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Ophthalmic Emergency Tips/Guidelines

1. Corneal Foreign Body


2. Descemetocele
3. Iris Prolapse
4. Anterior Uveitis
5. Lens Luxation
6. Glaucoma
7. Herpetic Keratitis
8. Prices

Corneal Foreign Body
← Corneal Foreign Bodies can be
• Adherent to the corneal surface
• Embedded in the superficial corneal tissue
• Embedded deep into the corneal tissue
• Full Penetration of the Cornea

For those foreign bodies that are adherent to the corneal surface or superficial,
removal can be attempted with care. Foreign bodies that are embedded deep or
have penetrated the cornea, or if you are not sure if they are deep or penetrated,
an ophthalmologist should be called to do removal.
It is common for a secondary anterior uveitis to develop as a result of a corneal
foreign body (reflex anterior uveitis), however if there is hyphema present,
shallow anterior chamber or anterior synechia – iris prolapse, it is likely that a full
thickness penetration has occurred and an ophthalmologist should be called to
do removal.
If there are signs of infection or melting, the cornea should be treated as a
complicated* corneal ulcer.

If you are CONFIDENT that the foreign body is not deep nor has penetrated the
anterior chamber, the following suggestions may be helpful:
a. Apply topical proparacaine - recommend 1-2 drops every 1 minute for a total
of 3 – 4 applications
b. Patient must be sedated if not adequately still/restrained
c. Attempt removal using a sterile cotton swab, Weck Cell Sponge,
(cilia/jewelers/tying) forceps, or a 25- 30-gauge needle, or sharp irrigation (6
cc syringe filled with sterile eye wash and fitted with 24 gauge IV catheter) if
foreign body adhered to the corneal surface.
d. If successful, best to stain eye with fluorescein and record corneal defect size
and depth. TGH with: E-collar, Neopolybacitracin TID in dogs; Erythromycin
TID in cats, atropine 1% BID, and systemic NSAID until recheck exam in 3 –
5 days (hospitalize or recheck in 24 hours if the ulcer is complicated).

Treatment in ES until referral or an in-house ophthalmologist is available.


a. E-Collar
b. Ciprofloxacin Ophthalmic Solution: 1 drop every 2 hours
c. Cefazolin Ophthalmic Solution (50 mg/ml): one drop every 2 hours (keep
refrigerated) (when multiple eye drops are being used separate each by at
least 10 minutes to avoid wash out). See Reference section. It is ok to just
use ciprofloxacin drops if the pharmacy is not open.
d. Atropine 1% solution one drop every 5 minutes for 3 doses (or to effect =
pupil dilated), then two to three time per day.
e. Systemic NSAID of your choice
f. Systemic antibiotic (chose doxycycline if there is collagenase or melting since
doxycycline is an excellent antiproteinase and gets into the tear film when
given systemically). Choose other antibiotic systemically per your clinical
judgment.
g. Further systemic analgesia PRN
h. DO NOT USE TOPICAL ANESTHETIC THERAPEUTICALLY –
PROPARACAINE WOULD DO HARM if used therapeutically!
Descemetocele
A Descemetocele is a surgical emergency. Needs a surgical graft. Diagnosis is made by
observation. Do not stain with fluorescein if it appears that a Descemetocele is present
since fluorescein stings and the rapid closure of the eye could rupture the cornea.
Whether fluorescein would be retained or not is a moot point with a Descemetocele
since this ulcer is too deep to expect to heal with only medical therapy. Do NOT use
ointments.

Therapy prior to surgery


1. E-collar
2. Keep animal calm as possible even if this means drugs – something with
analgesia i.e.: low dose torbugesic or buprenorphine.
3. Ciprofloxacin ophthalmic solution: 1 drop every 2 hours
a. Cefazolin Ophthalmic Solution (50 mg/ml): one drop every 2 hours (keep
refrigerated) (when multiple eye drops are being used separate each by at
least 10 minutes to avoid wash out). See Reference section. It is ok to
just use ciprofloxacin drops if the pharmacy is not open.
4. Serum or plasma (EDTA) or EDTA: 1 drop every 2 hours
5. Atropine 1% solution one drop every 5 minutes for 3 doses (or to effect = pupil
dilated), then two to three time per day.
6. Systemic NSAID of your choice
7. Systemic antibiotic (chose doxycycline if there is collagenase or melting since
doxycycline is an excellent antiproteinase and gets into the tear film when given
systemically). Choose other antibiotic systemically per your clinical judgment.
8. Further systemic analgesia PRN
9. DO NOT USE TOPICAL ANESTHETIC THERAPEUTICALLY –
PROPARACAINE WOULD DO HARM if used therapeutically!
Since this is a surgical disease, when Emergency submits the pre-anesthetic blood
work, this will help the ophthalmologist a lot.
Be sure to sedate the animal before taking blood or placing an IV catheter, since
struggling during venapuncture or catheter placement could rupture the cornea from
struggling.
Iris Prolapse
An iris prolapse is a surgical emergency and should not be stained with fluorescein. If
the full thickness wound becomes unsealed/ruptures, the same therapy is used as for
Descemetocele. Do not use ointments.
Surgery must be arranged as soon as possible.

Therapy prior to surgery


1. E-collar
2. Keep animal calm as possible even if this means drugs – something with
analgesia i.e.: low dose torbugesic or buprenorphine.
3. Ciprofloxacin ophthalmic solution: 1 drop every 2 hours
a. Cefazolin Ophthalmic Solution (50 mg/ml): one drop every 2 hours (keep
refrigerated) (when multiple eye drops are being used separate each by at
least 10 minutes to avoid wash out). See Reference section. It is ok to
just use ciprofloxacin drops if the pharmacy is not open.
4. Serum or plasma (EDTA) or EDTA: 1 drop every 2 hours
5. Atropine 1% solution one drop every 5 minutes for 3 doses (or to effect = pupil
dilated), then two to three time per day.
6. Systemic NSAID of your choice
7. Systemic antibiotic (chose doxycycline if there is collagenase or melting since
doxycycline is an excellent antiproteinase and gets into the tear film when given
systemically). Choose other antibiotic systemically per your clinical judgment.
8. Further systemic analgesia PRN
9. DO NOT USE TOPICAL ANESTHETIC THERAPEUTICALLY –
PROPARACAINE WOULD DO HARM if used therapeutically!
Since this is a surgical disease, when Emergency submits the pre-anesthetic blood
work, this will help the ophthalmologist a lot.
Be sure to sedate the animal before taking blood or placing an IV catheter, since
struggling during venapuncture or catheter placement could rupture the cornea from
struggling.

Anterior Uveitis
← Try to determine if Exogenous or Endogenous if possible.

← If exogenous (external blunt trauma) or Lens Induced Uveitis, or Pigmentary
Uveitis of the Golden Retriever, Lens Induced Uveitis, etc., then a physical exam and
basic laboratory work is all that is necessary (CBC, Chem Panel) just to be sure that the
medical therapy is suited to the patient.
← The full diagnostic work-up must be offered if thought to be endogenous or if no
obvious underlying cause; of course use clinical judgment based upon signalment,
history, physical examination, geographic exposure and financial concerns (sort list
based on above to put the most likely or important tests at the top):

← DOG ← CAT
CBC CBC
Chem Panel Chem Panel
Chest X-Ray Chest X-Ray
Snap 4 (Lyme, HW, E. canis, A. FeLV/FIV
phagocytophyllum
Bartonella WB Bartonella WB
Lepto TOXO IgM IgG
RMSF Save Extra Serum
TOXO IgM IgG Crypotococcosis, Histoplasmosis pending
PE, ocular exam and exposure potential.
Babesia canis
Brucella Plate Screening Test
Neospora
Save Extra Serum
Deep Fungal Titers pending PE, fundic
exam and Geographic Travel History
Abdominal Ultrasound if PE indicates that Abdominal Ultrasound if PE indicates that
this would be a valuable test. this would be a valuable test.

← Therapy
1. E-collar
2. Prednisolone acetate 1% (dogs or cats) or Neopolydexamethasone (dogs): 1 drop
QID*
3. Flurbiprofen: 1 drop BID-see below
4. Atropine 1%: 1 drop to effect to get pupil dilated (must consider resistance due to
posterior synechia) and then BID**
5. Starting doxycycline may be helpful for treatment of possible tick-borne disease until
lab tests are back and to help control inflammation
6. Consider starting clindamycin as well in cats
7. Systemic NSAID (pending CBC and Chem Panel first)

8. *Important to check for ulcers prior to topical steroid therapy. if present, use only
flurbiprofen BID instead* Caution topical NSAIDs could lead to a worsening of ulcer
or collagenase ulcer (melting). Therefore systemic NSAID is often sufficient if labs
OK with only the use of a topical antimicrobial and atropine.
*if patient is diabetic, topical steroids generally do not cause significant changes in
glucose levels*
9. **check IOP first and do not use atropine if elevated or if normal but higher than the
normal eye [normal 12 – 26 mm Hg with no more than 6 – 8 mm Hg difference
between the two eyes – the uveitis eye should have a lower pressure than the
normal eye in acute anterior uveitis!] If the Uveitis eye pressure is greater than 18 –
20 mm Hg that could mean a compromise in aqueous outflow and frank glaucoma
could occur with Atropine treatment, especially in a breed predisposed to glaucoma
(Bassett Hound, Cocker Spaniel). The systemic NSAID may be sufficient for pain
relief. Tropicamide has the same risks as atropine when the IOP is abnormally
elevated or of a concern. In addition if the STT is low, consider the need for atropine
since atropine will further decrease tear production. If atropine is necessary with low
STT, be sure to add in extra ocular lubricants to protect the corneal surface from
drying and exposure.

Lens Luxation
← Lens luxations can be primary (inherited) or secondary.
← Primary Lens luxations occur in dogs and cats. The Terrier breed is over
represented for primary lens Luxation as well as several dog breeds (see list in
References section). Secondary lens Luxation occurs as the result of chronic uveitis
weakening the lens zonules, lens resorption, buphthalmos causing stretching and
breaking the lens zonules, and trauma. Lenses can be luxated anterior or posterior, the
anterior lens luxation is the most dangerous in that it can suddenly block the aqueous
flow through the pupil causing acute glaucoma.
← When there is acute glaucoma and generalized corneal edema, one often needs
an index of suspicion that there is an anterior lens luxation. This is where knowing the
breeds that are predisposed to lens luxation is helpful and if presented with such a
breed and acute glaucoma; either an ocular ultrasound or giving IV mannitol would be
the first step. Ocular ultrasound can localize the lens but sometimes it is not clear. IV
mannitol will shrink the vitreous and thereby reduce intraocular volume, which will
reduce intraocular pressure. When the pressure reduces the cornea will clear and the
lens luxation can be see directly. If one were not to recognize that there is an anterior
lens luxation and if Xalatan or Travatan were given the glaucoma would worsen since
the pupil would become more miotic and further reduce aqueous flow since the lens is
in the anterior chamber.

In the case of Anterior lens luxation this is a surgical situation


however the intraocular pressure needs to be reduced first.
A. If IOPs elevated* (> 30mmHg in small animals) – IV Mannitol at 1-
2 GRAMS/kg IV should be given slowly over 30 minutes. Use
cautiously in patients with heart disease, kidney disease or patients
that are dehydrated or hypovolemic.

Be sure to stain for corneal ulceration and treat accordingly


- superficial ulcer: TAB ointment TID-QID should suffice
- deep ulcer:
 E-collar
 Ciprofloxacin: 1 drop q2 hours
 NO Atropine
 Serum: 1 drop q2 hours
 Systemic analgesia PRN
 Systemic NSAID or steroid (not both systemically)
Steroid such as dexamethasone SP (0.1-0.2 mg/kg) is
preferred since there is likely retinal and optic nerve
damage from the acute pressure rise.
 Methazolamide: 2 – 5 mg/kg PO BID
 Cosopt: 1 drop TID

The IOP should start to decrease in about 30 – 60 minutes.


*Re-check IOPs over peripheral cornea, try to avoid going right over
the lens

• Evaluate the "good" eye for sight, signs of lens luxation or
subluxation, retinal exam (DO NOT dilate) and measure IOP. DO
NOT DILATE THE PUPIL. If there is sign of posterior subluxation
(deep anterior chamber, iridodenesis, aphakic crescent and the lens
is behind the iris; consider starting on Xalatan once daily as well as
a topical ophthalmic steroid such as Neopolydexamethasone or
Prednisolone acetate. If the IOP is abnormally elevated the Xalatan
should be enough however if there are no signs of lens luxation but
the IOP is marginally elevated, start Cosopt TID. The mannitol and
methazolamide as part of the therapy for the fellow eye above
should markedly improve (reduce IOP) as well in the “good eye”.
Clearly an ophthalmologist must remove the anterior luxated lens surgically
as soon as possible. Your management as above is to try to keep the IOP in
the normal range to preserve retinal and optic nerve function until the lens
can be removed.

← At times, the lens will flip back to the vitreous at which point we can try a PGF2
(Xalatan or Travaprost/Travatan) to close the pupil and keep the lens posterior. If not
already, in time the posterior subluxated or completely luxated lenses will develop a
complete cataract and secondary LIU (lens induced uveitis). Treatment for the LIU is
necessary. Removal of a posterior subluxated or completely luxated lens is not
commonly recommended because of the high risk for retinal detachment; however there
are select patients that would benefit from this surgery.
Glaucoma
The term glaucoma means abnormally high eye pressure.
← There is normal amount of pressure in the eye to maintain the normal
health and function of the eye; however, if the eye pressure is abnormally
elevated permanent damage to the eye can rapidly occur. The front internal
portion of the eye contains a fluid called aqueous which brings in nutrition to
the eye and carries out waste material from the eye. Aqueous fluid is
constantly circulating in the front portion of the eye starting with the
creation of aqueous behind the iris and then outflow through the pupil finally
exiting the eye internally into the blood stream. The exit or outflow from the
eye is through a sieve like structure called the “angle”. In the normal eye
there is a balanced inflow and outflow of fluid, which results in the
maintenance of normal eye pressure.
← Glaucoma always results from fluid not being able to escape from the
eye through the pupil and / or angle.
← Glaucoma is a “clinical sign” and not a specific disease. There are
many causes for glaucoma, all of which relate to obstruction of fluid outflow.

← Causes of Glaucoma
← Causes for restriction of aqueous humor outflow can be due to an
inherited defect in the angle, which can predispose the eyes to restricted
outflow. There are certain breeds of animals that are over-represented for
the development of glaucoma and within these breeds there are known
anatomical angle abnormalities or weak lens ligaments, which could lead
pupil block by a displaced lens. In addition there are situations where
abnormal material in the aqueous, or swelling can obstruct the outflow as in
hemorrhage, inflammation and scarring. Should these latter problems occur
in an eye or eyes with an inherited angle defect, the likelihood of glaucoma
developing is greater.

← Glaucoma is a “clinical sign” with many causes for abnormal elevation
of IOP, here are some of the causes:
← 1.Primary or Breed Associated
← 2.Uveitis
← 3.Trauma
← 4.Lens Luxation
← 5.Neoplasia
← Signs of Glaucoma
← Animal with glaucoma can show many signs or combinations of signs
such as a painful, red or cloudy eye, vision loss and abnormal size of the
eye. Irrespective of the clinical signs, measurement of the eye pressure is
the only way to know if glaucoma is present. Various instruments are
available to measure eye pressure and the Tonopen is the most common at
this time.
← Normal intraocular pressure in an otherwise normal eye for the dog
and cat is approximately 12 – 26 mm Hg with both eyes being with in 6 – 8
mm Hg of each other. These pressures must be interpreted based on the
condition of the eye and the breed of animal, for example a Bassett Hound
with anterior uveitis in one eye with an IOP of 22 mm Hg with the fellow
normal eye at 14 mm Hg is of a great concern. Even though the uveitis eye
has a pressure in the normal range the pressure is too high for an eye with
uveitis since the eye pressure in uveitis should be lower than normal. In
addition the Bassett Hound can have a congenitally abnormal iridocorneal
angle. Combining the abnormally elevated intraocular pressure with the
breed and the presence of uveitis makes an IOP of 22 mmHg abnormal! The
pressure of 22 mmHg in this patient means the outflow is starting to be
obstructed. Glaucoma can be quite painful especially in the acute phase.
Permanent loss of vision due to retinal and optic nerve damage can occur
after only 12 hours of elevated intraocular pressure.

← Treatment of Glaucoma
← Treatment of Glaucoma is directed at first trying to determine the
cause as well as reducing the eye pressure. Reduction of the eye pressure is
done with medicine and / or surgery to reduce the production as well as
increase the outflow of aqueous humor.
← Medical therapy can be in the form of eye drops and / or oral
medications. Surgical therapy can be either with laser; cryosurgery; and / or
shunt implant or lens removal in the case of a displaced lens.
← The ophthalmologist determines the choice of therapy after a thorough
examination of the eye and animal so the optimal therapeutic plan can be
crafted. There is no single standard treatment since glaucoma varies greatly
across patients.

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Guidelines for Emergency Therapy
• Determine if there is an anterior lens luxation. Many times it is
difficult to see beyond the cornea due to generalized corneal
edema, therefore use of an osmotic diuretic such as Mannitol is
helpful in shrinking the vitreous thereby decreasing intraocular
volume and subsequent lowering of intraocular pressure. Once the
intraocular pressure is reduced the corneal edema will clear
allowing you to see if there is an anterior lens luxation. It is
important to determine this for two reasons: one – treatment for
anterior lens luxation is surgical not medical and two – the use of a
strong miotic such as a prostinoid (latanoprost) could further trap
the lens in the anterior chamber and even raise intraocular pressure
more. Ocular Ultrasound is also useful in determining the position of
the lens but this method is sometimes hard to interpret if the
examiner is not used to imaging the eye with ultrasound or the
probe is not correct for ocular ultrasound.
• Posterior subluxated lenses however are often times best treated
with a strong miotic such as latanoprost to attempt to trap the lens
behind the iris.

Care should also be taken to note if the glaucoma is secondary to


uveitis since drugs such as miotics/prostinoids will further
breakdown the blood aqueous barrier and worsen the uveitis. There
comes a time in some patients with uveitis induced glaucoma that
latanoprost is the only option and in that case anti-inflammatory
drugs must be used as well. Topical nonsteroidals have been
reported to increase intraocular pressure a few mm of Hg. Systemic
nonsteroidals do not seem to have the same effect.
Anticholenergic drugs (atropine and Tropicamide) as well as
antihistamines (have an anticholenergic effect) are contraindicated
with glaucoma.

3
← General Therapy Guidelines
← if you are confident there is no anterior lens luxation OR
uveitis:

1. 2 drops Latanaprost (Xalatan) or Travaprost (Travatan) - PGF2


analogues every 5 minutes for 3 doses.
2. Recheck IOP in 30 to 45 minutes. If pupil is not becoming miotic or
pressures are not down, repeat Xalatan and IOP check 20-30 minutes
later.
3. Start Cosopt or Trusopt eye drops (tid)
4. Start Methazolamide orally
5. If pressure is still not down OR there is anterior uveitis OR if you
know or are worried there may be an anterior lens luxation, DO NOT
use PGF2 analogues or any other drug to make the pupil miotic.
Mannitol, 1-2 GRAMS/kg IV should be given slowly over 30 minutes.
Use cautiously in patients with heart disease, kidney disease or
patients that are dehydrated or hypovolemic.

6. Determine if it is OK to withhold water 1-2 hours since if the animal is


allowed to drink during this time the osmotic effect will be lessened.
Recheck IOPs in one hour- remember peak effect is about 1.5 hours
after Mannitol was given. If no success, determine if Mannitol can be
repeated.
7. It is not recommended that an inexperienced person performs
paracentesis of the anterior chamber, however, that is often the next
step if pressures are still not resolved within a few hours.
8. Once pressure is down, initial following therapy of affected eye:
a. Maintenance of Methazolamide: 2-5 mg/kg PO BID
b. Cosopt: 1 drop TID
c. Maintenance of Xalatan or Travaprost bid

4
Subsequent immediate referral to an ophthalmologist when one is available
is the next step for follow-up since some glaucoma patients may also benefit
from surgery (Ciliary body ablation with cryosurgery or diode laser and or
shunt implantation) to maintain sight! It is not uncommon for glaucoma
patients to improve with the emergency therapy but then to soon
deteriorate. An ophthalmologist must be involved for management and
deciding if adjunctive therapy is needed.

← F. If you suspect primary glaucoma (especially in a dog, rarely


primary in the cat), the other eye WILL develop glaucoma so start therapy
to keep pressures down and try to delay onset  Cosopt: 1 drop BID in
NORMAL eye

← G. If UVEITIS is present (2ndary glaucoma) also start in affected eye:

• Prednisolone acetate 1% or Neopolydexamethasone drops: 1 drop
QID
• if ulcerated, a topical antibiotic should be used
• Do not use Flurbiprofen in the face of glaucoma since it will increase
intraocular pressure. Flurbiprofen will also compromise the healing
of a corneal ulcer much like a steroid would therefore topical non-
steroidal drugs should not be used in the presence of a corneal
ulceration.
• Prepare for/begin work-up for primary cause and hold off on
systemic steroids but systemic non-steroids can and should be used
as long as there is no evidence of liver or kidney problems or
bleeding disorders or potential for a bleeding disorder such as
thrombocytopenia.
• Starting doxycycline may be helpful for treatment of possible tick-
borne disease and to help control inflammation
• Consider starting clindamycin as well in the cat.
• A complete uveitis workup must be done if this is an endogenous
uveitis or if you are not sure.

5
← Prognosis for GLAUCOMA in general: If eye is blind at presentation
there still may be a chance at vision return if the history and or exam
indicate that the glaucoma has been present for less than 24 – 48 hours. If
the globe is buphthalmic (except Shar Pei and Chow since their globes can
enlarge from glaucoma initially and still be sighted) or pressures can not be
decreased/maintained to a reasonable level; the next step is aimed at
providing pain relief either by Enucleation or intrascleral prosthesis. Certainly
if the veterinarian can not determine or is not sure if this is a hopelessly
blind and painful eye, a referral to an ophthalmologist immediately should be
done before any permanent sight taking procedure is done.
← If the patient is not a good anesthetic/surgical candidate, intracameral
gentamicin injection may be an option but only for a globe that one is sure
there is no intraocular tumor or infection. Intracameral gentamicin injection
should not be done in the cat since a very malignant tumor could develop
(traumatic sarcoma)! The intracameral injection should not be done in eyes
that have potential for sight since the gentamicin will permanently blind the
eye by damaging the retina.



6
Herpetic Keratitis

Herpes felis
← You should be suspicious for herpetic keratitis when a cat presents
with an acute corneal ulcer that is punctate or geographic (map shaped) in
pattern or shape with no obvious history of trauma, being sprayed in the
eye. This should also be a high suspicion in a cat that has had Upper
Respiratory Infection history or currently on systemic or topical steroids.
← THE MOST COMMON CAUSE FOR A SUPERFICIAL NON-HEALING
CORNEAL ULCER (INDOLENT ULCER) IN THE CAT IS HERPES!!!!

← Antiviral medications are all virostatic but to date there are no virocidal
drugs.

← The choices are both topical and systemic. The topical drugs come as a
drop or ointment. There is only one commercial FDA approved topical drop
and the others are compounded by a compounding pharmacy. There is one
safe systemic drug for cats that is commercially available.

The topical choices are:


1. Idoxuridine drops (available only from a compounding pharmacy): one
drop 3 – 4 times per day. Too frequent use will cause severe
secondary irritation and it not necessary to use more than 4 times per
day.
2. Trifluridine drops (commercially available as generic or trade name
[trade name more expensive] or compounded as a preservative free
drop from Wedgewood Pharmacy. Trifluridine commercial drops can be
very irritating to many cats and in some cats it must be discontinued
for that reason. Trifluridine is the best topical antiviral and most
effective. Some think the preservative in the commercial product is
what causes the irritation therefore some use the preservative free
product (short shelf life).
The ONE systemic choice is Famciclovir (trade name = FAMVIR

NOTE DO NOT USE ACYCLOVIR


ACYCLOVIR is TOO TOXIC DO NOT USE IN THE CAT EVEN IF
YOU SEE IT LISTED IN A VETERINARY TEXT! IT SUPRESSES THE
BONE MARROW

Famciclovir is a prodrug. Famciclovir enters the body via the GI system and
is converted to penciclovir by the liver which is the virostatic agent.
Penciclovir then leaves the body via the kidney.

Therefore patients put on Famciclovir should have normal kidney and liver
function.
Famciclovir should be avoided in kittens until further data is obtained and in
kittens topical treatment with one of the topicals listed above and L-lysine is
the safest.
The dose for Famvir is:
Adult cat: 250mg - 1/4 tab PO once daily for 20 days (script out 5
tablets)
Kitten: 125mg - 1/4 tab PO once daily for 20 days (script out 5
tablets).

In addition to the antivirals we usually use a topical antibiotic that has an


effect against Chlamydia and Mycoplasma (erythromycin, ciprofloxacin or
oxytetracycline [Terramycin].

L-lysine is an aminoacid that blocks the availability of arginine (virus needs


arginine to replicate) and can be useful as a prophylaxis or as part of the
initial therapy. Be sure the L-lysine does not contain any glycol preservatives
since glycol preservatives can cause a Heinz Body Anemia in the cat.
The dose is: 250 mg to 500mg PO BID in adult, 250mg PO BID in kitten (for
life)

2
If your adult feline patient is being treated appropriately with poor results,
consider starting Famciclovir or Famciclovir can be used in the initial
treatment regimen. Famciclovir can help the cornea/conjunctiva with out the
aid of topical antivirals as well. In some stubborn or more serious cases the
use of both is warranted.

Recheck with your service or Ophthalmology in 7-10 days unless the corneal
ulcer is deep or complicated.

3
References
Dog breeds over represented for primary lens luxation:
• Australian Cattle Dog
• Border Collie
• Brittany Spaniel
• Brussels Griffon
• Bull Terrier
• Chinese Shar Pei
• Great Dane
• Greyhound
• Italian Greyhound
• Italian Spitz
• Jack Russell Terrier
• Miniature Bull Terrier
• Petit Basset Griffon Vendeen
• Pyrenean Shepherd
• Sealyham Terrier
• Smooth Fox Terrier
• Tibetan Terrier
• Welsh Terrier
• Wire Fox Terrier
The Siamese cat is a breed of cat that is overrepresented for primary lens luxation.
References Continued
← Cefazolin Eye Drops

← Add 792 mg = 2.4 ml of Cefazolin (330 mg/ml) to 12.6 ml of Artificial
Tears. Exp. = 14 days.
← Refrigerate. Shake well. The final concentration is 50 mg/ml.

← Details: Reconstitute a 1 gram vial of Cefazolin to 330 mg/ml. Remove
2.4 ml
← Aseptically remove the top of a new artificial tear drop bottle (15 ml)
and with a sterile needle and syringe remove 2.4 ml.
← Add the 2.4 ml of Cefazolin to the bottle of artificial tears
← Final Concentration = 50 mg/ml

Our pharmacy does it a little differently. It is ok to just use ciprofloxacin


drops if the pharmacy is not open.

← Hospital pharmacy could make up several aliquots of 2.4 ml of the 330
mg/ml in a 3 cc syringe and freeze. Then when it comes time to make the
drop just thaw and add to a bottle of artificial tears that has had 2.4 ml of
the tears first removed as above.
← Put the cap back on and shake well.
Prices:

Atropine solution: 11.00

Atropine ointment: $10.00

Cefazolin drops that the pharmacy makes up: $22 + $8.85 (for the artificial tears)

Ciprofloxacin drops: $28.00

Cosopt (dorzolamide + timolol): $175.00

Dorzolamide drops: $105.00

Erythromycin ointment: $10.50

Famcyclovir tablets: 125 and 250 mg tablets: $6.25/tablet

Flurbiprofen drops: $23.00

Latanoprost (Xalatan): $95.00

Methazolamide: 25 mg tablets: .40/tablet 50mg tablets: .50/tablets

Prednisolone acetate: $35.00

Terramycin ointment: $21.00

Timolol drops: $21.00

Ophtho consult: $92

Enucleation by ophthalmology: $1350-1550

Conjunctival flap: $220-2600

NOTE: this DOES NOT include ES charges

If surgery is done other than Tuesday or Thursday morning – there is an


emergency surgery fee of $350 added!