Ophthalmology Conundrum

by Shannon Gaffaney

What is Wrong with This Eye? 

      

What are your first thoughts? 

  1. Glaucoma 
  2. Retrobulbar space occupying lesion (neoplasia, granuloma, abscess) 
  3. Intraocular mass 

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Miss Tabby is a 5 year old Female Neutered DSH 

Reason for presentation: 

She was presented to MGR for concerns about her right eye exophthalmos and epiphora which had developed over 24 hours.  

Relevant history: 

Tabby was initially seen by her regular vet for concerns about 3 days of mild lethargy, poor appetite and intermittent epiphora of the right eye. She was given a metacam injection. She improved for about 24 hours but was still off form; she returned for a recheck 2 days later. Her right eye looked swollen and her intraocular pressure was found to be 36 mmHg. She was started on trusopt and gabapentin, and a referral was arranged for the following morning. 

Clinical exam: 

Right eye: 

  • Marked exophthalmos with prolapsed third eyelid 
  • Superficial corneal ulcer centrally, lagophthalmos 
  • Conjunctivitis, chemosis and episcleral congestion 
  • Epiphora 
  • Mild miosis 
  • Visual 
  • IOP 45 mmHg 
  • Temperature 40* 

What would you do next? 

  1. Blood work 
  2. Ocular ultrasound 
  3. X-ray skull 
  4. CT skull 

      

Blood work: 

  • No significant abnormalities 

CT scan: 

  • Retrobulbar space occupying lesion- suspected abscess, no foreign body found 

GA and oral exam: 

  • Found a swelling caudal to the right upper M1 tooth 
  • Lanced and drained abscess material- sampled for bacteriology 

Culture abscess material: 

  • Pasteurella 

Diagnosis: 

Retrobulbar abscess of the right eye 

Medical plan: 

  • Amoxyclav twice daily for two weeks 
  • Meloxicam orally once daily 
  • Gabapentin twice daily for 3 days 
  • Corneal lubrication and management of the corneal ulcer 

Outcome: 

There was a slow reduction in the periocular swelling with full resolution by  Tabby’s 2 week check-up. The corneal ulcer healed quickly once the ocular swelling reduced and the eye could close completely.