well as matching the patient's and donor's blood types becomes necessary due to the potential need for multiple transfusions.
I can't tell from the information that you know so far what the most likely diagnosis is. Hopefully as your vet does more testing it will be possible to come to an understanding of why this anemia is present. It can take a great deal of testing to rule out all the possible diseases that can cause anemia, especially when non-regenerative anemia is present. Keep working with your vet and don't rule out things like X-rays, ultrasound examination, gastroscopy or other tests designed to look for underlying causes if it is not readily apparent why the anemia is present.
Good luck with this. Make sure that your vet has a complete list of all medications that Thor has had recently, including an over-the-counter medications. If he isn't eating a commercial dog food be sure to mention that, as well. Think about the possibility of toxins, such as toy ingestion or eating metal (zinc is in pennies and was in some of the bolts used on older pet carriers -- probably ones from at least 15 to 20 years ago if you still have one of those). Watch him urinate to make sure that there is no blood in the urine and consider bringing a stool sample to your vet's in case it is hard to get one from him at the office.
Mike Richards, DVM
6/20/2004
Giving Bulldogs Tums for tear stains on faceQuestion: Dear Dr. Mike,
I've been a subscriber since Sept, and this is my second of 2 important
questions I have. One of our pets is a wonderful 4 month old English Bulldog,
"Ruby". An online group of Bulldog enthusiasts share experieneces and
suggestions on raising bulldogs. I had asked about the tear stains Ruby is
developing on the white side of her face. At least a dozen people replied
that they give their bulldogs "tums" on a daily basis. It apparently
neutralizes protein or acid in the tears and eliminates staining.I am aware of the numerous risks of elevated calcium and I assume that the
tums are pretty potent as a supplement, considering that post-menopausal
women are often prescribed just one Tums/day. Ruby only weighs 18 lbs, so a
little bit of anything goes a long way. With so many other health
considerations in Bulldogs, I don't want to introduce one more, for the
purpose of a clean face. I also heard that many people who show their bullies
administer a round of antibiotics for a week or so before a show. Ruby is a
princess, not a show dog. She can live with a dirty face.
If, however, the tums are unquestionably harmless, I'd like to know that, and
what you recommend.
Thank you!
Sincerely, PamAnswer: Pam-
This was actually the question that made me think I should come back to
your questions later. I have had a hard time researching this but I think
that I can help some. I had two questions when I got your question, 1) does
this work? 2) would it cause problems?I really can't answer the first question. I had not actually heard of using
Tums (tm), which I think have 0.5mg of calcium carbonate as their active
ingredient, for tear staining. There are several topical treatments for
this condition sold in pet stores (Diamond Eyes (tm), is one name I
remember) and some people have used tetracycline antibiotics in low doses
because this has been reported to help, as well, but does raise questions
about the proper use of antibiotics. When I researched your question I did
find several anecdotal references to the use of Tums to control tear
staining, so there is at least some indication that it might be helpful.If one or less Tums tablet per day was sufficient to control tear staining
then it is unlikely that there would be a problem with the calcium
supplementation from the tablets in an adult dog but I would be reluctant
to use calcium supplementation during the growth period in a puppy. The
recommended calcium levels in puppy foods is higher than the requirements
for most puppies and over-supplementation of calcium has been linked to
some orthopedic conditions. I really think it might be best to wait until
Ruby is a little older before trying this.Mike Richards, DVM
3/28/2001
Herbal Supplements for eye problem in Pug
Question: Dear Dr. Mike,
I'm Liz from Vermont and I have a senior pug (we are not sure of her age
because she is a rescue, but we believe she is between 8 & 10 years old). I
think I should give you some background on Dixie since she has had many
problems. First, she is a special needs dog since she only has 1 eye and on
Optimunne and Gentocin with Durafilm for dry eye and PK in the other. I have
had my vet cut her eyelid back so the lashes wouldn't rub on her eye like
they were doing and also she has had infected back teeth that had to be
removed a couple of times . She is also on soloxine for her thyroid and has
arthritis in her front elbows and shoulders. My vet had taken x-rays and
said her third spine disc is compressed. Recently, she had a bad case of
pancreatitis, but is fully recovered from that. I have been giving her
gloucousamine and chrondroitin sulfate for her arthritis along with coated
ecotrin for pain.My question is I have been thinking of ordering an herb supplement for her
made up of alfalfa, acadia and marigold from Natural Herbal Remedies out in
California. Joel Hyman is the herbalist who owns the company. Ever heard of
him? But my main question is what do you think of herb supplements and if I
try this, can I continue to give her the gloucousamine and chrondroitin
sulfate? Or should I stop giving her those two supplements? Any opinions
you have would be greatly appreciated. Thanks for your time and please
excuse the typos on the medicinal names, LizAnswer: Liz-
Before getting to the herbal question I think that I should say one thing
about the KCS problem. There do seem to be times when a corticosteroid eye
drop is helpful in conjunction with cyclosporin (Optimmune Rx) for this
problem but there may not be a need to use the antibiotic gentamicin. Since
Gentocin Durafilm (Rx) contains both the steroid and the antibiotic, using
a cortisteroid only drop might be advisable. Sometimes the antibiotic is
not helping or can even be irritating to the eye and it probably isn't
necessary at this time.On herbal medicine, I think that there are lot of of times when herbs can
be effective, or partially effective, in the treatment of medical
conditions in dogs and cats. However, it is hard to find exact dosing
information and often hard to understand the rationale behind various
combinations of herbs in products or in recommendations for herbal use.I am not very familiar with Joel Hyman, although I have seen his name
mentioned on a couple of web sites about herbal medicine.In the "PDR for Herbal Medicines" alfalfa is listed as having unproven use
for diabetes and thyroid disease, marigold is listed as having positive
effects in the treatment of HIV and other viral illnesses, and I can't find
acadia. There is a section for acacia, though. If that it is the third
medication, then it is used for oral inflammation and diarrhea based on the
information in the PDR. Not being an herbalist, I can not say that there
are not other uses, or that combinations may have effects not listed under
the individual herbs. There do not appear to be contraindications for using
these herbs in combination with glucosamine and chondroitin or the other
medications you mentioned in your note.Hope this helps some.
Mike Richards, DVM
2/19/2001
Collapsing of the eye - phthisis bulbiQuestion: hello,
my name is Amanda, and I am doing a science fair, and I am going to do
it on the eye cells of my dog. He is a pug, and he only has one eye, we are
trying to find information on why his eye just shrunk and if the eye cells are
dead.
If you have any information about this kind of stuff, if you have any other related information to
this anything will do.
Thank you! Amanda
Junior High studentAnswer: Amanda-
Collapse of the eye is referred to as "phthisis bulbi" and the appearance
of a sunken eye is referred to as exophthalmoses, so as you search for
information, it might help to search on these terms.The most common causes of phthisis bulbi are traumatic penetrating injury
to the eye, corneal ulcers that are severe enough to cause collapse of the
eye and degenerative diseases that destroy the function of the eye and
eventually lead to collapse. Examples of the last set of causes would
include glaucoma and cancer of the eye. Some dogs are born with smaller
than normal eyes. If they eye has normal function this is referred to as
nanopthalmos and if the eye has defects the condition is referred to as
microphthalmos. I do not believe that either of these conditions is common
in pugs.My guess is that most pugs that have collapse of an eye probably have this
due to a corneal ulcer or perforation of the eye due to trauma because
their eyes are very prominent and are more easily injured due to this.
Sometimes there are problems with the lids shutting completely in pugs due
to the prominence of the eye, or irritation to the eye from folds of skin
on the face rubbing the eye surface, which lead to corneal irritation
(keratitis) and then eventually a corneal ulcer.It is sometimes possible to determine the cause of collapse of an eye with
ultrasound examination or removal of the collapsed globe and
histopathologic examination of the eye tissues. These tests would not give
any hope of a return in function of the eye and would be most appropriate
when cancer is the suspected cause of the collapse, probably.I hope that this helps some.
Mike Richards, DVM
2/8/2001
Horners and Hypothyroidism - is there a connection
Question: Dr. Richards,
In February I wrote with questions about my 5 year old
Golden Retriever who had just been diagnosed with Horner's syndrome. Our Vet
said it would take up to 4 months for the symptoms to go away and he was
right. It took every bit of four months. By the end of June, the eye was
looking perfectly normal again. But then another problem developed. He
developed skin lesions, some hair loss and seborrhea. I initially thought it
was allergies since Goldens are so prone to skin allergies. But after
battling for most of this summer with medicated baths, Benadryl and
antibiotics for his skin, our Vet suggested we test his Thyroid gland to see
if his T4 level was low. It was 1.3 (normal range = 1 - 4). So we started
him on Soloxine twice a day and the sores, seborrhea, and allopecia have
improved remarkably.
As we were leaving the office following our recheck
visit, our Vet mentioned that they (Veterinarians) are taught that if a dog
develops Horner's Syndrome you should consider checking the thyroid gland
function. I was just wondering what the correlation is between Horner's
Syndrome and Hypothyroidism? Does one tend to lead to the other?Hope
Answer: Hope-
In a study of 100 dogs with Horner's syndrome, 9 of the dogs had concurrent
hypothyroidism. (Jaggy, et al, 1994). It has been argued that this is a
higher than expected number of dogs with hypothyroidism than would be
expected, so there must be a correlation between hypothyroidism and
Horner's syndrome. It has also been argued that this is about the number of
dogs who are expected to have hypothyroidism in a population of 100 dogs,
especially when age is factored in. At the present time, I think that all
that can be said is that there is a weak link between hypothyroidism and
Horner's syndrome. Facial paralysis has also been linked to hypothyroidism,
in a similar manner and sometimes facial paralysis and Horner's syndrome
occur together, too.I know that doesn't clear things up very much but there doesn't seem to be
a really clear answer to your question based on a review of the literature,
at this time.Mike Richards, DVM
10/14/2000
Question: I wrote to you recently about my dog, Dandi, who had a hemangioma taken out,
and everything went well. My dog is an 11 year old mix breed, and is never sick.
After this I found two more small lumps on my Dandi one on his front left leg and one on his hind leg.
My vet said the one on front was probably just fatty tissue and the one on the back was like a wart.
That thrilled me. I did forget to mention he does have a couple of these wart like things around his left
eye (tiny little warts), and he once had like a little sty removed from his right eye which grew back but
does not seem to bother him.I noticed something new last night too. His eyes are reflecting in the pupil area like they never had
(kind of like cataracts). I am very paranoid about this, because my very loved Irish Setter had
diabetes and then cataracts and went blind. I taught her all the blind dogs stuff around the house
and she was doing great when she all of a sudden got acute glaucoma with high pressures in both
eyes causing her a lot of pain. They were able to bring the pressure down in one eye but not the
other I brought her to a ophthalmologist and surgery was not an option, and because she was so ill
I had to put her to sleep.Tina
Answer: Most dogs develop hardening of the lenses of their eyes as they age. This causes the lens of the eye to become slightly opaque in the center region, changing the way the eye looks when light hits it by
producing a bluish tinge where the color was previously bright green (usually). This process is called
nuclear sclerosis and becomes noticeable on close examination around eight to ten years of age and
becomes more obvious with time. In most cases it will never become severe enough to cause loss of
vision but it probably does reduce visual acuity. You should mention noticing this change on the next
visit to your vet, so that you can be sure this is the problem. It is important to remember that this is a
process that affects the lenses, inside the eye. If the surface of the cornea (the clear outer portion of
the eye) is getting cloudy, that is a much more serious thing and does require immediate attention
from your vet.Hope this helps.
Mike Richards, DVM
9/8/2000
Rusty color under eyes and around mouth in Dalmatian
Question: Dr. Mike,
My 8 1/2 year old Dalmatian "Mugs" recently started to "rust". His eyes
are weepy and rusty under the eye area as well as around his mouth. Of
course every where he licks becomes rusty from his saliva. He hasn't
experienced any environmental changes which might have triggered an
allergic reaction. Earlier this summer he was treated with antibiotic
drops for an eye infection. His eyes were very mattery at the time of
treatment but not "rusty".
He has never experienced this type of rusty condition. I'd like to know
if parasites or mites of some type could be the cause. He is otherwise
in healthy condition. He does take daily doses of soloxine for his
thyroid condition. Please reply with any info you may have.Thank you, Kathleen
Answer: Kathleen-
The bronze or rust color in the tears and around the mouth are due to
bacteria breaking down porphyrins, which are part of the heme molecule that
carries the iron in the blood stream. This can happen in tears or in
saliva. For this reason, tetracyclines will often help to control the
staining. This is probably not the best use of an antibiotic, though.When there is discoloration around the mouth, it is important to look for
dental problems, for infections in the folds around the mouth and for
disorders that cause generalized itchiness and lead to secondary bacterial
infections. Allergies are very common in Dalmatians. Most commonly these
are inhaled allergies (atopy) but Dalmatians also get food allergies and
they seem to be more prone to this than many breeds.For discoloration around the eyes, it is best to look for changes in the
anatomy of the eyelids that sometimes occur with age and allow tear flow
over the eyelids, disorders that irritate the eyes, such as glaucoma,
allergies and uveitis and to also check for tear deficiency which can
actually cause periods of increased tearing early in the disorder. Since
allergies appear on both of these lists, they have to be strongly
considered. I do not know how common allergies are in Alaska, though.Sometimes, resistance to bacterial infection drops with hypothyroidism. If
it has been awhile since thyroxine levels have been checked, to be sure
they are in the normal range with the supplement, it might be a good idea
to check on those levels.Hope this helps some.
Mike Richards, DVM
10/18/2000
Question: I had a question about Neuclear Ventricullar Sclorosis.
Marsha
Answer: Marsha-
I am not familiar with the term nuclear ventricular sclerosis. There is a
condition referred to as nuclear lenticular sclerosis, which affect the
eyes of pets and I have seen the term ventricular sclerosis used to
describe scarring associated with heart muscle damage, though.I suspect you are looking for information on nuclear sclerosis of the lens
of the eye, though. This is a normal age related change that occurs in the
lens of the eye. At about 8 years of age in dogs and about 10 years of age
in cats it is usually possible to see cloudiness in the lens of the eye and
the reflection from the eye may change from green (or red) to a hazy blue
color. This happens because the lens is a very special tissue. In order to
be clear so that light can pass through it, the cells in the lens have be
oriented just right and there can not be a blood supply -- or you would see
red all the time. The lens adds new cells from the edges, making the center
cells get more compact as time goes on. Eventually they become compact
enough that cloudiness occurs. This would be more of a problem if dogs had
to read or if they were strongly dependent on central vision but they don't
read and they don't lose the ability to see movement which is more of a
peripheral vision ability. So most dogs with lenticular nuclear sclerosis
will continue to see well enough to get around for the remainder of their
lives. The same is true for cats, although we do have a few cat patients
who live long enough that this change does eventually seem to affect their
vision some. When I am not sure if a problem is a cataract or nuclear
sclerosis I send the patient to an ophthalmologist but this doesn't happen
very often.Hope this helps some. If this reply is way off the mark and you are looking
for information on an entirely different condition that I don't know about
I'll be glad to look into it for you.Mike Richards, DVM
6/30/2000
Retinal folds and PPM's in Belgian's
Question: I just heard about retinal folds and PPM's being present in some belgian
pups. Marked weight loss in the mother was present during early pregnancy.
I'm unfamiliar with both retinal folds and PPM's. Please discuss retinal
folds & PPM's as they might relate to maturation. Also please give info on
the heritability of these conditions in respect to belgians as a breed.
Thanks.Cordially,
KarenAnswer: Karen-
Persistent pupillary membranes are present as a congenital abnormality in
many dog breeds on an occasional basis and are known to be inherited in
Basenji's. I am not aware of evidence of inheritance in Belgian shepherds
but could not be sure it wasn't a problem. Most of the time persistent
pupillary membranes cause no harm but most ophthalmologists do advise
against breeding dogs with this condition, just to be cautious. If a dog
was very good and had many other attributes that would be beneficial to its
breed this would be a hard decision to make, though.I am not sure if you are referring to retinal dysplasia when referring to
retinal folds as a problem. Retinal dysplasia is abnormal development of
the retina and can include folds and other defects in the retina. This is
a condition that is thought to be inherited in a number of dog breeds.
There may be no visual defect discernible in affected dogs, so this may be
a problem that is only found when the eye is examined. Despite this, since
it is an inherited defect that is thought to be an autosomal recessive
trait, a case can be made for avoiding breeding. This is especially true in
Labrador retrievers, samoyeds and English springer spaniels, since the
condition in these breeds is associated with other genetic abnormalities
(according to Wheeler, in Morgan's Handbook of Small Animal Practice). I
do not know the situation in Belgians.This condition can also be acquired as an injury or due to viral
infections, toxins and nutritional disorders (probably a rare cause).If I run across anything specific to Belgians, I will try to remember to
post it online.Mike Richards, DVM
6/4/2000
Question: Hi Dr. Mike! Well it's me, the infamous pug rescue lady again..doing her
deal. Actually, we have affiliated with a rescue in Missouri where the
puppy mill horrors of the world are, and recently were contacted by a breeder
who had a litter of puppies with horrid eyes, the breeder referred to them as
"sick" eyes. She added that the bubble-like cysts in the eyes either go away
in three weeks, or the puppies die. Apparently the mother has the same
looking eyes, but there were other breed puppies nursing nearby who appeared
to be fine. My question...could this be a herpes type infection - we cannot
seem to find adequate information to point us elsewhere. If so what it the
prognosis...is this contagious, and is treatment possible?Thanks Dr. Mike.
PamAnswer: Pam-
It is supposed to be possible for dogs to have herpes virus corneal
infections but they are supposed to be pretty rare. I didn't find any
references to outbreaks among litters.There seem to be a fair number of pugs who develop tear deficiencies or who
have an inability to completely close their eyes due to the bulging nature
of their eye anatomy and sometimes multiple members of a single litter are
affected by this combination of problems. The current approach to this
problem is to close the eyelid margin surgically, just enough to allow
these puppies to close their eyes. Using artificial tears or a tear
production stimulant like cyclosporin might also help, if this is the
problem. Measuring the tear production is pretty easy and most veterinary
hospitals can do this. Evaluating whether there is a problem with the lids
closing is a little harder and it may take observation by a veterinary
ophthalmologist. Problems like distichiasis (eyelashes arising from the lid
margin which irritate the eye) can also lead to early signs of corneal damage.If I find anything more about herpes causing eye problems in dogs I'll try
to remember to send it to you or post it on the site.Mike Richards, DVM
5/23/2000
Discharge from eye in German Shepherd
Question: Dear Dr. Richards,
I recently subscribed to vetinfo and would like to ask a question. For
several months now, my five-year old female German Shepherd has been having
greenish-yellow discharge in her eyes, especially her right eye. Also, the
pigment on her nose was very dry and chapped for a while and now is a dry
pink. I took her to my regular vet who gave me some type of cortisone pills
to be given to her for a about a month and a half. It helped a little but
now her eye seems to be even worse. My vet referred me to an animal
dermatologist who could possibly check her for allergies. He said that the
nose problem may be some type of lupus and he gave me an ointment to try and
see if that helps. Well, as soon as I put it on she just licks it off so I
can't tell whether it is working or not. I am more concerned about her eye,
however. He said he suspected it was an allergy and gave me some drops to
put in her eye but it is extremely difficult for me to get the drops in her
eye. Her eye is very red and the discharge is constant. I wipe her eye
with a wet towel but I have been very unsuccessful with the drops. My
question is: can you suggest anything else that I can do for her and also,
is there any danger in her having this infection for so long?Thank you so much for your help.
Sincerely, Sheryl
Answer: Sheryl-
German shepherds get several disorders that can lead to chronic runny
eyes. Allergies are probably the most common cause of conjunctivitis in
dogs. This is irritation of the pink tissues of the eyes which can lead to
eye discharges. However, German shepherds get a pannus, which is an immune
mediated condition that can lead to eye pain, corneal damage and
conjunctival signs. There are also some dogs with discoid lupus or
phemphigus that develop conjunctivitis. This sounds possible in your dog's
case due to the history of nasal problems as well. Due to the potential
need to treat dogs with discoid lupus or phemphigus for life, it is usually
better to get a biopsy sample and try to confirm that one of these
illnesses is present if it is necessary to go to systemic medications (oral
medications, injections).Topical corticosteroids will sometimes work well despite the fact that dogs
lick a lot of the medication off of their noses. They do not always work,
though. Eye drops are sometimes very hard to administer. It helps to
remember that it is the upper lid that has most of the motion, so that is
the one to gently press upwards in order to administer the drops. If you
can't use drops it may be necessary to use pills. This does mean that you
are treating the whole dog to get the eye problem under control, though.I have a number of clients who have trouble with eye drops and I have a
canine patient who I can not successfully administer eye drops to, so you
have a lot of company in this difficulty.If cortisones did not help the eyes it would be a really good idea to get a
veterinary ophthalmologist to look at your dog. I know that it gets old
running around to different specialists, but sometimes it really does help
a great deal.You might also want to ask your vet's technician to show you how to
administer eye drops. Sometimes, seeing how someone else does this can help
a great deal.I wish I could help more.
Mike Richards, DVM
5/12/2000
Buttons update - not blindUpdate: It's been a long road, but finally some good news about Buttons. We thought he
was blind after having an ulcer on his eye, but it has healed and he is seeing
just fine. After having nausea with Lysodren for Cushings, our vet told me to
give him half the dose for twice as long. Buttons is a strong willed dog and
I had a gut feeling that he could do this with a lot of TLC, so I didn't do
what I was told. Instead I gave him half the dose one day,3/4 the next, and
followed with the full dose and he has been taking it ever since with no side
effcts. His last dose will be this Sunday, then we'll start on the Prednisone.
Buttons is beautiful, his eyes are big and bright, he looks better than I have
seen him in about 2 years. We were able to have him groomed for the first
time in 3 mths. today. We are beside ourselves with wonder at how he has come
out of all the problems, just keeping our fingers crossed that there is no
relapse, time will tell! I hope that you have printed all the letters I sent
so that others can read them and realize that there is hope, it just takes a
very firm commitment on the owners part to do everything necessary for the
welfare of the animal. Being a retired RN, I never had a problem with all the
meds and treatments, I was just very determined to get this dog well. It has
taken myself, our Vet and you to accomplish what looked like an impossible
task at the beginning. I include you because It was your recommendation to
test for Cushings that motivated our Vet to do just that, I thank you very
much for that and also for being there and listening and encouraging me. It's
been a tough battle ,after spending many nights in tears over
Buttons, finally, all is well. Thank you again JoanAnswer: Joan-
I am glad to hear that Buttons is doing better and that you were able to
help him get through all the problems. He is lucky to have a dedicated owner!Mike
4/22/2000
Question: Dr. Mike, It's been a while since I wrote last, there's been a lot going on
with Buttons.The Demodectic mange seems to be improving with Ivermectin. He
was tested for Cushings with positive results, he was started on Lysodren 500
mg.,1/3 tab daily, gave him one pill and he became nausious the next
morning, gave him Prednisone 10 mg. and he improved shortly, called the vet and
stopped the Lysodren. This was a week ago,still waiting to see what we are
going to do. In the meantime, his left eye became runny and closed, took him
to the vet ( we had already had an appt. for that day),he has an ulcer on that
eye, vet stained it and gave us Triple abx oint. to apply 3 times daily,also
Vitamins and Iron as he did a CBC and found he was still anemic. We're very
concerned as he doesn't seem to be able to see very well, he has to nudge with his
nose to locate his food and water bowls. He manages to get around okay,but of
course, he knows the house well. It seems like there is a drama unfolding day
by day. Can you give me any encouraging words about all of this? Thanks, Joan
One more thing that is very strange, Buttons eyes are now opened very
big, what I want to say about that is that the only time w have ever seen his
eyes so big is during a thunderstorm when he's upset, don't know what to think
about this?
Answer: Joan-
The wide open pupils may be an indication that Buttons has become blind,
especially with the other signs you have observed. There is some chance
that this could be due to hypertension, as that is a common problem in dogs
with Cushing's disease. Hypertension can cause retinal hemorrhaging and
sudden onset of blindness. This is more common in cats, although the
hypertension is usually due to renal failure in cats. An ophthalmic exam to
see what is happening with Button's eyes would be a really good
idea. Blindness from hypertension will respond to therapy for the
hypertension in many cases.There are times when administration of Lysodren (Rx) will bring on a sudden
onset of neurologic problems that are actually due to the Cushing's
disease. I don't think this occurs very often with the first treatment,
but I couldn't be sure it wouldn't happen that way, either.Sudden acquired retinal degeneration (SARDs) is a condition in which the
retinas deteriorate very rapidly for reasons that are not entirely clear.
However, this condition is seen more often in dogs with
hyperadrenocorticism than in dogs that do not have Cushing's disease. This
is actually the most likely problem, probably. It is not a treatable
condition. It can be difficult for dogs to adjust to the blindness in these
cases because it comes on so suddenly. However, most dogs do adjust and if
their environment is kept pretty constant (don't move the furniture much)
they do well.I know that wasn't a very encouraging note.
If Buttons can't tolerate treatment with Lysodren, there is selegiline
(Anipryl Rx), which is also approved for the treatment of Cushing's
disease. It doesn't work as fast and it doesn't work as often, but it
doesn't cause as many side effects. It is especially worth considering in a
dog in which Lysodren is known to be problematic.I know that this is all pretty discouraging. It doesn't seem fair when you
do the right things and find out what is going on, treat it properly and
problems still occur. If you hang in and keep working towards getting the
hyperadrenocorticism under control there still is a chance that Buttons
could have a good quality of life, even with persistent blindness. The next
few days will tell you if he is able to cope with this new problem, too.Mike Richards, DVM
4/15/2000
Question: Hi Dr. Mike,
I am a former Veterinary Technician and a new subscriber to
Vetinfo Digest. I am writing because my 5 year-old Golden Retriever, Midas,
was recently diagnosed with Horner's Syndrome. A few weeks ago we arrived
home to find his lower left eyelid was drooping and his eye appeared smaller
than usual --almost to the point where you could hardly tell there was an eye
there at all. With no history of injury or illness, we assumed that our
other dog may have scratched the cornea since they play together often. Of
course, this occurred on a weekend, so I rushed him to the only place where I
could get an appointment, an Emergency Clinic. They diagnosed him with
Uveitis (no scratch evident with staining) and prescribed a Triple Antibiotic
Ointment with a steroid for a few days.
Three days later, with no improvement we took him to our
regular Vet for a recheck. He diagnosed him with Horner's Syndrome, an eye
disorder that he says is common among male Goldens of his age. He recommended
we continue applying the ointment and also prescribed Atropine eye drops twice a day.
Unfortunately, he said the symptoms could take up to 4 months to go away.
Although he doesn't seem in pain or uncomfortable, I am concerned about how
this may effect his sight and any long term neurologic problems that may be
ahead. Do you recommend we seek an eye specialist to treat this kind of
disorder? Will this be a chronic problem that will continue throughout his
life?
I would appreciate any information you could offer or recommend.Sincerely, Hope
Answer: Hope-
It can be pretty hard to differentiate Horner's syndrome from uveitis when
it first occurs, so I can easily understand the EVC vet's initial diagnosis.Goldens do seem to be prone to Horner's syndrome. Most of the time it
occurs for no discernible reason and most of the time it eventually clears
up but it may take months, as your vet has said. It isn't actually
necessary to treat for Horner's syndrome but it may make the eye more
comfortable and it usually makes it look more normal to treat.I don't think that it is necessary to see an ophthalmologist for treatment
of this condition but it may be worth a visit to an ophthalmologist if it
doesn't clear up.Horner's syndrome occurs due to damage to the sympathetic nervous system
(part of the autonomous nervous system). The damage can occur in the brain,
in the spinal cord or along the path of the sympathetic nerve after it
exits the spinal cord, travels through the chest, under the front leg,
along the neck, past the middle ear and back to the eye. This makes it
possible for the damage to the pathway to occur in a number of ways. Head
trauma, brain tumors, other brain damage, hormonal illnesses affecting the
brain (hypothyroidism and hyperadrenocorticism have both been implicated),
damage to the spinal cord, chest injuries, chest tumors, injuries causing
pressure on the area of attachment of the front leg to the body, neck
injuries and middle ear infections can all lead to Horner's syndrome.
Thinking about all these possibilities is necessary even though lots of
times Horner's syndrome occurs for no discernible reason.The most common complicating illness is probably inner ear infection. Some
vets advocate using antibiotics or doing diagnostic testing (X-rays or even
MRIs) to rule out inner ear infection as a cause.I don't personally believe there is a strong correlation with
hypothyroidism but this is common in goldens, too. So it might be worth
considering testing for this problem.If, after a careful exam, none of the above problems seems likely, the best
thing to do is wait and see what happens. I think that most of the time
Horner's syndrome does improve on its own. It can take several weeks to
several months.Medicating the eye is supposed to be unnecessary unless the degree of third
eyelid elevation or globe retraction seems to interfere with vision. I have
mostly seen recommendations to use phenylephrine long term when treatment
is necessary.It is possible to partially localize the point of damage to the sympathetic
nervous system by placing phenylephrine (usually 10%) drops in both eyes
and then watching the dilation of both eyes, checking every few minutes for
about an hour. Rapid dilation of the affected eye and slower dilation of
the normal eye is suggestive of a lesion along the path of the nerve
returning to the eye (postganglionic lesion). This can guide further
testing in cases in which there is not a reasonably rapid return to
normal. Ophthalmologists have the most experience evaluating this test and
may have access to imagining equipment that can help to localize the lesions.Hopefully, Midas will have the self correcting version of this problem. If
he does develop balance problems or other signs of neurologic disease
affecting his face, try to rule out inner ear disease. The facial nerve
also is sometimes affected in inner ear disease.Mike Richards, DVM
3/24/2000
Eye removal surgery - calcinosis cutis, Cushing's and Addison's
Q: Dr. Mike Richards
About six weeks ago, my peekapoo, Bitzi, had eye removal surgery. She had developed
glaucoma. She had been blind from cataracts due to diabetes for about two years. We also believe that her diabetes developed from Cushings disease. Bitzi was treated for the Cushings with Lysodren. After her initial dosing phase, she was given an maintenance dose for awhile. After a routine ACTH Stim test, her vet recommended stopping the Lysodren altogether because Bitzi was in danger of becoming Addisonian. So, anyway, after her eye surgery she developed a severe itchy sore on her chin. When this sore did not respond to treatment we did a biopsy on it. The results of the biopsy were that the sore was calcinosis cutis. Bitzi's vet said that calcinosis cutis was caused by Cushings so we did a dex suppression test to confirm. The dex suppression test came back negative. Can you think of any reason that my dog should have calcinosis cutis? Her kidney values are good. She has not been exposed to any chemicals. The only thing that I can think of that has been different for her is she no longer has her eyes. The opthomoligist who did the surgery inserted silicone prosthesis before he stitched her eyelids shut. Also, after her surgery she had a really bad reaction to the morphine type pain-killer she was prescribed. We are treating her neck with DMSO applications once a day and there seems to be a little improvement. This problem has been very uncomfortable for her and I would like to make it go away. She needs to have some peace and pain-free comfort after all she has gone through. If you have any suggestions I would
really appreciate them. I would do about anything to help her. Our veterinarian is very open to suggestions, also.Thanks for anything you can offer,
CarolA: Carol-
I think with the history that the most likely problem is that the Cushing's disease (hyperadrenocorticism) is still the problem. Lysodren (Rx) kills adrenal gland tissue. If enough of it is given, it will destroy the adrenal gland's ability to produce cortisol and the patient will develop Addison's disease (hypoadrenocorticism). When a dog has hyperadrenocorticism the adrenal glands continue to hypertrophy (to grow) throughout the course of the disease, either in response to a stimulating hormone (ACTH) being produced by the brain or because the adrenal glands are affected directly by cancer. Most vets in the United States try to give enough Lysodren (Rx) to kill just enough of the adrenal gland at a time to keep it functioning at a normal level --- so as the brain stimulates the adrenal gland more, the medication destroys its ability to respond, keeping a balance. In some countries and in some cases in the United States, vets just give enough Lysodren (Rx) to destroy the ability of the adrenal gland to function and then treat the patient for hypoadrenocorticism (Addison's disease).
Your vet elected to stop short of killing the adrenal gland. The adrenal gland was very suppressed but would still be stimulated by the brain or cancer to grow and produce more hormone. Even though it has taken some time, it is likely that she now has hyperadrenocorticism again. Of course, there is no way to be sure of this except by repeating the lab tests (dex suppression or ACTH stimulation). It seems to me that would be a good idea at this point. If the tests do not support a diagnosis of Cushing's disease it may be necessary to think through the problem again.
To the best of my knowledge, calinosis cutis only occurs in response to Cushing's disease. So it is a pretty good hint that the problem has returned.
Mike Richards, DVM
4/20/99
Question: hi - i got into the cybervet because i have a 13 year old westie who is
now crying after she eats. she walks around with her pillow in her
mouth wailing for @ 15 minutes, no matter how much food i give her (tsp
or plate). she has been to the dog psychiartrist in the past for faking
limping, but i would never forgive myself if she had a stomache problem
and i dismissed it for that. also, she has a malignant tumor in her arm
pit 1.5 years ago, so i wanted her checked out. my regular vet in on
vacation until 8/11 so i took her to the associate who said she was
faking for attention. i am not comfortable with this, so i am taking
her to the regular doctor when he returns. do you think this is a real
problem? please help!!!
Answer: Lynne-
You should watch very very carefully for signs of swelling around either
eye with the symptoms you are seeing. There are a number of potential
causes for pain around the time of eating but the most serious one is a
retrobulbar abscess, or an abscess that forms in the space behind the eye.
These can cause serious problems fairly quickly, including blindness and in
severe cases, death. In most cases, dogs with retrobulbar abscesses are
really pained by having their mouths opened -- some dogs refuse to allow
this and others just scream when someone attempts to open the mouth beyond
a certain point.Our dog had a retrobulbar tumor and had similar signs -- but she would
open her mouth part way before it hurt. She continued to eat but sometimes
acted as if she was in pain afterwards. So this would be a concern, too.Dogs that have periodontal disease will sometimes have pain but I can't
recall a patient having severe pain for fifteen minutes after eating.Dogs with marginal liver function can have behavioral changes associated
with the period immediately after eating. In severe cases this can cause
severe neurologic signs, including stupor or seizures.Older dogs get a condition known as canine cognitive dysfunction that can
cause odd behavioral signs. We have one patient in our practice who wailed
for ten to fifteen minutes at a time, several times a day who responded
well to selegiline (Anipryl Rx), the medication approved to treat this
condition.Gastric problems are conceivable, as well.
Westies are prone to craniomandibular osteopathy. If she had difficulty
with this as a puppy, there is some chance that she has arthritis in the
mandibular joints now. This can happen without having the craniomandibular
osteopathy, too. Recognizing TMJ in dogs isn't easy, since they can't
complain effectively.I think that it is worth continuing to look for a medical cause of this
problem, personally. I am sorry that the list of differential diagnoses for
the symptoms is long enough to make it difficult to search through. Please
keep checking to be sure she can comfortably open her mouth and that there
is no visible swelling around one eye. If these signs develop, don't wait
for your regular vet.Mike Richards, DVM
8/5/99
Q: Background:
Since the rescue, our Lhasa has given me 8 wonderful years of companionship
and I love her so much it hurts. She has also had a cancerous tumor
removed from her vaginal area (she was spayed during this surgery) and
flank area. She's been lethargic all day, but will take water.QUESTION: She also has isochoria (my spelling is off - one
pupil is larger than the other. Vets think it may signify a neurological
problem) What do I do first? I am so worried!!!!!!!!!!!
A: Steve or Pam-Anisocoria is the name for the symptom of one pupil being larger than the
other one. It can occur for a number of reasons, including:brain disease/brain injury -- trauma, brain cancer, central nervous system
infections, systemic infections affecting the brain (feline leukemia virus
infection is one example, but not in a dog)autonomic nervous system disorders -- dysautonomia, peripheral nerve
injuries, Horner's syndromeeye injuries - uveitis, keratoconjunctivitis sicca (KCS), iris
degeneration, adhesion of the iris to the lens, glaucoma, ocular painmedication or drug effects -- there are several eye medications that can
lead to this effect and organophosphate poisoning may cause thisI think that anterior uveitis (eye inflammation) is a fairly common cause
of this condition that is easily overlooked. I tend to send my patients to
an ophthalmologist when this problem occurs but I have the advantage of
having an ophthalmologist practicing within an hour drive from my office.Anesthesia can lead to weird side effects at times and given the recent
surgery this seems possible, too.Having the tumor examined by a pathologist would be helpful since it may be
benign, which would lessen the worry of metastasis to the brain. Was this
done?There was an article on localizing the lesions associated with anisocoria
in the Compendium on Continuing Education in May of 1995. If your vet
subscribes to this journal the article may be helpful.Mike Richards, DVM
Optic nerve hypoplasia/micropapilla
Q: I have a Sheltie puppy who was checked by a certified canine opthamologist and was diagnosed as having optic nerve hypoplasia/micropapilla. What is this condition? What are the recommendations for breeding? Lyn
A: Lyn- I am not an ophthalmologist so there is some chance that my understanding of these conditions is not entirely correct, but here goes. As far as I can tell, optic nerve hypoplasia is one condition and micropapilla is another unrelated condition. They are supposed to be very hard to tell apart on an ophthalmic exam according to Cynthia Wheeler (Handbook of Small Animal Practice, Rhea Morgan editor, Churchill Livingston pub., 1992). They do have significantly different effects on vision, though.
Micropapilla is a small optic disc (site of attachment of the optic nerve to the retina) without blindness.
Optic nerve hyoplasia is a smaller than normal optic nerve which does cause blindness in the affected eye or eyes. If the other eye is normal the blindness may go undetected. Optic nerve aplasia occurs when the optic nerve is not present at all. It is probably best to avoid breeding a dog with optic nerve hypoplasia or aplasia as these may be genetic in origin.
So, if your dog is blind in one or both eyes then breeding would be questionable. If not, it is harder to give you advice. I tend to fall back on the standby logic that the dog must be very good in some or several other aspects that are important to improving the breed to justify breeding when there is a known defect with an unknown heritability.
One thing about CERF exams -- there tend to be a lot of unanswered questions when many dogs are examined in a short period of time at a show or other gathering. I think that if there is any question of an ophthalmologic defect it pays to schedule a more private appointment with an ophthalmologist and to come with a list of questions you need answers for. It is worth paying for the visit in most cases.
Hope this helps.
Mike Richards, DVM
Q: Dear Dr. Mike - I have a barely 6 year old Pug who suddenly went blind. We have taken him to two different vets and a neurologist. He has also been seen while at the neurologist by an ophthalmologist. He passes their physicals and examinations. Shows no signs of head trauma and did not react to medication either. He has passed all basic blood work. He even had a spinal tap, which showed no traces of virus' and his protein levels were very average, which I believe would not be the case if he had a tumor. His eyes appear to be a good condition; though I guess there is a possibility he has SARDS, but it just not showing any signs yet. His appetite has grown and so has his thirst. He is gaining weight too. He does lose control of his bladder and bowels, and it just happens like he didn't even know it was coming. Though I must admit that the bladder/bowel issue has gotten better by 100% over the last week. He was lethargic, but is doing much better in that area too. We have had him on Amoxicillin 250 mg for about 12 days now. We have only known about his condition for about 1 month. He went blind extremely fast. Today he underwent the 8 hour test for Cushing's. So, my question is has vision loss ever been a symptom of Cushing's? Does his other symptoms or lack of symptoms sound like Cushing's or anything else that you can think of? I get the feeling that no matter what his problem is, his vision is most likely permanently gone...do you agree? Thank you for your help, Alex
A: Alex- I think there is a relationship between SARDS and hyperadrenocorticism and so there would be a connection between Cushing's and blindness. Dogs with SARDS tend to have other clinical signs of Cushing's disease including increased drinking, increased urination and increased appetite. The blindness has no obvious cause on ophthalmologic exam. I am not sure exactly what is known about the cause of the blindness in SARDS other than this connection. There is probably a small chance that a pituitary tumor causing Cushing's disease could impinge on the optic chiasm and cause blindness but this doesn't seem to happen very often in dogs. I am not aware of any treatment for this condition and have not heard of sight returning. Oh, one other thing I just thought of. There is some chance of hypertension associated with Cushing's disease leading to retinal damage and blindness and cataracts are more common in dogs with Cushing's disease but these things have obvious clinical symptoms on an exam.
Mike Richards, DVM
Q: Hi Dr. Mike, I have a 10 year old Shih-tzu and 2 days ago he woke up with his eye-lenses covered with a gray cloudiness. I thought it was cataracts. I took him to his vet and they told me that it was not cataracts, but something to do with the blood vessels in the lens. They didn't give me any good explanation. They gave me a prescription of Gentocin Durafilm Eye drops to give him 4 times a day. The drops already seem to be working a little. I'm wondering if he got this cloudiness from the sun that we have been having lately, or the fan in my room, since he doesn't have hair over his eyes like Shith-tzu's are supposed to have. He has been vomiting allot also, and he hasn't been eating very much. Could he just have allergies? Could it be from the sun? Could it be from the fan? Desperately Wondering, Ryan
A: Ryan- I can not tell from your message what is going on, or what your vets are thinking about. It is important with eye diseases that you do understand what is happening. Hopefully, you have been able to come to a better understanding by now with your vet's help. If not, please ask for referral to a veterinary ophthalmologist or seek a second opinion if you just can't get an understanding of what your vet is saying. There are some clients who I just can't communicate effectively with. Everything I say to try to make things clearer just causes more confusion. Once in a while, I just have to ask one of these people to get an opinion from another vet in a hope that they will find someone who can explain the problem to them.
I have had the same problem with an accountant. I really liked my accountant and he helped me a lot with some non-accounting problems but we couldn't talk about accounting issues because I didn't understand him well. So now we're friends but I use a different accountant.
Hopefully all is well and this advice is unnecessary.
Mike Richards, DVM
Chronic conjunctivitis in Bullmastiff
Q: I adopted a Bullmastiff about 5 months ago. I took him to the vet right away for a health exam. I was told that the dog had conjunctivitis and that this condition is common in Bullmastiffs. I was given a cream to treat his eyes, but it doesn't seem to help. Do you have any suggestions?
A: I think you should ask your vet to refer your mastiff to a veterinary ophthalmologist. Conjunctivitis that does not respond to treatment often has an underlying cause like entropion (rolled in eyelids), ectropion (rolled out eyelids), tear film deficiency, or other eyelid abnormalities. In addition, allergies can lead to a chronic conjunctivitis in dogs that is difficult to control. Finding out what is going on is important. Your vet may be able to tell on a re-exam if one of these problems is present -- if so, the referral may not be necessary.
Mike Richards, DVM
Q: Dear Sir, The other day I bathed my Yorkie and soon afterwards we found that his right eye began to swell, discharge, and began to remain shut. There was also some discharge from the left eye but not as pronounced. We called our vet and was advised to flush the eye with saline solution which we promptly did. After washing the eye with saline the eye would open up some. It is now the 2nd day and the eye is still discharging and has a blue tint. The left eye has cleared pretty well. We tried looking for dialation in the right eye but was not able to detect any. We are sickened by the fact that our Yorkie may have been blinded in one eye. His behavior on the first day was laying around and laying on his affected eye. The 2nd day he does not appear to have as much discomfort but the eye is still discharging and cloudy blue in color. Is it possible that Dog shampoo can actually cause blindness? Is it possible that vision may return to this eye? What other alternatives or treatment plans can we initiate? Your prompt attention to this matter would be greatly appreciated. Bob and Jan
A: Bob and Jan- Anytime the clear part of the eye turns blue it is extremely important to see your vet. This can be an indication of corneal ulcers, glaucoma and cataract development (doesn't really cause corneal cloudiness but many people confuse these appearance). Corneal ulcers can perforate in a very short time. Almost any irritant can lead to an ulcer, either through direct action or because the dog scratches its eye in an effort to relieve the itch or burn of the irritant. I am hopeful that you did see your vet and that your Yorkie is now OK.
For future reference, it can help to put a small amount of sterile lubricant in the eyes prior to bathing. For dogs that are prone to eye irritation from shampoos this can help prevent problems. Your vet can supply you with this if you ask, probably.
Mike Richards, DVM
CERF testing - eliminating inherited eye disorders in purebred dogs
Q: Dear Dr. Mike, Our family has three miniature schnauzers which are loved pets. Their ages are three, two and almost one year. They are very healthy in all ways. Lately I have been online on the Schnauzer Bulletin Board at Frank's World and The Hoflin List for schnauzer owners and breeders. I have not bred my dogs, but may breed the young almost year old male in the future. The breeders and showers of miniature schnauzers are so adament about having the dog's eyes tested (CERF) by a veterinary opthamologist every year. I called my vet here in Huntsville and he said he hadn't heard of PRA in schnauzers and didn't know about the test. So, I called a more recent graduate of A&M, here in town, and he hadn't heard of it. He in turn called a colleague in Humble, north of Houston, and he hadn't heard of it.
My vet says it probably is just an elective test.. Also, the test can only be done by a veterinary opthamologist - not a general veterinarian. I related this information to the breeders and showers, and they basically said that these vets were uninformed any any responsible schnauzer owner should have this done. I feel I am responsible and now wonder what all the big deal is with these people. They say they do it to keep from passing on the bad genes. However, I understand that a dog can come up clear for years, be bred, and then years later come up with the disease. So, how does all this testing really help? Also, I've checked out sites on the web explaining PRA and the CERF test, but I can't see where it is recommended for schnauzers in particular. Sincerely yours, Carol
A: Carol- The Canine Eye Registry Foundation (CERF) is an organization devoted to tracking and hopefully eliminating inherited eye disorders in purebred dogs. Any ocular disease that is heritable is of interest to them, not just progressive retinal atrophy (PRA). The importance of CERF testing probably does vary a little from breed to breed but almost all breeds have an eye problem they are prone to. Miniature schnauzers are susceptible to congenital cataracts that are believed to be passed genetically through an autosomal recessive mode of inheritance.
If you would like more information about CERF and their registry, you can contact them by writing to them:
Canine Eye Registration Foundation (CERF) 1235 SCC-A Purdue University West Lafayette, IN 47907-1235
It is true that the ophthalmologist may examine a dog that does not have a visible condition at the time of exam. This is particularly problematic with cataracts which tend to show up during middle age after many dogs have been bred several times. Despite this, an attempt to help limit the occurrence of heritable diseases seems worthwhile, even if it isn't perfect. I do not know the situation in your area but CERF exams are often done in conjunction with things like dog shows in our area and area usually pretty reasonably priced. The only reason I can see to certify a dog that won't be used for breeding is the opportunity to have an eye examination done by a board certified ophthalmologist at a reasonable price.
Mike Richards, DVM
Uveitis and generally poor condition
Q: First, I would like to commend your work on a tremendously informative website.Wish I could have found it sooner. I have a problem with my buddy Stosh. He is an 11 yr old short hair terrier mix. A little lap dog. He was having problems holding food down, and eating in early february, while developing a white pusy discharge from one eye, that had a droopy eyelid. Also noticed hair on hind quarter getting 'thin', which after reading through other Q&A's might be called bleaching. Took him to the vet. Left blood, stool, exam. No diagnoses. Blood, stool sample, come back 'negative'. Back to vet, getting worse. Perhaps infected tooth below eye. Tooth gets pulled. Surgical center that pulled tooth diagnosed uveitus. Post surgery trip to vet, got meds for uveitus. Drops and pills. No real change. Coat is now totally thinned, he has lost alot of weight, has no appetite. Eyes are glassy, has problems walking (seems achy in rear ), coordination is off. His hair is falling out like crazy. He is in real sorry shape in such a short time. Are these the symptoms for MG, hypothyroidism, or should I have him tested for erlichia?
A: Uveitis is often associated with a systemic illness leading to immune system problems in older dogs. Unfortunately this can be almost any systemic illness, although infectious diseases like ehrlichiosis, fungal infections, leptospirosis and others have most commonly been associated with uveitis. It can occur secondarily to cancer in some cases. There is a condition "uveodermatologic syndrome" in which uveitis and skin disease occur together (usually affecting mostly the face) but this usually occurs in young dogs of the northern breeds (Akitas, Siberian huskies, etc.). Hormonal diseases may be able to induce uveitis, too. Uveitis also occurs for no discernible reason in dogs.
It is a good idea to make sure a good ophthalmic exam, general bloodwork and chest X-rays are done on any dog with uveitis. It is a lot harder to figure out which infectious diseases to test for but eliminating the fungal, parasitic, viral and bacterial possibilities that are common in your area may be worthwhile.
Most of the time, vets like one disease that explains all the symptoms but that might not happen in your dog's case. Hypothyroidism and Cushing's diseases might cause both the eye and skin signs and dogs with cancer can have almost any set of clinical signs but it is more likely that there is a second disease causing the skin symptoms. There are a lot of possible causes of skin disease. Allergy is the most common cause of hairloss in my practice area, followed by parasitic skin disease -- but then there are a lot of other possible causes.
Keep working with your vet to find a diagnosis -- it may be hard to do but it is worth the effort.
Mike Richards, DVM
Sudden Acquired Retinal Degeneration - SARDQ: My dog is 6-7 years old. She is a Cockapoo. About a two months ago her appetite increased dramatically and she has gained at least 7 pounds. I have taken her to the vet serveral time and ended up at the ophthalmogist. She seemed to go blind in just a few days. The ophtalmogist believes that my dog has Sudden Aquired Retinal Degeneration (SARD). The electroretinogram (ERG) results were not conclusive. The ERG did show some activity to light. Now the doctor is not positive that it is SARD but the increased appetite and the sudden blindness points to SARD. At this point they do not believe that the problem is in the brain, because the retina is damaged.
The doctor put my dog on a low dose of cortisone. I am giving her vitimins specifically for vision problems, along with garlic, MSM, and cod liver oil. (She is so hungry she'll eat anything).
My questions: What else could this problem be? What else can I do for her blindness? What can I do for her increased appetite?
She has had her blood tested two times and everything looks normal. Physical exams seem normal. Her feces test was also O.K. The vets do not know what to do for her at this point but I want to do anything I can to help her. Can you help? Your response would be greatly appreciated.
A: I only have two references at home for this problem ( I tend to answer these questions at night when I'm not at my clinic). Both of them mention that SARD is more common in overweight, middle-aged, spayed female dogs. Neither of them says anything about an association with an increase in appetite, though. This may be a sign that the ophthalmologist is familiar with that just hasn't made it into print.
If you are not absolutely certain that the blindness is sudden onset, it seems possible that it may be progressive retinal atrophy (PRA) instead of SARD. It can be really really hard to recognize the initial onset of blindness. My own dog had PRA and we knew it, but were taken by surprise when the ophthalmologist said she had been blind for at least six months prior to our visit with her! We really thought she just had diminished vision. Poodles are prone to this problem and so are cockers so it seems likely that cockapoos might be, too. In PRA, the ERG tends to be diminished but present, while in SARD it tends to show total inactivity of the retina. I am not an ophthalmologist by a long stretch, so I'd definitely put a lot more weight in what the ophthalmologist says about all of this!
Why would your dog suddenly have an increase in appetite? I'd worry about Cushing's disease, diabetes, pancreatic insufficiency if there is diarrhea or loose stools and other systemic illnesses. In a cockapoo, I think it would be worthwhile to rule out Cushing's disease if routine bloodwork shows no other obvious problems. It takes testing specifically for this disease, but it is pretty common in middle-aged, overweight, female dogs. If she does have Cushing's disease it can be treated. Most dogs with this condition are also drinking and urinating more than normal.
There is nothing I know of that can be done for PRA or SARD. The best thing to do is help her adapt to the blindness if these problems are present. Don't move your furniture too often. Fence in your yard or walk her on a leash so that she is safe. Feed her in the same place all the time. Dogs adapt amazingly well to living without sight. My dog was blind for 6 years and very few people who came to our house noticed. She did just fine as long as she stayed in familiar surroundings.
Mike Richards, DVM
Q: Dr. Mike, I have a fourteen week old black male labrador. He seems to be doing fine, but his pupils seem to be extraordinarily large as compared to my other lab. Is this unusual? He does not seem to have any noticeable problems with his vision. I'm just wondering if this is a symptom of something like PRA, or if he could have some problems in the future. I'm probably just an overly worried parent. I would appreciate any thoughts you might have!
Thanks for the help!
A: This is one of those times when over-the-computer advice just doesn't work. You need to find someone who can see your pup's eyes to evaluate what it going on. I do think the odds are very good this is normal. In Labradors, progressive retinal atrophy (PRA) generally shows up at about 4 years of age, so your pup is too young to be worrying about it, probably.
If there are any other signs of visual problems at all, take the puppy to your vet as soon as you can. If not, mention this on the next visit for puppy vaccinations.
Mike Richards, DVM
Last edited 05/06/05