This is one of my favorite patients and success stories….
Salem is a middle-aged chihuahua that came to see me. His very observant owner thought one eye “appeared” bigger than the other. He was doing great, but she thought something could be wrong. So, to me, his eyes appeared normal. I checked his pressures, and they were in the normal range, but each eye had a very different number (weird, right?). We decided to watch it to see if anything would declare itself. Within a few days, we rechecked Salem’s pressures, and they spiked up to three times the previous measurement!
Glaucoma is a condition where there is an increase in pressure inside the chamber of the eye from a build of up aqueous humor (fluid). There is primary, which is genetic, and there is secondary, which is due to an obstruction of some kind, so the fluid does not drain properly. An example of this is a lens luxation, which Salem does have. Though in his case, it likely happened after the pressure increased since it was in its normal place at the first visit. Patients almost always go blind, and it can be seen in one eye or both. For Salem, it only occurred in his left eye.
This is a condition that typically needs lifetime monitoring and medications. Surgical intervention such as enucleation (removal of the eye) or evisceration (removal of eye contents) with a prosthetic in place is also a treatment option. Obviously, surgery requires general anesthesia and is not always the best option for a patient.
We decided to take it old school!
We opted to do an intravitreal gentamicin injection, which was more common in the past but still works great for many glaucoma patients. This procedure requires us to sedate the patient, drain some of the fluid out and then inject the left eye with steroids and antibiotics. We basically “kill” the eye. I know it sounds so scary! However, it is super effective! We stop the eye from producing any more fluid, which then normalizes the pressure in the eye. The side effects of doing this are permanent blindness (which he already was), and cosmetically, the eye crystalizes over.
Within 1-2 weeks, Salem was back to normal! We were able to stop medications completely in his left eye. He is now getting one eye drop ONCE a day in his right eye, which was his normal eye. We do this because there is a risk of that eye getting glaucoma, too, and we want to protect it as much as possible.
It is so amazing how quickly the eyes can heal but can also take a turn for the worse. Owners know their furry friends better than anyone else, and this was the perfect case of that. We now monitor Salem’s pressures every 3-6 months. He is much more comfortable, and his sweet owners have one thing less to worry about with their busy days. This was my first glaucoma case out of veterinary school, and Salem was the perfect teacher!
By Dr. Carlen Ledain