I’m winking because it hurts!
 

Poor Duke was having a bad day. While hiking with his owner he ran off through the brush to chase a squirrel and now his eye really hurts. He had to hold it shut so it looked like he was winking and he kept rubbing it with his paw. His owner took him to AMC the next day.

On presentation, Duke’s eye was red and painful. He was unable to open his eye due to pain and had developed a yellow ocular discharge. A couple of anesthetic drops were applied to make him more comfortable. Once his eye was open we could see a blue haze in his cornea (the clear part of the eye) and his pupil was very constricted compared with his normal eye. The eye was also very red and inflamed.

There are multiple maladies that could cause these signs, so multiple tests were performed. First we used a special instrument called a Tonopen to check the pressure in his eye. Increased pressure is a sign of glaucoma and decreased pressure is a sign of inflammation. Duke’s pressure was low. Next a special dye called fluorescein stain was placed in his eye to see if there was an ulcer or abrasion. The normal outer cells of the cornea allow the stain to wash away, but if there is a scratch or ulcer, the stain will stick to the abnormal area. Duke’s cornea took up some stain to reveal a large corneal ulcer. Very likely Duke scratched his cornea while playing outside.

The doctor prescribed two medications to help Duke feel better. First he was placed on a medication called Atropine which would help him to feel less pain and allow his pupil to dilate. The second medication was a triple antibiotic ointment that needed to be applied every 2-4 hours to prevent infection. Duke was also fitted for an Elizabethan collar to prevent him from scratching his eye. Duke was scheduled to come in for a recheck in 2-3 days.

At recheck Duke was feeling a lot better. He was holding his eye open and it was no longer red and irritated. The cornea was stained again and the ulcer had resolved. The antibiotic ointment could now be given 2-3 times per day, and the Atropine could be discontinued. Duke was unhappy to hear that he still had to wear his E-collar but he was happy to be feeling better. He was scheduled to come in for a recheck in a week.

A few days later his eye was sore again. Duke had been a naughty boy and convinced his owner he didn’t need to wear the E-collar anymore. So back to see the doctor and sure enough the ulcer was back. Duke must have scratched it while rubbing his eye. Poor Duke had to go back on his medicine every 2-4 hours and this time he would keep his E-collar on.

After 1-2 rechecks, Duke was healed and the medicine and E-collar were discontinued. His cornea healed very well and the only sign that there was a problem was a tiny white scar on his cornea which won’t affect Duke’s vision much at all.