Update On Katie's Eyes

[philospher77]

And the diagnosis is very very very very mild pannus in the right eye. Did I say very mild? It's at a level where the opthamologist wasn't quite sure that it is in fact pannus, but is seeing a very small area of vascularization, which not likely to be anything else. So I have drops to use in that eye for the next 4 weeks, and then in for a re-check to see how things are going. If it is in fact pannus, this is early enough that I don't think that it is going to cause any issues, and the drops will just become part of the routine.

 

Slightly more disturbing is that there is "very mild crystalline corneal degeneration" in both eyes, i.e. fat and calcium deposits. This is apparently not uncommon with pannus, but it does seem a bit odd that it is in both eyes if the pannus is currently only affecting the right eye. However, this can apparently have several causes, from pannus to metabolic disorders to simply being "one of those genetic things". Right now they are very mild, and not bothering Katie any, so we are going to take a watch and see approach. I didn't ask, but if it is related to the pannus, I am assuming that getting that under control would also keep these from progressing, right? He said that if the deposits get too bad and start limiting vision, they can be surgically removed (essentially, it sounds like they scrape them off the eye ), but for now that would be overkill.

[Guest LindsaySF]

I remember the photos you posted! I'm surprised that they said it was Pannus. Glad you caught it early.

[seeh2o]

My boy has perilimbal lipid keratopathy, it started with hazy rings around his corneas. Once we tested him for his thyroid and began to treat him with Soloxine his eyes got a lot better. Have you had her thyroid checked? Carl was misdiagnosed with Pannus by several vets (including one who promoted himself as an eye expert). He is receiving no eye drops for the condition (he had received tacrolimus ointment, had a terrible reaction to it, then a terrible reaction to cyclosporin ointment both from the "eye vet"). I'd be happy to email you pictures of his eyes for you to take a look at. You can't PM me yet (you need 50 posts in order to PM).

[philospher77]

I'd love pictures, and I am going to talk to my vet about the thyroid tests. I'm pretty sure we checked them before putting Katie on the Elavil, and that it came back greyhound-normal, but it's worth another check, since that was mentioned as a potential cause of the deposits.

 

And, in the pictures, what you are seeing are the deposits, which is why it doesn't look like pannus in them.

 

And finally, this is part of the problem with being proactive and trying to catch things early... it's at a stage where the symptoms are just beginning to show, and there are, unfortunately, often many diseases that have overlapping symptoms. So you assume "horse", not "zebra" (in other words, go for the most likely and common illnesses first), and see what happens. Which is statistically going to be the right decision, but can mess things up if it is a zebra.

[seeh2o]

I'd love pictures, and I am going to talk to my vet about the thyroid tests. I'm pretty sure we checked them before putting Katie on the Elavil, and that it came back greyhound-normal, but it's worth another check, since that was mentioned as a potential cause of the deposits.

 

And, in the pictures, what you are seeing are the deposits, which is why it doesn't look like pannus in them.

 

And finally, this is part of the problem with being proactive and trying to catch things early... it's at a stage where the symptoms are just beginning to show, and there are, unfortunately, often many diseases that have overlapping symptoms. So you assume "horse", not "zebra" (in other words, go for the most likely and common illnesses first), and see what happens. Which is statistically going to be the right decision, but can mess things up if it is a zebra.

So very true. Here is a link on Picassa to pictures of Carl's eyes, progression from 2008 until last year (I need to take some updated pictures and include them).

 

Carl's thyroid numbers in October 2008 (before we started treating him with Soloxine):

Test Requested-----------------Results---------------Reference Range in 2008---------Reference Range in 2011

T3(RIA)---------------------------71---------------------50 - 150 (sighthound)-----------------35 - 70 (sighthound)

T4(RIA)---------------------------.67--------------------1 - 3 (sighthound)----------------------1.0 - 2.0 (sighthound)

Free T3---------------------------3.9--------------------1.7 - 5.3 (sighthound)-----------------1.6 - 3.5 (sighthound)

Free T4(RIA)---------------------.35--------------------.05 - 1.2 (sighthound)----------------.65 - 1.30 (sighthound)

T3 autoantibodies---------------.08--------------------less than 2.0

T4 autoantibodies---------------.09--------------------less than 2.0

 

Bear in mind the reference range has changed (I included the new range in the last column). These are reference ranges from Jean Dodds lab. Thyroid tests and treatment are a VERY hot button issue on GT. Some folks, like me, in the Jean Dodds camp and others in the MSU camp. Whatever works and people feel is best for their dogs is all good. That said, I'm very very happy with my vet and with my vet using Jean Dodds lab and her treatment recommendations. I have no need or interest in sending his labs to MSU. I'm glad we started treating him when and how we did, otherwise his eyes would have most definitely become worse. He is on .7mg of Soloxine per day, .35 in the morning and .35 mg at night. Other reference ranges for T4 would find his results on the low end of normal. However, he was having thyroid related issues, just not the most common of them.

 

I don't know if any of this applies, or will apply, to your girl, but if it does, I hope it is helpful. I didn't have any reference for this at the time and there's not much literature out there (at least I couldn't find it) on Google.

Edited September 13, 2011 by seeh2o

[Guest LindsaySF]

Interesting pics of Carl's eyes! I guess I'm in the MSU "camp" then (I like to see what the TSH value is, is that the MSU camp? I'm not sure ). Glad to hear that the treatment made a difference for his eyes. I can't really tell from the photos (because they are at different angles), did the ridge recede? Or just stop advancing?

Edited September 14, 2011 by LindsaySF

[seeh2o]

The ridge (s) wax and wane. The one in his left eye is really almost all gone, just small fragments linger. The one on his right eye is much more obvious, about 2/3 around the eye, sometimes parts of it go away, fade, come back, then go away again. I've had him on niacinamide for 9 months, the vet said to give it a try for his eyes, but it hasn't made any difference. He's about due for his exam with the ophthalmologist. She said to follow up in 2 years, I can't wait that long, so I'm going to make him an appointment next month or Nov., that will be 1.5 years.