Calling ecf8503

[LAJennifer]

I have a question for you if you don't mind answering. I understand it is probably bad etiquette to ask this here.

I am having an issue with my cat seeing an eye doctor for Uveitis. The prescribed drops seem to elevate his eye pressure. So he now has to take an anti-glaucoma eye drop.

The drops Prednisolone Acetate and Flurbiprofen (NSAID), can they be dangerous over time? I know that NSaids aren't great for cats - but perhaps it is different in an eye drop. Can these treatments cause glaucoma or hurt his kidneys in any way?

I would appreciate any insight you would give. The docs just try to get you in and out, so there isn't a lot of time for Q&A.

 

[ecf8503]

Long term use of steroids (Pred) can *potentially* increase the chance of developing ulcers on the surface of the eye. (It is contraindicated in cases of actual ulcers.) But in general topical meds (both steroids and NSAID's) are very safe, as they are not absorbed in large amounts into the system. (You are correct that NSAID's are very dangerous to cats when taken internally, e.g. if they swallow a human tablet).

Are you seeing a veterinary ophthalmologist or your regular vet? Do they use a tonopen to actually measure the intra-ocular pressure?

Secondary glaucoma is a commonly recognized complication of chronic uveitis, so I'm not surprised it's there now, and is likely not due to the anti-inflammatory meds themselves, but rather as a subsequent complication of the inflammation already present. Unfortunately all of these problems will need to be addressed with medication, likely long term. Uncontrolled uveitis / glaucoma will result in chronic pain and possibly vision loss, so it's important to keep up with the therapy.

Uveitis can sometimes be associated with other systemic diseases, usually viruses like Feline Leukemia, FIV, FIP, etc - so make sure he has been checked for them with blood tests and a thorough physical exam. Has he suffered any trauma to the eye? And have they looked for any evidence of cancer?

It sounds like they are doing all the right things, with the right meds. But uveitis (especially those cases where a definitive cause is never determined) can be a long road. I'm sorry you are having to go through this - *sending kisses for your little man* - it's never easy to see our precious friends in pain.

Here are some useful articles; hopefully they can give you a little more insight into what is happening:
http://www.animaleyecare.com/aec/index.php/Common-Eye-Diseases/feline-uveitis.html
http://www.eyecareforanimals.com/animal-eye-conditions/feline/347-felineuveitis.html
http://www.animaleyecare.net/diseases/uveitis.htm
http://www.vcahospitals.com/main/pet-health-information/article/animal-health/uveitis-in-cats/3858
http://veterinarymedicine.dvm360.com/vetmed/ArticleStandard/Article/detail/640123
http://veterinarymedicine.dvm360.co...uveitis/ArticleStandard/Article/detail/640127

Please let me know how things go - >^..^<

 

[LAJennifer]

Thank you so much for replying, ecf8503. I really appreciate it.

He is FIV+ but the docs feel the uveitis is unrelated, as he is otherwise very healthy with perfect levels on his blood panels. He is negative for FeLV and Corona Virus. They do, however, think it is probably caused by herpes or a past injury (he was feral). It is only in one eye. His eye pressures were normal. Three weeks after starting the Pred. Acetate and Flurbiprofen, his pressure jumped from 17 to 35 - so the Dorzolamide (anti glaucoma) was added to his regimen. This was in June and his pressure has been around 23 since then.

Two weeks ago, he started squinting. The very next morning his lid appeared swollen, so I called the doc (he does see an Opthalmologist at Eye Care For Animals) and rushed him in. He had an ulcer that covered the whole front of his cornea - massive Herpes outbreak. The doc placed a contact lens on his eye to protect it and promote healing. He was taken off the Pred. Acetate for good. An anti-viral drop (Cidofovir) and an antibiotic (Tobramycin) were added until the outbreak subsides.

He had his 2 week recheck yesterday. I was expecting the worst case scenario, but we got great news. The ulcer is 90% healed and his pressure was down to 13. I believe the Pred. Acetate was increasing the pressure, but I don't know for sure. But, his 14 eye drops a day got reduced down to 6. So happy. He is still on the anti-glaucoma drop, but the frequency has been reduced.

His original eye doctor (in June) has left the practice and he is now seeing her replacement and I like him much better. He is very thorough and he took the time yesterday to sit down and answer all my questions and told me that I could call him anytime.

My cat is young (4 - 5 years) and will probably remain on the Flurbiprofen for the rest of his life - so I am happy to hear your opinion that it is safe for the long term. His eye doc confirmed this yesterday, but it is always nice to get as many professional opinions as I can. Thanks, again.

 

[ecf8503]

Oh no - I'm sorry about the FIV. Hopefully he remains healthy for a long time!

From what you said it sounds like the doctor is doing all the right things. Herpes is difficult to deal with, especially when it tends to pop up so severely. And bottom line it doesn't matter if he has herpes or FIV, as there is no cure for either of those viruses, and the eye problems still need to be addressed,. Sounds like things are on the right track - you have a vet who listens and takes the time to explain things, and the number of drops you are using has decreased with concurrent improvement in clinical signs! Yeah!

Keep me posted -

>^..^<