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Martha's Vineyard Times is a weekly publication.
March 31 - April 6, 2005 Edition
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Vet Crying kitties cause concern March 31, 2005 By Michelle Gerhard Jasny, VMD I recently saw two young Persian cats, let's call them Drip and Drop. Like all Persians, they had little pushed-in noses and big flat faces. Small trails of liquid leaked from the corner of their eyes. Only one of Drop's eyes was affected, while both of Drip's were runny. Their owners were concerned. Was this normal? Their eyes did not seem painful, but the discharge was reddish-tinged. Was this blood? What should they do? The nasolacrimal system is the part of the body that produces and drains tears. It consists of several parts. The lacrimal gland is a large, modified skin gland located within the eye socket. It secretes lacrimal fluid, a watery discharge, commonly known as tears. The fluid collects in the corner of the eye in what is poetically known as the lacrimal lake. From here, fluid drains through two tiny openings called the lacrimal punctae, that are located on the eyelids near the medial corner (the side closest to the nose), one on the upper lid, one on the lower. The tears are supposed to flow through these ducts into the lacrimal sacs, then down the nasolacrimal duct through the nasal passages, and out the nose. This mechanism keeps the nasal passages and nose lubricated. It is also why you sniffle when you cry. An animal with a normally functioning nasolacrimal system will have nice moist eyes and nose, and minimal discharge from the eye. So what about Drip and Drop? Abnormal outflow of tears onto the face is technically called epiphora and can result from a variety of circumstances. The first possibility is overproduction of tears due to irritation. If Drip's eyes are irritated for whatever reason, they will produce extra tears. This is why when you get a grain of sand in your eye at the beach, it waters - Mother Nature's own little eyewash station. Exposure to environmental irritants like sawdust or tobacco smoke may cause epiphora. I see this frequently in dogs that hang out on construction jobs. They are intermittently exposed to everything from paint fumes to sawdust. If Drip's eyes stop running when he is removed from a specific environment, that can help us pin down the cause. If his father is a heavy smoker or his mother likes to burn incense, he might be sensitive or even allergic to such substances. Seasonal symptoms suggest allergies to things like pollen or house dust mites. Ophthalmic diseases such as glaucoma, corneal ulcers, or eyelid infections may all irritate the eye and cause epiphora, but in these situations there will usually be other symptoms of the primary disease. Irritants inside or out? Sometimes the irritant is part of the animal's own body rather than an external agent. Trichiasis is a syndrome in which normal hair growing at a normal location protrudes in such a way as to irritate the eye. Shih Tzu and Lhasa apso owners are familiar with those pesky tufts of hair that grow on their pups' muzzles and can turn into stiff, spikey sticks that poke their pups in the eye. Careful grooming can eliminate this problem. Distichiasis and ectopic cilia are conditions in which extra eyelashes grow from abnormal locations, such as the inner eyelid margin, thus irritating the eye. Abnormal conformation of the eyelids may also be a source of irritation, such as in entropion, a condition in which the lid margin rolls inward so that the hairy surface of the skin rubs on the eye. All of these conditions can cause epiphora from overproduction of tears secondary to irritation and can be corrected surgically. Distichiasis and entropion are fairly common in Persian cats. Although I did not see any evidence of either in Drip and Drop, I did suggest that a visit to a veterinary ophthalmologist might be helpful. I once treated a little dog for chronic ocular discharge for a long time, thinking it was an allergy, because I didn't see any anatomical abnormalities. I finally referred him to a specialist. At the ophthalmologist, the powerful magnifying equipment used there, combined with the doctor's expertise, allowed them to diagnose the teensy abnormal eyelashes that I had been unable to see. The lashes were removed with cryosurgery and the problem solved once and for all. The next possible cause for epiphora is obstruction of the nasolacrimal system. In other words, tear production is not excessive, the faucet is running normally, but the “drain” is clogged. This can be tentatively diagnosed by applying fluorescein dye into the eye. In about half of normal animals with normally functioning nasolacrimal systems, the bright green dye will drain through the ducts, down the nasal passages, and eventually drip out of the nostrils. If this occurs, you can rule out nasolacrimal duct blockage as the cause of epiphora. If no dye comes out the nose, this is suggestive of an obstruction, but remember, it is not a 100 percent definitive diagnosis. If blockage is suspected in very young animals, the first thing to rule out is imperfecta puncta, a birth defect in which the openings to the nasolacrimal ducts do not develop properly. Picture that the plumber forgot to remove the plastic wrapping from the drain. It is most common in Cocker spaniels and poodles. Other animals may simply be born with unusually narrow nasolacrimal ducts. (Picture that the plumber installed pipes that weren't wide enough.) In one study done at the University of Veterinary Medicine in Vienna, Austria, it was found that in short-nosed cats such as Persians, the foreshortening of the face contorts the path of the nasolacrimal system in such a way as to hinder tear drainage, even if the ducts are all normal in size. Treatment options Obstruction of the nasolacrimal ducts may also be caused by infection or inflammation. Bacterial infections are treated with antibiotics, usually topically with ointments or drops, but sometimes systemically with oral medication. Viral infections, such as herpes, are common in cats. Herpetic infections may be mild and self-limiting but can become recurrent, chronic, and quite severe. Irreversible scarring from herpes virus infection is one of the most common causes of epiphora in cats. If your veterinarian suspects any type of infection, he or she can discuss with you diagnostic and treatment options. Other causes of blockage may include foreign bodies, tumors, trauma, or structural abnormalities of the eyelids. In animals with entropion (the rolled in lower lid discussed above) not only can irritation cause overproduction of tears, but also the rolled lid may physically occlude the duct so that fluid is unable to drain normally. (Picture the bath mat rolled over the drain. Water backs up even though the drain is open and the pipes are clear.) Conversely, if the lower lid is excessively droopy or rolled out, as in a condition called entropion, the duct may be too far away from the pooling fluid to accommodate normal drainage. Your veterinarian may flush an obstructed duct using a special tear duct cannula and saline solution. If this is not effective, I generally recommend evaluation by an ophthalmologist for any further procedures, due to the delicate nature of the structures and the specialized diagnostic and surgical equipment that may be warranted. If the underlying problem is an eyelid abnormality, it is generally considered ideal to wait until Drip is a year of age before attempting surgical correction. Facial conformation matures over that year and some problems may resolve on their own. On the other hand, if Drop has a very severe defect, early correction may be necessary to avoid serious damage to the surface of the eye. In any case, it is better for the surgeon to be conservative in how much tissue is removed. If necessary, a second procedure can always be done to further correct the problem, but if too much tissue is removed initially, that can be hard to fix. I think Drip and Drop are just typical, healthy Persians with a normal amount of epiphora for their breed, but we'll keep an eye on those eyes, and consult an ophthalmologist if indicated. What about that “bloody” tinge in the ocular discharge? Well, it's not really blood. It's just benign pigments that can sometimes be found in kitty tears. Totally normal. |
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