Advice needed for eye specialist appointment

Piceag

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Hi! First post on this forum and I wish it was in happier circumstances.

Tl;dr at the end of this long post. English is not my first language so I apologize for any mistakes.

So over the course of the summer, my approx. 5 years old rescue cat developed a spot in her right eye that you can see in the pictures. She is neutered and vaccinated.

At the start of July, when we took her to the vet for her yearly visit, it was just a white pinpoint and the vet told us it was nothing to worry about, just a little scar, and that we couldn’t and shouldn’t do anything about it. Over the next two months it grew to be quite a bit more than that, first a sort of translucent whitish raised spot and now a flatter, more pinkish one. Her eyelid often looks a bit inflammed and half-closed.

Obviously I began to have my doubts as to whether it was really a scar. I did some research and found that the chronic virus flares (probably herpes) that my cat has can cause problems to the eyes. It didn’t look like an ulcer, so I thought maybe it could be eosinophilic keratitis, as the pictures looked quite similar to what my cat had.

Apparently herpes is linked to this, and as stress can cause flare-ups and my cat is really super scared of the vet (she drools and pants all the way to and from the office), I wanted to wait to see if it cleared out on its own, as she didn’t seem all that bothered by it.

But it didn’t, so a few days ago we decided to go see the vet again. It was a different vet this time, a young woman who had the humility to admit that she didn’t know what it was, but that it looked worrying and that it could be either viral, inflammatory or tumoral. She just tested for ulcers and thankfully there weren’t any.

We were advised to go see a specialist and I have an appointment there on Wednesday. However I am a little wary of this eye specialist, as according to his reviews on google he seems prone to hasty diagnosis and doesn’t seem to care a whole lot about the pets general wellbeing. We would happily go elsewhere, but sadly we don’t have a choice as he is the only eye specialist in our area and we don’t have a car to go seek another one.

I want to be well prepared for the appointment and not let him bullshit me into a misdiagnosis or a treatment option that is needlessly invasive. According to you, what test should he run in order to know what the cause is and rule out other possibilities (keratitis vs uveal tumor vs keratopathy) ? And what are the most sensible ways to treat each of these diseases? Not going to lie, the possibility that this could be a malignant tumor is terrifying, and I saw pictures that looked like what my cat has. It's worrying me sick right now.

Tl;dr: I’m taking my cat to the eye specialist in 2 days and need you guys to tell me what to expect what test they should run in order to be certain of their diagnosis (keratitis vs uveal tumor vs keratopathy), and what treatment options they should suggest. Thanks a lot for your help!
 

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verna davies

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I have had a cat with EK and have a little knowledge of it. The specialist I took mine to did a close examination and a scrapping which was tested and confirmed to be EK. She had different eye drops but only after having 1% cyclosporine drops did it get under control. The specialist should be able to see if she has had herpies, it looks like a squiggly green line, scarring within the eye.
I dont know if I can answer the questions you have but I will try.
 

fionasmom

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Ulcerative Keratitis in Cats | VCA Animal Hospital
eye-tumors-melanoma-in-cats | VCA Animal Hospital
Tumor of the Eye in Cats | PetMD
Feline corneal diseases: Herpes and more (Proceedings)

I would try to read up on the disorders that you suspect your cat might have. The articles above, and they are certainly not the only ones out there, discuss treatments and diagnoses for the various conditions. If you use those as a baseline, you may be able to ask enough questions to assure yourself that you are getting attention and informed answers.

Any records of any tests that have already been done should be taken with you to show the specialists and to prevent running the same ones over again, especially if they are recent enough to be valid. It will also confine him to what you already know to be true about your cat's health. Write down questions or have them in your phone or the like so that you can systematically go through your list.

I am certainly not a vet nor medical professional, but the only melanoma I have ever seen has presented as dark spot. There is also a benign condition known as melanosis. While this is just my opinion, this looks like keratitis or a form thereof.
 
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Piceag

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Thank you both for your answers.

V verna davies , does your cat have to be under continuous treatment for EK or did it eventually "go away"?
When I learned about this and began thinking that my cat might have it, I felt really bad for her. It's crazy to think that in the last few days, after stumbling upon this page about a case report, I've been almost praying that this is EK and not some kind of cancer. I really hope we can get some answers soon.

fionasmom fionasmom Thanks a lot for the links, this is very helpful. I had planned to take some notes with me, I just hope he lets me talk and ask stuff and doesn't just go 'who's the vet here, you or me'. I hate those types :fuming:
 

verna davies

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It never goes away but once you have it under control its just a case of one drop a day into the eye. EK can be in one eye only but is usually in both eyes. My cat had it in both eyes but was only minor in one, no signs visible to the naked eye. It can flare up from time to time but its just a case of putting drops in twice a day until it recedes. The sign of a flare is usually misty pin pricks on the outside of the eye. I live in the UK, treatment where you live may be different BUT once you have the right eye drops, it can be easily controlled.
 

fionasmom

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Let us know what happens when you see the specialist. Remember that you are paying the bill, if nothing else, and deserve to leave the office feeling as if you have been helped.
 

verna davies

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I agree with fionasmom fionasmom , you are paying them so ask all the questions you need. Even after the appointment and you have absorbed all the information given, if you have any more questions, put them in an email or phone them.
 
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Piceag

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Sorry for the delay!

The appointment went rather well. The vet looked at her eye under different lights, mesured the pressure I think, and took some high quality pictures. According to him it is EK. He prescribed 4 drops a day of dexamethazone for 2 weeks, and then we have another appointment to check progress and ajust treatment accordingly.

However my mind is not completely at rest concerning the whole tumor thing. The last day before the appointment we were in a panic because my partner had shown pictures of our cat to a friend's dad, a former vet, who said it looked cancerous to him. When we were at the vet we asked him clearly what made him think it was EK and not a tumor or something else and all he had to say was 'don't worry, I am absolutely certain' with nothing more to prove his point.

Since then I have looked online extensively and found at least two websites/articles that said clearly that you couldn't be sure without a cytology at least. At first I thought that if the treatment worked maybe it could confirm the diagnosis, but apparently corticoids have an effect on cancer cells as well so I'm not sure. We really have to find a way to make the vet agree to more tests next time.
Maybe I sound a little paranoid, but I don't want to regret not having pushed this.

The other issue I have is that apparently corticoids are not recommended for EK, as it can hinder the body's defence against Herpes virus, which could be causing EK in the first place... And it can make the eye pressure go way up after only a few days, which is never a good thing. So I also have to push for another treatment at the next appointment, maybe Cyclosporine as you mentionned V verna davies ?

Anyway thanks a lot for your concern, you are both totally right that as long as I'm paying the vet and being decent with him I deserve answers to my questions.
 

verna davies

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You need to be certain what is wrong with the eye for your cats sake and your peace of mind. Next visit TELL the vet you would like a cytology test done.

I asked a lot of questions, got some answers from the specialist I saw but on one occasion she was on holiday and saw someone different. Asked all the same questions again and this time got all the answers and a lot more information that put my mind at rest.

Cyclosporine isnt absorbed into the system so doesn't affect the other organs only the eye. I dont know if its the same in your part of the world but here its olive oil based and is mixed at the eye clinic. They said it was good for one months usage only but after speaking to several different specialists in different practices, its good for 6 weeks.

Keep us updated on your progress.
 

fionasmom

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I completely agree that you should ask for the cytology test. Tell the vet that you are more than willing to pay for it for your own peace of mind, it is your decision to go to this next step, whatever you think will suit the situation the best.

Sometimes vets do think that they are saving you money, but in this case you don't want guesswork. I have had to "demand" that certain tests be done when vets said that they did not think that they were necessary.
 
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Piceag

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Thanks again for your advice. We're going to the vet in two days, hopefully we can get a cytology done.

In the meantime I've done my homework on eosinophilic keratitis, and while I'm happily surprised to see that there's quite a bit of research that has been done for this condition, trying to figure out which treatment is best out of all the possible drugs and posologies is very overwhelming.

It seems that vets really don't agree on this issue (whether to treat with steroids / NSAIDs / immune suppressors / anti-virals) and most of these treatments can have serious side effects (ranging from ulcers, glaucoma or infection to elevated risk of diabetes or renal failure) that would make one hesitate to give large doses or a lifetime treatment.

Besides, I suspect that a lot of these meds won't even be available where I live :frustrated:
In France laws dictate quite strictly how a substance can be used and prescribed (for a reason of course) and I'm pretty sure doctors can't compound their own medicine.

So we'll see, we're going to have to make do with what we have and hope that the vet knows what he's doing. But I'll read my notes again before the appointment, so I know which treatments to say a definite 'no' to. I'll keep you posted!
 

verna davies

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Its a minefield trying to decide the best treatment. I hope your specialist is good and chooses the best treatment for your cat. Please keep us updated.
 
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