The take home essentials from Robin Stanley’s talk to the AVA Victorian Division meeting. If you were not able to attend this fantastic meeting in the Yarra Valley, then here are the important points in dealing with geriatric eye problems.
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OLDER CATS
Dilated pupils, poor vision, or blood in an older cat's eye...
Think Hypertension
Most older cats have high blood pressure. Always check the fundus in ALL cats over the age of 10 years - if you see any haemorrhages or exudates in the tapetum this means that you should be measuring the blood pressure.
Early treatment with amlodopine will save vision!
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Iris pigmentation that is growing, is a dark blackish-brown color suggests a diffuse iris melanoma (DIM). Small lesions can be lasered, but larger lesions need to have enucleation as DIM has a high mortality rate.
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Think entropion in older cats presenting with mucoid ocular discharge, especially those that have had weight loss. Enophthalmos can cause the lower lateral lid to roll in.
OLDER DOGS
Most older dogs have cloudy eyes. Most of the time this is normal lens ageing. Remember that vision is normal in these cases. To differentiate between senile nuclear sclerosis and cataracts is not always easy. For more information see our first PONG (Practical Ophthalmology for the New Graduate) newsletter.
Eyelid lesions in older dogs will need to be removed if they are causing irritation. Check the cornea and conjunctiva for blood vessel formation and or pigmentation.
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Corneal oedema may be seen in older dogs as the corneal endothelial cells degenerate. These cells acts as pumps to keep the cornea dehydrated. Topical hyperosmotics such as 5% Na Cl may help. In severe cases there is a new surgery that can be considered to try and improve vision.
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Corneal lipid in older dogs should be treated with topical Cyclosporin. As these dogs age the lipid can become calcified, become fragile and suddenly create a very deep ulcer. Treatment can reduce the amount of lipid and calcium degeneration in the cornea, greatly reducing the risk of deep, painful corneal ulceration developing.
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Older Cocker Spaniels and Basset Hounds can present with irritated eyes because of ptosis – droopy upper eyelids. Their large ears end up dragging the face down onto the eyes. These dogs often have a secondary dry eye. With an upper eyelid lift these dogs are a lot more comfortable.
