VOP182.

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Veterinary Ophthalmology (2001) 4, 2, 99 –106

O ri g i n alScience,
Blackwell A rt i c alLtd

Enrofloxacin-associated retinal degeneration in cats

Kirk N. Gelatt,* Alexandra van der Woerdt,† Kerry L. Ketring,‡ Stacy E. Andrew,* Dennis E. Brooks,*
Daniel J. Biros,* Heidi M. Denis* and Timothy J. Cutler*
*Department of Small Animal Clinical Sciences, College of Veterinary Medicine, Box 100126, University of Florida, Gainesville, FL, USA, †The Animal Medical
Center, New York, NY, USA, ‡All Animal Eye Clinic, Cincinnati, OH, USA

Address communications to: Abstract

K. N. Gelatt Objective The objective of this study was to evaluate the possible relationship between
Tel.: (352) 392-4700 ext. 5855
the administration of parenteral enrofloxacin and the onset of acute retinal degeneration
Fax: (352) 392-6125 in cats. The animals studied included 17 cats that received systemic enrofloxacin and
e-mail: developed retinal degeneration soon thereafter.
Gelattk@mail.vetmed.ufl.edu Procedures In this retrospective clinical study, cats that received parenteral enrofloxacin
and developed acute blindness were identified. Parameters recorded included breed,
age, sex, enrofloxacin dosage (daily dose and number of days administered), medical
condition for which the antibiotic had been prescribed, ophthalmic signs, examination
results, and the visual outcome. Fundus photographs were obtained in seven cats, and
electroretinography was performed in five cats. Histopathology was performed on two
eyes from one cat (case 1) that received enrofloxacin 5 months previously and developed
retinal degeneration.
Results All cats were the domestic shorthair breed; seven were females (one neutered)
and ten were males (seven castrated). Ages ranged from 3 to 16 years old (mean ± SD;
8.8 ± 4.6 years). The medical disorders for which enrofloxacin was administered ranged
from lymphoma and pancreatitis to otitis and dermatitis, and eight cats had urinary
diseases. The daily and total dosage of enrofloxacin and number of days of administration
were also highly variable. Presenting clinical signs were most often mydriasis and acute
blindness. All cats had diffuse retinal degeneration as evidenced by increased tapetal
reflectivity and retinal vascular attenuation. Absence of recordable electroretinographic
responses suggested diffuse and extensive outer retinal disease. Vision returned in a few
cats, but the retinal degeneration persisted or even progressed. Histopathology of two
eyes revealed primarily outer retinal degeneration, with diffuse loss of the outer nuclear
and photoreceptor layers, and hypertrophy and proliferation of the retinal pigment
epithelium.
Conclusion Parenteral enrofloxacin is potentially retinotoxic in some cats, and may
result in acute and diffuse retinal degeneration. Blindness often results, but some cats
may regain vision. Practitioners should adhere closely to the manufacturer’s current
enrofloxacin dosage recommendation (5 mg/kg q 24 h), and continue clinical
observations for this drug toxicity in cats.
Key Words: enrofloxacin, feline, retinal degeneration

and blepharospasm.1,2 Both topical 1% atropine and topical

IN TR OD U C TI ON
Adverse drug reactions are infrequent in small animal oph-
thalmology occurring more commonly in the dog than the
cat. These reactions range from mere annoyance to life-
threatening events. Topical anesthetics have been associated
with corneal epithelial sloughing, conjunctival hyperemia,
anesthetics decrease tear formation.3,4 Topical pilocarpine
causes conjunctival hyperemia, and a breakdown of the blood–
aqueous barrier.5,6 Topical corticosteroids 4 times daily
cause an increase in intraocular pressure in Beagles with prim-
ary open angle glaucoma within 2 weeks,7 but do not alter
intraocular pressure in normal Beagles after 6 months of drug

© 2001 American College of Veterinary Ophthalmologists

VOP182.fm Page 100 Wednesday, May 30, 2001 5:18 PM
100 GELATT ET AL.
administration.8 The sulfonamides, especially trimethoprim-
sulfadiazine, have been associated with decreased tear forma-
tion as documented by the Schirmer tear test in 63% of
the dogs, and the development of keratoconjunctivitis sicca in
4 to 15% of dogs receiving these drugs. The smaller breeds
of dogs were at greater risk.9,10 Doberman Pinschers with
cardiomyopathies treated with tocainide, an oral antiarrhythmic
drug, developed progressive and irreversible corneal edema.11
Disophenol, an injectable anthelmintic for ancylostomiasis
in puppies, caused cataracts at 3 times the recommended par-
enteral dose.12
Because the dog is often used to test the toxicity of many
drugs, several agents have been reported to cause retinal and
chorioretinal changes. Ethambutol, an antitubercular agent,
produces a reversible color change of the canine tapetal
fundus.13 Intravenous diphenylthiocarbazone (diothizone)
produces tapetal changes and retinal edema followed by
retinal pigment epithelial changes, retinal detachments, and
blindness.14 Hydroxypridinethione, a zinc chelating drug,
causes tapetal necrosis and edema, retinal detachment, and
blindness.15 Quinine produces rapid vasoconstriction of the
retinal arterioles and pallor of the optic disc. Optic disc
atrophy and partial loss of the retinal ganglion cells may
occur.14 The antibiotic, azalide, causes tapetal color changes
and swelling, and vacuolation of the tapetal cells and retinal
ganglion cells.16 Closantel, an antihelmintic used in ruminants,
causes swelling of the optic nerve head with papillary and
peripapillary hemorrhages. Generalized retinal degeneration
and optic nerve atrophy eventually occur.17 Overdoses of
ivermectin in dogs may result in mydriasis, tremors, muscle
fasciculations, ataxia, and stupor. Ophthalmoscopic changes
include papilledema and retinal edema with folds. Pigmentary
changes in the nontapetal fundus may develop. Vision loss is
usually temporary with recovery in 2–10 days.9,18
Reports of adverse drug reactions in the cat eye and
associated structures are rare. Topical 0.1% dexamethasone
or 1.0% prednisolone for 5–7 days can increase intraocular
pressure and produce cortical cataracts in normal cats.19,20
Intravenous fluorescein in a cat produced anaphylaxis.21 Acute
transient sialoadenomegaly occurred in two cats following
topical administration of tropicamide.22 The combination of
methylnitrosourea and ketamine in cats produced severe
retinal degeneration, characterized by photoreceptor and
outer nuclear loss 5 days following drug administration.23
The association of enrofloxacin, retinal degeneration, and
blindness in cats was first noted in a retrospective study of
26 cats with diffuse retinal degeneration attributed to various
causes.24 Five of these 26 cats received oral enrofloxacin,
four cats received amoxicillin, and two cats prednisolone.
In this report diffuse retinal degeneration is associated with
parenteral enrofloxacin administration in 17 cats.
MATER I AL S AND M ETH ODS
The medical records of all cats with blindness, and/or retinal
degeneration that received parenteral enrofloxacin between
© 2001 American College of Veterinary Ophthalmologists, Veterinary Ophthalmology, 4, 99–106
1 January 1994 and 1 September 2000 were included in
this study from the Comparative Ophthalmology Service,
Veterinary Medical Teaching Hospital, University of Florida,
Gainesville, Florida; the Ophthalmology Service, the Animal
Medical Center, New York, NY; and the All Animal Eye
Clinic, Cincinnati, OH. Cats that developed retinal degen-
eration secondary to other ophthalmic diseases ( glaucoma,
retinal detachment, and chorioretinitis), and from systemic
diseases including hypertension were excluded. Complete
ophthalmic examinations performed on all cats included
applanation tonometry, slit lamp biomicroscopy, and indirect
ophthalmoscopy. Fundus photography was performed using
either the RC-2 and/or Genesis Kowa fundus camera ( Kowa
Optimed, Torrance, CA). Electroretinography ( Retinographics,
Norwalk, CT) was performed with the cats under general
anesthesia.
The medical records of 17 cats were identified and reviewed,
and the following information obtained: breed, age, sex,
enrofloxacin dosage (daily dosage per kg and number of
days administered), systemic medical condition, ophthalmic
signs, ophthalmoscopic examination results, and the final
status of vision (based on menace and owners’ observations).
As the cats had systemic diseases, the results of physical
examinations, clinical laboratory results, and radiology were
also evaluated. Fundus photographs were obtained in six
cats, and an additional cat had four sets of serial fundus
photographs over 8 months of monitoring. Clinical electro-
retinography was performed in five animals (twice in one
cat). One cat died from lymphoma, and 6µ sections were
evaluated histologically following routine processing, and
staining with hematoxylin and eosin (H and E) and periodic
acid Schiff (PAS).
R E S U LT S
Information from the medical records for the 17 cats is sum-
marized in Table 1. All cats were of the domestic shorthair
breed. Ages ranged from 3 to 16 years old with a mean ± SD
of 8.8 ± 4.6 years. There were seven females (one spayed)
and 10 males (three intact and seven castrated). The systemic
medical conditions for which enrofloxacin was administered
were quite variable, and included lymphoma, pancreatitis,
otitis, dermatitis, postoperative bowel obstruction, pleural
effusion, and urinary tract disease (eight cats). One cat had
two seizures; one occurred during recovery from general
anesthesia and a skin biopsy, and the other occurred while
the cat was at home. Both seizures occurred while the cat
was on systemic enrofloxacin (10 mg/kg).
The most common presenting ophthalmic abnormalities
included mydriasis, absent menace reflex, and variable but
slow and incomplete pupillary light reflexes. Acute blindness
was often noted by the owner and in a few animals abnormal
behavior (confusion, collision with objects) was observed.
The ophthalmoscopic abnormalities were generally limited
to the ocular fundus, and included increased tapetal reflect-
ivity, attenuation of the diameter and loss of the retinal blood
 VOP182.fm Page 101 Wednesday, May 30, 2001 5:18 PM
© 2001 American College of Veterinary Ophthalmologists, Veterinary Ophthalmology, 4, 99 –106
Table 1 Summary of cats with retinal degeneration and parenteral enrofloxacin
Age Enrofloxicin Ophthalmic Ophthalmic
Case Breed ( Years) Sex (Dosage/duration) Medical condition signs findings Outcome
1 DSH 16 MC 4.4 mg/ kg – IV Lymphoma Mydriasis (2–3 days) Increased tapetal reflectivity; Slow PLR;
twice daily – 6 days Pancreatitis Blindness retinal vessel attenuation; questionable
PLR – slow tan-rust areas in tapetal fundi vision
Menace absent

2 DSH 14 Fe 4 mg/ kg PO twice Otitis: Horner’s Blindness Increased tapetal reflectivity; Blindness
daily – 7 weeks syndrome Mydriasis retinal vessel attenuation
– onset unknown

3 DSH 15 MC 4.6 mg/ kg PO once Upper respiratory Mydriasis (3– 4 days) Increased tapetal reflectivity; Blindness
daily – 8 days infection Blindness marked vessel attenuation;
PLR – slow gold-rust spots in tapetal fundi;
Menace – absent pigment loss – nontapetal fundi

4 DSH aged Fe 4.5 mg/ kg PO Pancreatitis Mydriasis (4 days) Initial – multifocal retinal Menace and
twice daily – Blindness degeneration; PLR – decreased
14 days tapetal hyperflectivity

ENROFLOXACIN-ASSOCIATED RETINAL DEGENERATION IN CATS

5 DSH 8 Fe 27 mg/ kg PO – Chronic otitis Blindness (14 days) Diffuse tapetal hyper- Some vision;
twice daily (4 days) reflectivity; vessel temporary
attenuation; optic atrophy staggering and
abnormal behavior;
PLR returned

6 DSH 7 FE 11 mg/ kg PO twice Dermatitis Mydriasis (15 days) Advanced retinal Blindness;
daily – 3 months Blindness degeneration (9 months); two seizures
and 10 mg/ kg PO increased tapetal
twice daily – 30 days reflectivity; retinal vessel
attenuation

7 DSH 13 M 4 mg/ kg am and Cystitis Mydriasis, Progressive increase in Extinguished

10 mg/ kg pm PO decreased vision, tapetal reflectivity; ERG – 8 & 16
for 4 days and slow PLR vascular attenuation; days; limited
increased pigment vision in bright light
clumping in nontapetal fundi

8 DSH 15 F 7.3 mg/ kg PO – Renal failure Slow PLR; Increased tapetal Progressive
– twice daily vision decreased reflectivity; vascular vision loss
– 21, 10, 14 and attenuation; cortical
28 days cataracts

9 DSH 3 MC 14 mg/ kg PO Urinary Loss of vision; Complete retinal Blindness

– twice daily obstruction mydriasis degeneration; few
– 10 days attenuated retinal vessels

101
 VOP182.fm Page 102 Wednesday, May 30, 2001 5:18 PM
102
GELATT ET AL.
Table 1 continued
Age Enrofloxicin Ophthalmic Ophthalmic
Case Breed ( Years) Sex (Dosage/duration) Medical condition signs findings Outcome
10 DSH 5 MC 6.5 mg/ kg PO Urinary Loss of vision Diffuse retinal Blindness;
twice daily obstruction Slow PLR degeneration menace – absent
– 19 days;
3.2 mg/ kg PO –
10 days

11 DSH 5 MC 7.5 mg/ kg IV Cystic calculi Slow PLR Increased tapetal ERG-
– 5 days mydriasis reflectivity; retinal vessel extinguished;
attenuation positive menace
© 2001 American College of Veterinary Ophthalmologists, Veterinary Ophthalmology, 4, 99–106

12 DSH 13 MC 5.4 mg/ kg IV Cystitis Slow PLR; Increased tapetal Blindness;

– 3 days; 11 mg/ kg mydriasis; reflectivity; ERG-extinguished
PO – 28 days menace absent marked retinal attenuation

13 DSH 8 MC 10 mg/ kg – IV Urinary Slow PLR; Increased tapetal Vision returned

– once to twice obstruction menace present reflectivity;
daily – 5 days; retinal vessel
5 mg/ kg PO twice attenuation
daily – 14 days

14 DSH 4 FS 8 mg / kg – IV Renal disease Mydriasis; Increased tapetal Unknown

– 4 days; questionable reflectivity;
6 mg/ kg – PO menace retinal vessel
twice daily – 16 days attenuation

15 DSH 5 Fe 10 mg/ kg – IV Bowel perforation PLR-present; Increased tapetal Blindness

– twice daily – 4 days; Menace-present reflectivity;
5.7 mg/ kg IV retinal vessel
– 2 days; 4.5 mg/ kg attenuation
– twice daily – 2 days

16 DSH 2 M 7 mg/ kg-IV Pleural effusion Mydriasis Advanced retinal ERG-extinguished

twice daily – 6 days; degeneration
7 mg/ kg PO – 14 days

17 DSH 8 M 15 mg/ kg – PO Diarrhea Mydriasis; Subtle retinal ERG-extinguished;

twice daily – 14 days questionable vision degeneration some vision present;
return of PLR
and menace
VOP182.fm Page 103 Wednesday, May 30, 2001 5:18 PM
ENROFLOXACIN-ASSOCIATED RETINAL DEGENERATION IN CATS
vessels (Figs 1 and 2). These changes appeared to develop
rapidly and could be observed within a few days following
enrofloxacin administration. Occasional rust to gold-colored
spots were scattered throughout the tapetal fundus and
variable pigmentary changes were noted in the nontapetal
fundus (Figs 3A and B).
One cat (case 7) was examined and photographed starting
6 days after receiving only 3 days of oral entrofloxacin
(4 mg/kg in the morning and 10 mg/kg in the evening). This
cat was subsequently monitored over 8 months (3, 15, 31,
and 228 days post enrofloxacin administration). The initial
tapetal changes consisted of subtle increased reflectivity and
increased granularity that gradually progressed to a marked
increased tapetal reflectivity signaling diffuse and advanced
retinal degeneration (Figs 4A, B and C). Retinal vascular
attenuation (diameter or caliper) progressed to nearly
complete loss of the retinal arterioles and venules. The
pigmentary changes in the nontapetal fundus consisted of
focal pigment loss and increased pigmentation. The optic
disc changes included a progressive decrease in the nerve
size, pallor of the nerve surface, and the development of a
granular peripapillary ‘halo’ around the disc.
In some cats rust to gold-colored spots were scattered
throughout the tapetal fundi and were best observed when
the illumination of the ocular fundus was reduced during
indirect ophthalmoscopy. Eventually these spots coalesced
and disappeared as the tapetal reflectivity increased.
Electroretinography in five cats demonstrated no observ-
able responses. In one cat tested twice (8 and 16 days after
enrofloxacin administration), no observable responses were
recorded in either electroretinogram.
The daily and total of enrofloxacin dosages that these
cats received were quite variable, and ranged from a low
of 4.6 mg/kg PO administered once daily to 27 mg/kg PO
administered twice daily. The dosages appeared generally
within the recommended dosage of 11 mg/kg Q 24 h. The
onset of mydriasis and blindness, as detected by the owner,
was also variable, but was between 2–3 days and 12 weeks or
longer after drug administration. Many cat owners noted
mydriasis initially, before they ascertained blindness was also
present. Recovery of vision was variable, and more difficult
to assess. Many cats demonstrated positive menace reflexes,
even though mydriasis was present and the retinal degen-
eration diffuse. The possibility for return of vision seemed
higher in cats in which enrofloxacin was stopped as soon as
mydriasis and blindness were observed. However, ophthal-
moscopic signs of retinal degeneration can progress over
several months, as observed in case 7.
Both eyes of a blind cat (case 1) that received enrofloxacin
(4.4 mg/ kg IV twice daily for 6 days) 5 months before the cat
died of systemic lymphoma were examined histologically.
Remarkable lesions were limited to the retina and included
diffuse retinal degeneration, primarily affecting the outer
nuclear and photoreceptor layers (Figs 6A, B and C). Both
peripheral and central retina were affected. There were focal
areas of hypertrophy and proliferation of the retinal pigment
© 2001 American College of Veterinary Ophthalmologists, Veterinary Ophthalmology, 4, 99 –106
103
epithelium. The inner retinal layers were preserved to some
extent and still recognizable.
D I S C U S S IO N
Retinal degenerations appear clinically infrequently in cats.
In America the Siamese breed appears predisposed.24 In
contrast to the dog, inherited progressive retinal degenera-
tions have been only documented and characterized in the
Abyssinian breed.25 Two drugs have been reported to cause
retinal degenerations in cats. The combination of methylni-
trosourea and ketamine hydrochloride induced retinal degen-
eration in cats, and histologically the outer nuclear and
photoreceptor layers were the most seriously affected.23
Chloroquine diphosphate (1.5–6.0 mg/kg daily) in cats
produces a retinopathy characterized ophthalmoscopically
by increased pigmentation of the ocular fundi (salt and
pepper retina) within 4–7 weeks, and histologically by the
enlargement of the retinal pigment epithelium filled with
PAS-positive granular material.26 Sudden acquired retinal
degeneration (SARD) is suspected but not documented in
cats to date.25
Reports of toxicity to fluoroquinolone and classic quinolone
antimicrobial agents in man appear related mainly to the
central nervous system and are characterized by convulsions,
involuntary movements (tremor, myoclonus, and chorea-like
activity) and visual hallucinations.27 Similar CNS effects have
been reproduced in rodents.28,29 Fluoroquinolone and qui-
nolone toxicologic studies in ophthalmology have concentrated
on topical and intraocular routes of administration, the latter
route for panophthalmitis. The retinal toxicity after topical
and oral ofloxacin has been studied in rabbits, primarily to
determine aqueous and vitreous levels. Serial ophthalmoscopy
and electroretinography detected no toxicity.30 In another
study, intravitreal injections of liposome-incorporated and
free ofloxacin in rabbits produced significant retinal damage
at the 500 and 1000 µg levels with the photoreceptor layer
mainly affected.31 In a study in rabbits receiving intravitreal
injections of ciprofloxacin (100, 250, 500, 1000 and 2000 µg),
a significant reduction in the electroretinograms occurred
within the highest dose group, and the central retina demon-
strated pigmentary changes.32
In this study the administration of enrofloxacin was fol-
lowed by acute blindness and retinal degeneration in some
cats only a few days after the beginning of drug administration.
The cats’ age, sex, and medical condition seemed unrelated
to the drug toxicity. The daily enrofloxacin dosages ranged
from a low of 4.6 mg/ kg PO once daily to 27 mg/kg PO twice
daily. The number of days that enrofloxacin was administered
was also highly variable and ranged from 4 to 73 days. In
some cats the possible association of the administration of
enrofloxacin to the acute retinal degeneration prompted
discontinuation of antibiotic therapy or switching to another
antibiotic; these cats appeared to recover some vision. In other
cats no such association between antibiotic and blindness
was recognized, and the prescribed time course of therapy
VOP182.fm Page 104 Wednesday, May 30, 2001 5:18 PM

104 GELATT ET AL.

Figure 1.

Figure 2.

Figure 3. Figure 4.

© 2001 American College of Veterinary Ophthalmologists, Veterinary Ophthalmology, 4, 99–106

VOP182.fm Page 105 Wednesday, May 30, 2001 5:18 PM
ENROFLOXACIN-ASSOCIATED RETINAL DEGENERATION IN CATS
continued. Based on this study, the cats’ adverse retinal reac-
tion to enrofloxacin appears rare and idiosyncratic, but indi-
cates the drug’s potential predilection for the cat’s outer
retinal tissues (probably the photoreceptor layer initially).
Additional experimental studies in cats should be conducted
to evaluate further the potential retinal toxicity of systemic
enrofloxacin.
The manufacturer has recently lowered the recommended
dosage for cats from 11 mg/kg PO q 24 h to 5 mg/kg PO
q 24 h. Hence, the enrofloxacin dosage for the dog (11 mg/
kg q 24 h or 2.5–20 mg/kg PO or SC q 24 h or q 12h33) is
now significantly different from that of the cat. If enrofloxacin
dosages higher than the manufacturer-recommended 5 mg/
kg q24 h are used in cats, periodic ophthalmoscopy is rec-
ommended. Onset of mydriasis and blindness should cause
prompt cessation of the parenteral enrofloxacin.
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