Feline Acute Bullous Keratopathy (FABK)?

Bobbiann Mako

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Hi there,

I’m brand new to this site and this is my first post. I came across another post here from 2016 about something similar I think I’m going through: Cloudy bubble on eye

My indoor cat Link about to turn 9 years old in June, and he is a pretty sick cat and always has been. As a kitten when I adopted him from the shelter, he had Upper Respiratory Disease and he actually recently got that booster for it in February 2021. After turning about a year old, he developed these neck ulcers/scabs, which we didn’t do a biopsy but we’re sure it’s Eosinophilic Granuloma Complex (EGC). I believe it’s seasonal/dust allergies and probably stress is what causes it. So our decision was to prescribe lifetime prednisolone to him at 5mg/day. He’s been on it for years now. He would still get a small flare up on his neck from time to time but he hasn’t had something like that in a while. He is a lot less stressed living where I currently live now which is great. He also gets Viralys L-Lysine HCL oral gel twice a day. And he’s on Royal Canin Anallergenic vet prescribed food to make sure he doesn’t get urinary crystals (he didn’t like the hydrolyzed protein one) and that his flare ups aren’t caused by a food related allergy. He gets blood work done yearly (just to check things out) and nothing ever stood out except for the fact that he’s slightly anemic. He’s had an ulcerated cornea three times in the past before, but I just assumed it was because he scratched himself in the eye or something.

Fast forward to now, I’ve attached some pictures of a blue/white cloudy-ish looking growth/bulb that’s recently developed on his right eye. Bubbles inside it indicating fluid. I took him to the vet and originally there was no ulcer to be seen with the UV eye stain. So the vet perscribed Tobradex (Tobramycin) eye drops - 1 drop 3x daily. The upper bulb (first photo) then popped, which caused an ulcer and leaking of fluid. He squinted his eye for a few days because it probably hurt. At that time, another bubble was developing, same eye, but at the bottom of the eye this time (other photos). A week later, to treat the ulcer, he was prescribed Ocuflox (Ofloxacin) antibiotic eye drops - 1 drop 3x daily. As well as Optixcare Eye EMS - 1-2 drops every other day. The second developed bulb/growth still hasn’t popped yet. Through all of this, he’s never seemed bothered by it, only when it originally popped. He’s still having a bit of green discharge in the corner of the eye, but the vet didn’t mention anything when I brought it up.

I just took him to the vet yesterday to check how things are going. The ulcer is no more and that larger bulb at the bottom still hasn’t popped.
I’ve done a lot of research and believe it to be Feline Acute Bullous Keratopathy (FABK), or sometimes called Feline Acute Corneal Hydrops. It seems to be fairly rare and there’s not a lot of information on it. But I read everything I could possibly find. Causes, symptoms, pictures, stories, treatment, scholarly/student reports, post-surgery write ups, etc. I think it could be caused by his lifetime use of prednisolone. Or even he’s just more susceptible to it. I know that surgery is what can treat it, but even then it could still come back. I also believe he may have Cushing’s because of his belly, thinning hair and random small patches of fur missing, as I never see him lick or bite/scratch obsessively. And I know that that can be caused by long term steroid use as well. I’m working from home for the time being, so I’ve spent a *lot* of time with him for about 15 months now, so I know all his patterns and mannerisms even more so than before.

So, I asked the vet (a fill in vet for his actual vet this time) if I could try to lower/wean out his prednisolone dosage and give him saline drops to draw out fluid when he gets these bubbles. Muro 128 5% sodium chloride hypertonicity ophthalmic solution to be exact (not the ointment — although maybe that’s a better alternative?). And then if the bubble pops, give him antibiotic drops to treat the ulcer. I’m trying to avoid surgery as much as possible and because it’s just unfortunately not a financial hit I can take.
The vet agreed with my findings and at home remedies. I haven't started the saline drops yet as I have to wait for it to be delivered, but I have started the weaning off process for the prednisolone. I haven’t taken him to an ophthalmologist because of financial reasons. If I have to get him seen by one, that’s not so bad, but I don’t think I can afford surgery.

I apologize for such a long thread, I just want to know, does anyone have any knowledge or experiences about this topic they can share? How many ruptures can the eye take? Maybe it’s not even what I think it is.

I just want to share my experience in case in the future anyone goes through something like this. Thank you for your time.

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Bobbiann Mako

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Has your vet considered Eosiliphinic Keratosis. It is linked to herpies and autoimmune issues.
I extensively researched both ABK and Eosinophilic Keratitis because I wanted to understand the differences. They were the two that I wanted to look at because I figured it was one or the other for sure.
It seems more in line with ABK than Eosinophilic Keratitis from the symptoms, pictures and descriptions I read and saw. I won’t rule it fully out though. It just sounds and looks more like ABK, I think. His looks more bubble-like and bulged out, versus a flatter/gritty looking cloudy/foggy area and there’s no blood veins in or around it for my cat’s case either. And his case doesn’t appear to bother or irritate him, only when that first bulb/growth popped. But who knows. I’ll see what the vet thinks of it being Eosinophilic Keratitis versus ABK!
I do have a phone call with them this Thursday though so we can talk a bit more about it. I’d just be nervous to treat him with *more* steroids considering he’s been on prednisolone for almost his whole life, because I can’t help but just feel that that’s maybe where this problem is coming from. :confused: Not to mention, just age in general too, I’m in denial!
 

verna davies

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I hope you find out what it is soon so he can been treated, I'm so sorry he is going through so much and you have the worry of it. If it is EK, my cat had 1% cyclosporine drops, once a day and her eyes cleared up in a matter of a week and remained clear. Please keep us updated.
 
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Bobbiann Mako

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I hope you find out what it is soon so he can been treated, I'm so sorry he is going through so much and you have the worry of it. If it is EK, my cat had 1% cyclosporine drops, once a day and her eyes cleared up in a matter of a week and remained clear. Please keep us updated.
Thank you so much!!! I will keep that in mind though and see what the vet thinks about that kind of treatment for my boy. See if it could maybe work for him too.
 
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Bobbiann Mako

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Update 1:
I’ve started the weaning off the prednisolone process, so he’s getting a half of a 5mg pill for two weeks every day, then the same dose every other day for two weeks. I have been waiting for the Muro 128 5% to be delivered so haven’t even started administering them yet. The big growth he had on his lower quadrant has decreased, I don’t think it fully popped because he hasn’t squinted his eye. I did see some leakiness the other day, but the pollen is in full effect so it may just be his allergies (praying for no EGC flare up since I’m weaning off his prednisolone!).

I think I saw a small fluid filled growth at the top of his eye developing again but it’s difficult to see. The growth at the bottom of eye appears to just be lessened and more opaque white looking. It also looks like he has some wispy white streaks across his eye, maybe where the first original growth popped? I’m not sure if those are permanent now or will eventually heal. But I think his eyesight is a bit affected because that pupil is usually a bit more dilated than the other. Basically, nothing urgent or severe has happened on the healing process or reoccurring process. So I’m just watching him like a hawk and hoping for the best.

He’s been sneezing like mad over the course of this week though because of the pollen outside. So even though the weather is beautiful, I don’t want him to suffer too much so I’ve closed the windows and cranked up the air purifier so he can get some relief.
 
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