Eye Of The Storm

By Erika Collier, CVT

Co-written by Alexis Soutter, DVM

It started with a simple question: “What do you call that dark lining around the iris?” (with finger pointing and circling my own eye).

It’s a question I wish I never needed to ask, because I knew something wasn’t right with my dog’s eye. The answer, by the way, is “root,” the root of the iris.

A few days later I brought Jegos (pronounced “JAY-gis,” meaning “sandstorm” in the Native American Pima language) to work with me for Dr. Smedley to take a look. As you can see in the picture, that root is thickened in one area. The conclusion was that Jegos needed to see a veterinary ophthalmologist.

As we headed to the visit, I kept trying to convince myself that I was overreacting, that maybe he was born this way and I had failed to notice it for the last two years.

That would not be the case. He was diagnosed with a melanoma tumor. There are only two options for treatment; laser surgery to kill the diseased tissue or enucleation which is the removal of the eye. The advantage to removing the eye would be that we could send it to a pathologist for testing to determine if it was a benign tumor or a cancerous one. Of course, removing the eye would mean losing the vision on that side of his face. Having had the pleasure of working with many dogs and cats over the years that have lost one or even both eyes, I know that they do incredibly well and adapt quickly. It’s not nearly as devastating to the pet as it is to their human family. However, for my high-drive border collie that loves to catch disks and compete in Disk-Dog events, that would likely be a career-ender. So we elected laser surgery in an attempt to save his vision.

Prior to surgery day the ophthalmologist had us run a Complete Blood Count (CBC) and Chemistry panel to make sure that liver and kidney values indicated good function and that no other issues were lurking in his body. She also had us take radiographs (“x-rays”) of his entire body to make sure that the disease hadn’t already visibly spread. Everything was good-to-go! Jegos’ surgery day came and we made the trip to the ophthalmologist’s office before sunrise. I waited nearby for the call to say he was in recovery and when he’d be ready to go home. Surgery went well and we began our drive home shortly before 5pm. Now came the hard part: keeping track of the six different medications that needed to be given at separate times, some on a 2-, some on a 3- and some on a 4-times a day schedule. I have to admit I cheated a little as I was able to bring Jegos to work with me to make sure everything was administered exactly on time. As the days and then weeks went by, the medications were decreased.

Jegos went back to the ophthalmologist for follow up exams regularly for 3 months. Everything was going great. He was long recovered from the procedure. We were down to only putting one drop in his eye twice daily. And he was back to chasing balls, catching disks, and playing with his housemates.

Sadly, that 3 month follow up changed everything. The tumor was growing back and decisions needed to be made. In the days after that follow up, I watched his personality change. He wasn’t playing with his housemates, not even herding his favorite (and biological) brother. He began hiding from his sister that liked to groom him, and even showing his teeth if she pushed it. He also began to give us a hard time putting his eye meds in, rolling on the floor to get away or swatting us with his paws. Over a week, my happy dog disappeared. I panicked. I rushed him to another ophthalmologist for a second opinion since another round of laser surgery was scheduled in less than two weeks and I was worried we were making the wrong decision for him.

That second opinion yielded a diagnosis of uveitis which is inflammation inside the eye. The cause was uncertain. Was it the tumor in the eye? If so, the likelihood of it being cancerous just increased and that would merit enucleation. Was it some other cause in the body, like an infection or other cancer? Was it something simple, like he bumped his eye or maybe his sister groomed him too much? More decisions needed to be made and more testing was started along with switching the eye medication to a stronger anti-inflammatory. Surgery was delayed for a couple more weeks to allow the inflammation to quiet down and for all the tests to be completed.

We started by taking a big blood sample. We sent it to the laboratory for another CBC & Chemistry along with a panel of tests looking for antibodies against tick-borne diseases, the most common infectious cause of uveitis. The panel included a “4DX Plus” (the same test we perform as part of an annual wellness screening for tick diseases like Lyme and Heartworm disease) and also tested for much less common illnesses like Rocky Mountain Spotted Fever.

While we waited for results, which took almost a week, his eye quieted and his behavior returned to normal on his new medication. I had my happy boy back! My guess was his eye had become painful and caused him to withdraw from our family. The blood test results all came back perfectly normal.

The next diagnostic steps were supposed to be taking another round of full body radiographs and performing an ultrasound of his abdomen and chest, again looking for occult (hidden) disease. Reality check time. All of the previous tests, exams (initial, follow ups, second opinion), surgery and medications had added up to about $3,500, an expense we didn’t budget for. Luckily everyone along the way participated with CareCredit (a healthcare credit card / financing system) to help us spread that cost over six months. However, we would still need to come up with that money not to mention funds for the second surgery. Rather than spend our increasingly limited resources on more tests, we took the gamble, which I believe is small, to not finish the rest of his testing.

On his last follow-up exam prior to surgery the ophthalmologist told us that she did not see any tumor enlargement since the last visit and that the uveitis was completely resolved. So now back to decisions: repeat the laser surgery or remove the eye?

After much discussion about quality of life, likelihood of recurrence, his age (he turned 3, this spring), his lifestyle and what our gut was telling us…

…We repeated the laser surgery.

I can’t tell you what the end result will be. He is only a few weeks out of surgery now, and so far so good. All we can do is continue his medications as directed and hope that this surgery will be curative, or at least give him the use of the eye for many more years. But for now, he’s back to catching discs.