Applied Clinical Genetics Case Library
Signalment & History
Signalment:
- 5-year-old
- Spayed female
- Terrier mix
History:
- Diet: Blue Buffalo BID; HW Preventive: Interceptor monthly; Flea/Tick Preventive: none; Fecal/Parasite Exam and Tx: none
- Has had genetic screening; GP discussed with owner this dog’s predisposition to PLL, and that in the case of any eye abnormalities the dog should go directly to a specialty ophthalmologist to try and prevent the need for enucleation.
Presenting Complaint
- Squinting, scratching at eyes (onset earlier today); eyes now teary and red; “Doesn’t look right”; O suspects PLL based on previous conversation with GP about genetic screening results.
Physical Exam
- Temp: 102.5 F; Pulse: 150 bpm; Respiration: 42/min; MM: pink/moist CRT: 2 sec; BCS: 5/9; Eyes: Anterior lens luxation in right eye; Ears: wnl; Mouth: Dental Disease = Grade 2; LN’s: wnl; Cardio: wnl; Resp: wnl; Abd: wnl; GI: wnl; MS: wnl; CNS: wnl
What is on your problem list?
- Primary Lens Luxation OD
What diagnostics would you perform?
- Tonometry
- OD (in mmHg): 40, 32, 37
- OS (in mmHg): 18, 20, 17
What is your assessment?
- Abnormally high IOP OD due to PLL
- Emergency intervention required
What is your plan? How will you follow up with this patient?
- Emergency lens replacement procedure
- Referral to ophthalmologist recommended.
- Exams recommended every 6 months, with IOP checked every visit. Follow up appointment in two weeks.
- Vet communicates the risk that this condition is nearly always bilateral.
How would your treatment plan change if lens replacement surgery was not financially practical?
- Sedation can be done to medically widen the pupil, then push the lens into the back of the eye. Dog will need “life-long at least twice daily treatment with a drug that keeps the pupil small – which in turn ‘traps’ the lens in the back of the eye. This treatment approach is believed to be working in 8/10 patients – with an average chance of 50% that the eye will retain sight 12 months down the line,” according to the Eye Veterinary Clinic in Herefordshire, England.
Post-surgery summary
- Glaucoma secondary to PLL diagnosed @ 7 years-old; IOP in range of 30-35 mmHg (monitored every 6 months by GP)
- Latanoprost, applied topically BID (this is a prostaglandin analog.
Learn More: PLL & Glaucoma
- Lens luxation can be primary or secondary to glaucoma.
References/Additional Resources
- https://www.eyevetclinic.co.uk/directories/eye-conditions/lens-luxation-in-dogs/
- https://vcahospitals.com/know-your-pet/cataracts-in-dogs#:~:text=The%20most%20common%20cause%20of,spontaneously%20and%20are%20age%20related
- https://www.eophtha.com/posts/anatomy-of-lens
- https://eyewiki.aao.org/Zonulopathy:_Evaluation_and_Surgical_Management
- https://www.ofa.org/diseases/dna-tested-diseases/primary-lens-luxation
- https://ofa.org/primary-lens-luxation/
- https://www.eastcottreferrals.co.uk/anterior-lens-luxation-in-dogs/
- https://www.vin.com/apputil/content/defaultadv1.aspx?pId=11196&catId=30760&id=3854142
- https://vcahospitals.com/know-your-pet/glaucoma-in-dogs
- https://rethinkhealing.com/treatment-options-for-canine-glaucoma/
- https://vmcli.com/some-basic-principles-of-tonometry/#:~:text=For%20most%20dogs%20a%20%E2%80%9Cnormal,15%20mmHg%20to%2025%20mmHg
- https://www.merckvetmanual.com/emergency-medicine-and-critical-care/ophthalmic-emergencies/anterior-lens-luxation-in-animals
- https://www.webmd.com/mental-health/addiction/what-is-methadone#2
- https://www.dvm360.com/view/your-treatment-options-glaucoma-small-animals-0
- https://animalvisioncare.com/eye-conditions/canine/lens-luxation/
- https://www.petcarerx.com/article/how-to-treat-lens-luxation-in-dogs-and-cats/1721
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