Ocular Disease – From Cradle to Grave

Presenter: Dr David Williams MA CertVOphthal PhD VetMD CertWEL FRCVS, The Queen’s Veterinary School Small Animal Hospital, University of Cambridge

Dr David Williams lectured on the subject of brain pathways when I was at university, and his ability to explain such a complex topic in an interesting and engaging way never ceased to amaze me. There was no change in Dr Williams’s style when he led last week’s webinar renamed from ‘Acquired Ophthalmic Diseases of Paediatric and Geriatric Patients’ to the more headline grabbing ‘Ocular Disease – from Cradle to Grave.’

Dr Williams started this webinar from the very beginning of an animal’s life and explained how, within the developing embryo, the eye forms as part of the brain. Problems during this process can arise, causing conditions such as anopthalmus and colobomas which can develop in the optic nerve of collies and the eyelid of cats. The presence of hair growing where the cornea should be is a condition known as a dermoid and can also develop as a result of inappropriate embryo development. Dr Williams explained that treating a dermoid is actually relatively simple and involves undermining the section of hair away from the cornea using corneal scissors.

The other end of life can bring a whole spectrum of further problems. For example blockage of the nasolacrimal duct is frequently encountered in dogs with watery eyes, but how can we tell this apart from dogs with over production of tears? Dr Williams explained that tear over production is likely to be secondary to some form of irritation, and this would be physically manifested in the animal as blepharospasm (of course there should be no pain associated with a blocked tear duct). Dr Williams also advised on those highly frustrating cases of older dogs coming into practice with a mucky eye and no matter how many different types of topical antibiotics you administer (even if they are based on culture and sensitivity results), there is little improvement. This could be due to a dacryocystitis where topical antibiotics are just not reaching the source of infection. Dr Williams advises always flushing the nasolacrimal punctum in these cases and more often than not you will see a ‘wriggly worm’ of pus emerging from the tear duct.

Dry eye is another common problem in older dogs and Dr Williams asked us to leave our eyes wide open without blinking to experience the irritation caused by tears drying up. This certainly gives you a sense of how dogs with dry eye must be suffering, and understandably he recommends enucleating end stage eyes with chronic corneal scarring and a tear production of zero as they are very unlikely to respond to any of our standard treatments. However if owners are against enucleating Dr Williams recommends using long lasting viscous gel three times daily in affected eyes.

This webinar was a whistle stop tour of ocular disease, from the young to the very old and Dr Williams’s infectious passion and enthusiasm for this subject matter has a way of turning standard diseases into fascinating conditions and makes watching this webinar a must for all of us.

The Stethoscope (MRCVS)

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