Presenter – Pip Boydell CertVOphthal MRCVS, Co-founder and Senior Clinician (Neurology and ophthalmology) at Animal Medical Centre Referral Services (AMCRS)
I must apologise for having mentioned on several occasions that I really love interactive case presentations, but last week’s ophthalmological webinar was no exception. Pip Boydell had an infectious and enthusiastic approach that would keep the weariest of vets ‘wide eyed’ and interested with cases ranging from a cat with a perforated cornea to a Jack Russell terrier with an anterior lens luxation. We were all asked to make decisions about cases based on what could be seen as the worst case scenario: it’s the middle of the night and the afflicted pet belongs to our mother in law.
So what would you do with your mother in law’s cat that presented with an obvious perforated cornea in the middle of the night? My first thought was to offer this cat some pain relief, and the response of delegates generally was to suggest the use of NSAIDs or opiates in this instance. Whilst this was part of the solution, Mr Boydell tried to steer us in another direction by asking what was the factor most likely to cause this cat to go blind? The answer he was looking for was uveitis, and in an emergency treating uveits must always take priority.
The administration of atropine to dilate up the pupil was key. Not only would this treat the uveitis but it would also offer significant pain relief. The use of systemic steroids would also be necessary to minimise the effects of uveitis, and by doing this the use of additional pain relief in the form of opiates would be the appropriate option. Using NSAIDS alongside steroids would most definitely not be appropriate.
So we’ve administered the initial treatment, then what would we do? Go straight to theatre? Mr Boydell was keen to stress that as long as there was no fluid actively leaking from this perforation, surgery could wait ‘till morning. By waiting for normal working hours, a successful outcome is more likely to be achieved.
The use of atropine was vital in treating this cat and after listening to the entire webinar, a drop of atropine seemed to be the drug of choice in many of Mr Boydell’s emergency cases. Take the JRT with the anterior lens luxation: Mr Boydell now finds he no longer has to operate on the majority of these cases. By administering a drop of atropine and dilating the pupil, pupillary block glaucoma is prevented. This also gives the lens an opportunity to fall back into its normal position. Following this, the pupil can then be constricted to prevent the lens falling anteriorly by using a topical prostaglandin such as Travoprost.
Mr Boydell also advised to always insist on seeing ocular cases no matter how minor they may seem. He referred to cases that demonstrated the potential danger in leaving uveitis untreated. Dogs are particularly susceptible, and problems tend to arise when dogs suffer ocular trauma but their owners don’t seek veterinary treatment. Unfortunately these cases may present several days later with a sight threatening glaucoma caused by the uveitis. If these cases had been seen quickly and atropine administered promptly this glaucoma may have been prevented.
Mr Boydell’s webinar has significantly boosted my confidence when it comes to treating emergency ocular cases and if I could take home just one key message it would have to be always treat uveitis aggressively and think atropine, atropine and more atropine.
The Stethoscope (MRCVS)
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