Eye Socket (orbital) Disease (exophthalmos)

[Spoony]

It's been suggested I repost this thread in general due to the light traffic the area I posted in sees. I hope this is OK, perhaps a Mod can just merge the threads.

http://www.dolforums.com.au/topic/253879-eye-socket-orbital-disease-exophthalmos/

Reposted below also

...........

Anyone had this sort of thing happen to their dogs?

My 1 year 11 month old Shar-pei Cross (Dingo...... maybe kelipie, looks like a dingo a bit lol) Chilli, has been diagnosed.

https://dl.dropboxus...1204_073412.jpg

The problem is the cause is unknown. With this issue it is to do with something behind the eye pushing the eye forward, causing bulging eye, plus protruding third eyelid.

Causes are varied and many http://www.critters3...s-in-dogs-2860/

Being past the local vets abilities she's been to the specialist centre (VSS Brisbane (Underwood)........I practically live at the place, my other dog has Lymphoma and goes there for Chemo).

Today they did a local and used an ultrasound finding two areas beside each other behind the eye that were not normal, but were not appearing to be an abscess type infection that could be drained. With this inconclusive info there were not keen to put her fully under and go sticking needles behind into the unknown areas for fluid sample.

For 'more info' they recommended and said an MRI is really the best bet to get an 'idea'. $2000.

Now normally I would have said, yes do this, but my other dog (6 year old Traditional Chinese (bone mouth) Shar-pei) has Lymphoma, and this got me adding up costs, $17,000 (at the same centre) so far so understandably I'm not the most flush in funds these days.

The only alternative given (which in hindsight now the Vet said 'could try') is a course of anti-biotics and anti-inflamitories to see if it helps. There's a 'chance' it could work, as it is the treatment given for some of the causes. But no one sounds very confident in this.

From what I've assessed from the info at hand, an MRI would give a better idea of the issue, but the issue may well be still not treatable or possibly involve major surgery (ie skull/bone grafting etc), or the MRI could still not tell the story.

My logic now being if drugs work or help a bit, it does eliminate a few things on the list that don't respond to the drugs. Though still puts things in a very hard place.

While it's a rare condition keen to hear from anyone that's had experience with this.

[*kirty*]

Sorry to hear about poor Chilli. The most common, and easiest to fix, is some kind of infection or inflammation behind the eye. You could try putting her on a course of strong antibiotics and maybe cortisone. If its an infection or inflammation, it should show improvement within 48hrs. If no improvement within a few days, then you will need to do something more drastic.

If there is persistant swelling behind the eye, there will be pressure/squashing/stretching of the optic nerve and her vision will be affected. You could do the MRI but it might not show much more.

The other option is to just remove the eye, assuming the issue is contained within the orbit. This would fix the problem and relieve the discomfort.

I will mention that we recently saw a case like this and unfortunately it turned out to be lymphoma. There was no other indication that it could be lymphoma, even during surgery (eye removal) we were hopeful it wouldn't be anything too serious.

Good luck. :)

[Spoony]

Thanks for the info. She's now on 1x 20mg prednisone and 2x 250mg amoxicillin per day. The antibiotic dose seems reasonable (last time I was on them, the same stuff just 500mg, though I'm nearly 4x the weight), I think the anti-inflam dose is fairly low though? Harv's had a higher dose of pred before with chemo combined.

I'm so so hoping there is a positive reaction using the above.

Interesting input about removing they eye. I guess going straight in that way and then removing the 'issue' does it all at once and saves a possible non conclusive MRI.

That word lymphoma seems to haunt us though. It was mentioned but they really thought it extremely unlikely at under 2 years of age? Knowing a bit about it now having dealt with Harv's for over a year I didn't even realise it show up in such a place, scary.

[*kirty*]

How long has she been on the meds? As I said, they generally kick in pretty quickly. Fingers crossed it goes away with the meds!

An MRI would be great, but as you said its $2000 and they could end up telling you to remove the eye anyway. If you do remove the eye, make sure it is sent for pathology so they can tell you what's going on.

The poor boy we saw had no signs of lymphoma at all - no swollen glands, well in himself, etc. His only issue was a swollen orbit. But the meds didn't help and his eye got worse. Pathology on the eye revealed the cause and all involved (specialists and pathologists) said it was a very unusual presentation. But anyway, hopefully its not lymphoma. Sorry to scare you.

ETA: There are different doses of pred given for different reasons. When giving to reduce inflammation the dose is lower. When giving to suppress the immune system, the dose is higher. With the antibiotics, you might need to try different types.

Edited December 4, 2013 by *kirty*

[Spoony]

First med's given last night. So I guess by Saturday would hope to see some indication of improvement? I'm certainly hoping.

Yes this is my thoughts on the MRI too. Initially the plan was, Ultrasound under local, if looks like abscess or something the full anesthesia, ultrasound and needle aspire. But while they seen an 'irregular' shaped region they were a bit reluctant to go and and aspirate it. Turning to the MRI as their 'next' tool get get an idea, and aspiration from there. I do wonder sometimes when it comes to specialists who do have all the 'tools' and 'toys' if sometimes they play things too safe? Ie if I live somewhere more remotely, no access to and MRI would they have proceeded differently and perhaps had an answer at reduced cost also?

The case you describe sounds somewhat similar. She's 100% fine, eating, running, chasing, playing, battling harvey, doesn't seem to have any pain.

Thanks for explaining the drug doses, I did a bit of reading last night on the two myself.

While I know they work on referral only, I emailed UQ Vet Centre at Gatton with my situation in the hope they may be able to help, at reduced costs. Website indicates they have CT Scan ability, no MRI though.

[Spoony]

*double post*

Edited December 4, 2013 by Spoony

[*kirty*]

I work at an animal eye specialist clinic. We have an ultrasound but have referred cases for MRI's in the past, but we often have an idea of what the result will be. Lots of people want to do whatever it takes to save an eye, removing an eye is seen as such a drastic action. However sometimes eye removal is the simplest fix.

[Spoony]

South East Queensland based?

Does the clinic focus only on the eye ball itself, or extend to the orbit etc? (The eye services specialist I first saw said he only handles the eye it self).

I hear what you're saying with the whole eye saving, even the internal medicine vet I was talking to when I said, 'wouldn't you just remove the eye to get in and get rid of the problem' responded, no wouldn't be that drastic, would try to/should save the eye.

I guess that's where the use of MRI etc then comes in. Times gone would a vet/surgeon just gone straight in, removing the eye and then working with what they find at a guess?

I am still a bit confused as to why they were so reluctant to take a needle aspiration. Almost everything I've read it's what is normally done irrelevant of the type/level of non invasive scanning done.

The 'reasoning' was 'not quite sure what it is so didn't really want to go poking needles around back there'..... To me, the not knowing part is why it's done?

...............

2nd night of drugs and no real changes, I don't think it's any worse at least. I'm guessing should hope to see some improvement tomorrow arvo?

[*kirty*]

No I'm in Victoria. :) We look at all parts of the eye, including the orbit. It can be hard to access the orbit to do an aspirate. If the dog is uncomfortable (and it must be) and there is no improvement with meds, I think eye removal is a fair decision. Can you post a photo?

[Spoony]

Oh OK, just noticed QLD in your profile bit.

Oddly it really doesn't seem to bother her. Acting normal. I can even pat/scratch her (lightly) on her head just near the bulging and she doesn't care........ us humans really are sooks haha.

To me it looks like the eye is being pushed my out to the side of the head then forward.

Here is a few links to various photos taken today and yesterday. They are full size so you'll be able to zoom up really close (figured the more res the better?) so I wont embed them in here.

https://dl.dropboxusercontent.com/u/30992402/pics/20131204_173940.jpg

https://dl.dropboxusercontent.com/u/30992402/pics/20131204_173938.jpg

https://dl.dropboxusercontent.com/u/30992402/pics/20131205_182045.jpg

This one looks most exaggerated, due to flash/darkeness behind

https://dl.dropboxusercontent.com/u/30992402/pics/20131204_172604.jpg

Reference photo from when I first picked her up about 5-6 months ago. As you can see that eye has always wept a bit at times (comes and goes)

https://dl.dropboxusercontent.com/u/30992402/pics/HARVEY%20CHILLI%20TRIP%20HOME%20LUNCH.jpg

Also note that my initial thinking when it first showed up was trauma. She looooooooves to run through the bush, and the 3rd eyelid came up that night straight after she'd taken off for a bit of a scamper late that arvo. No other signs of trauma or pain though. As I think I mentioned I'm sure I did see a scratch in the eye just after that though.

This was take a bit over 2.5 weeks ago

https://dl.dropboxusercontent.com/u/30992402/pics/20131115_062233.jpg

Thanks heaps for your advise and information too by the way :)

Edited December 5, 2013 by Spoony

[*kirty*]

It doesn't look anywhere near as bad as the lymphoma dog we saw, so hopefully its not that. :) There doesn't look to be too much swelling around the eye, just behind it. So hopefully it is just an infection or cellulitis type thing. I'll cross my fingers for you. :)

ETA there doesn't seem to be much discharge which usually happens with an infection. So it could just be a random inflammatory issue. Sometimes foreign bodies can track behind the eye (like a grass seed) but again you woukd expect mucky discharge with that.

Edited December 5, 2013 by *kirty*

[Spoony]

Cheers. Yeah I've seen some scary pictures searching the net.

I guess I'm probably overly paranoid too with Harvey's (my other dogs) Lymphoma now advancing faster and fast (maybe a month or few left) thinking the worst etc given the bad luck haha.

Drug's will kick in and by tomorrow night should see it coming down..... there all fixed ;) lol.s

Edited December 5, 2013 by Spoony

[Guest Ams]

All paws crossed here, hoping the drugs kick in and it gets fixed soon.

[Spoony]

Seems the antibiotics and anti-inflammatory drugs are sadly having no effect. While not a huge amount worse, I still think the eye is now pushing out more than on Wednesday. More out to the side than forward at all.

She get's looked at again on Tuesday (Harv's usual visit day). Will discuss all possible options. Not sure if they see just going straight in to 'remove' the issue with the possibility to remove the eye if required as an option on their end though.

I've been in contact with UQ Gatton, they may be able to help if need be, though their 'rates' are generally similar to specialists anyways. However they can do a diagnosis using the CT Scan equipment, and I guess from there can enact a 'fix'. Though I do realise CT Scan is not as good as and MRI for tissue type issues like this? $1000 vs $2000 though. I fell petty/pathetic as comparing such costs lol.

The things now know are:

Third eyelid first sign of problem straight after running through the bush

Fairly certain the eye was also scratched (saw this 3 days later)

Taken a few weeks for eye noticably bulge

Antibiotics/Inflammatory drugs appear to have no effect (so not infection related?)

There appears to be not pain or anything my than visual effect on Chilli. She still is acting and eating 100% normal and no level of normal touching anywhere produces pain response.

I thing the 'trigger' is trauma related, impact to the eye and or head or something in through the eye.

(If I can get the vet to agree, my house insurance has accident cover for the dogs which should help/cover this)

..

Oh of interesting note also, the eye does seem to produce a slight odour. Hard to to describe but it's definitely there vs the other eye, not sure what that could mean/indicate.

Edited December 7, 2013 by Spoony

[persephone]

If there is an infection .. that prescribed antibiotic may not be the right one to kill it .

there may well be a foreign body encapsulated behind the eye ...

I hope you are firm on Tuesday ..and get some answers.

Glas she's not in obvious pain though :)

[*kirty*]

There could be a foreign body behind the eye, but *generally* there would be more discharge and pain. I personally doubt it is linked to the incident a few weeks ago. There is no sign of injury or inflammation to the cornea from what I can see in those photos. I hope you get some answers on Tuesday.

[*kirty*]

Any updates?

[Spoony]

Actually just got home from the specialists, thanks for asking.

It's progessed a little worse of the past week, so the drugs at antiinflammatory levels with antibiotics seems to have not worked.

Given this, the progression over a month is fairly slow, pain still isn't presenting and her young age it does indicate to have a few things very unlikely and the vet and oncology (harv went for chemo to so could chat to them also haha).

Lymphoma and Mast Cell Sarcoma (the more common cancers in young dogs),unlikely as the speed of progression is perhaps too slow.

No pain and lack of drugs doing anything indicate an abscess isn't likely.

That and the scan didn't show a clear distinct mass, irregular as mentioned.

The possibility was bought up by the eye expert there that it could be an autoimmune response going on, not well documented but he had seen cases before.

For 5 days will try double prednisole (20mg twice a day) to knock down immune system and see if it has an effect. Antibiotics will stay on just in case.

I'm hopefully seeing a friends vet tomorrow whom does surgery involving eyes and surrounds to get a second option.

[Spoony]

I typed all that on the phone so sorry for bad English/grammar haha

[Guest Ams]

Thank you for the update. Paws crossed the increase in pred will make a difference. Please keep us posted with her progress. Sending good healing vibes your way.