Friday, March 9, 2012

Poor Little Faye and her Herpesvirus Conjunctivitis

Faye, I simply love this cat.  Poor little Faye, a patient of mine for a long time, has chronic herpesvirus conjunctivitis.  Her eyes are always red, always inflamed, always runny.    She’s seen the veterinary ophthalmologist a few times, and basically there’s nothing that can be done except to give antiviral eye drops when she has a flare-up, but otherwise, she’ll always have a low level of eye inflammation.  The cat is fine with this.  This is all she’s ever known, and although the eyes are red, they don’t seem to bother her much.

Except today.
Faye’s owner reports today that Faye’s left eye has been really runny and she’s squinting it, and seems really uncomfortable.  Everything else is fine… appetite, thirst, peeing, pooping… all normal.

I looked at lil’ Faye and could see the problem right away.  Faye’s left lower eyelid was rolled inward a bit, and the hair on the skin just below the margin of the eyelid was now contacting the cornea.  Anyone who’s ever gotten an eyelash caught under a contact lens knows that the cornea is loaded with pain receptors, and that Faye was in significant discomfort.  Her eye was tearing a lot, which was the eye’s attempt at flushing out these irritating hairs, but to no avail.  This condition is called entropion, and it will sometimes happen to cats with chronic eye inflammation.

The treatment for entropion is surgical.  You have to roll the eyelid back out, so that the hairs no longer contact the cornea.  Normally, these cats are sent to a board-certified veterinary ophthalmologist, however, I know how to do this surgery, and I like to do them myself.  You see, when I was in veterinary school at the University of Florida, the dean of the school was Dr. Kirk Gelatt.  He is a big-name veterinary ophthalmologist.  He wrote the main text book about veterinary ophthalmology.  So, our ophthalmology department was very well-developed.  In fact, when I was a senior in veterinary school, we had four ophthalmology residents that were being trained.  Four! That’s unheard of.  So, I was very familiar with the condition, and when I graduated, I decided to give these surgeries a try when I was out in practice.  I did a few, and soon got pretty good at them.  Then, when I was at the ASPCA, I was the only doctor (out of the nine that were there) who knew how to do the surgery, so whenever one of the doctors had a case of entropion, they scheduled me to do the surgery. 

I like the surgery because there’s a little “art” to it.  It’s like plastic surgery.  You need to know how much skin to remove so that you roll the lid out correctly.  You don’t want to take out too much skin and over-correct, and you certainly don’t want to under-correct.  Also, you use very thin suture material, as thin as a human hair, and I kinda like working meticulously with such delicate suture.

I explained all of this to Faye’s owner, and he was fine with it.  We’ve been caring for their cats for years.  In fact, one of their cats, Chester, was adopted from us.  Chester was the sweetest, funniest cat, and we were happy to adopt him out to such nice folks, and we love the fact that we still get to see him twice a year for his exams.  It’s always a great day when he comes in. 

Anyway, we scheduled Faye for her eyelid surgery, and things went very well.  I took the right amount of skin, I believe, and the eyelid looked pretty good when all was done.  Faye did NOT like having the Elizabethan collar around her neck when she went home, though.  But she had no choice.  If she were to rub the incision line, she could disrupt the sutures and the surgery would have to be redone.  We weren’t about to risk that.  The sutures were dissolvable, so after about 7 days, there’d be enough healing so that they could take off the collar, and if she were to rub at the incision, it would be unlikely to break open.  So Faye’s gotta deal with her collar for 7 days.  She’ll be fine. 

I’m sure March will bring its share of fascinating cases as well.  As always, I’ll keep you posted.

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