Anterior Uveitis
“Gracie” a 2 year old, F/S, flat coated retriever, presented for acute onset of blepharospasm and anorexia. The night before presentation, her owner noticed she was lethargic and squinting both eyes. She was anorexic the morning of presentation and had an episode of retching. She had been playing in the yard, chewing on rose canes the day prior to the onset of signs. She has tested positive for Borrelia burgdorferi previously but was not treated as she had not developed any clinical signs, according to her owner.
We decided to assess tear production using a Schirmer tear test, fluorescein staining for ulceration and intraocular pressure was checked in both eyes. Tear production was normal and stain uptake was negative in both eyes. However, intraocular pressure was found to be low bilaterally, OD 7mmHg and OS 8mmHg. Buprenorphine 0.3mg SQ was administered for ocular pain and an E collar was placed to prevent self trauma to the eyes.
A CBC and profile were run in house and urine was sent out for analysis and culture. A tick panel including titers for RMSF, Anaplasma, Lyme C6 and Ehrlichia was submitted. An ophthalmology consult was sought as well. Our ophthalmologist, Dr. Michelle Willis, noted both irises were congested with pinpoint hemorrhages.
Prednisone acetate 1% OU QID and Metacam PO SID was administered for anterior uveitis and discomfort. Doxycycline 125mg PO BID was also started while awaiting results of the tick titers. Intravenous fluids were not started as the fever resolved within a couple of hours of presentation. Gracie was discharged the same day.
Gracie was positive for Borrelia burgdorferi (130U/ml). She was also positive for Anaplasma (titer 1:400) and weakly positive for RMSF with a (titer 1:25).
She was eating the next day and holding her eyes open, but still lethargic. Gracie’s eyes were rechecked by Dr. Willis one week later to monitor the uveitis and there was improvement. The iris edema had resolved and there was only mild hyperemia OU.
Discussion
Anterior uveitis, while often seen as primarily an ophthalmic problem, can be a sign of systemic illness as it was in Gracie’s case. As well as tick borne infections, it can be a harbinger of other infections including fungal, parasitic and viral. It can also be seen with neoplasia, lymphosarcoma being the most common type, or it can be the first indication of some immune mediated diseases. There are a variety of metabolic issues uveitis can be associated with, as well.
In some cases, uveitis may be the first indication of illness. This patient never did show the more classic signs associated with Lyme disease such as shifting leg lameness and the fever resolved within an hour after presentation.
A minimum database of CBC, blood chemistry and urinalysis are indicated in cases of uveitis. It has been recommended that thoracic radiographs be considered as part of the minimum database where uveitis is involved. Serological tests for infectious causes should also be considered, especially in areas where tick borne diseases are common.
At VESCONE, we perform all of these diagnostic procedures and have developed a comprehensive collaborative approach to your client’s pet care. Our specialists work together to make sure the right diagnostics and proper treatment are initiated as soon as possible.
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