Embark for Veterinarians

Applied Clinical Genetics Case Library
Case 2

Signalment & History
  • 5-year-old
  • Spayed female
  • Terrier mix
  • 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
  • Primary Lens Luxation OD
  • Tonometry
    • OD (in mmHg): 40, 32, 37
    • OS (in mmHg): 18, 20, 17
  • Abnormally high IOP OD due to PLL
  • Emergency intervention required
  • 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.
  • 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.
  • 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.
  • Lens luxation can be primary or secondary to glaucoma.