A challenging case: Painful periocular swelling in a cat

An ophthalmic examination provides valuable clues for diagnosing an uncommon disorder with mostly nonspecific signs.

A 4-year-old 10.1-lb (4.6-kg) spayed female domestic shorthaired cat was presented to the Louisiana State University School of Veterinary Medicine Veterinary Teaching Hospital for evaluation of painful periocular swelling of both eyes of about one month's duration.

HISTORY


Vital Stats
The cat was kept indoors but was allowed to go outside. The cat was current on vaccinations and had no travel history outside of Louisiana. The results of feline leukemia virus and feline immunodeficiency virus testing performed before referral were negative.

Previous therapies used to treat the swelling included administering an injectable long-acting corticosteroid, a topical triple antibiotic, and oral clindamycin. After an initial improvement in clinical signs, the ocular signs quickly returned and were unresponsive to oral cefadroxil therapy.

EXAMINATIONS

On physical examination, the cat's temperature, pulse, respiratory rate, and body condition score were normal.


1. A 4-year-old cat evaluated for painful periocular swelling in both eyes. Note the marked periocular tissue swelling present in the left eye. Epiphora and elevated third eyelids are present in both eyes. Central corneal changes are evident in the left eye and correspond to the area of exposure keratitis secondary to lagophthalmos.
An ophthalmic examination revealed periocular soft tissue swelling, epiphora, and exophthalmia with decreased retropulsion of both eyes. These findings were most pronounced in the left eye (Figure 1). A lack of menace response in the left eye was noted along with a markedly reduced palpebral reflex, which had resulted in significant central exposure keratitis and the development of a superficial corneal ulcer.

No active ocular motility could be elicited from the globe, and lateral strabismus was noted. There was a marked amount of conjunctival thickening and hyperemia of the left eye. Moderate conjunctival hyperemia and chemosis were noted in the right eye. Intraocular pressures measured by applanation tonometry (Tono-Pen XL—Reichert Technologies) were 19 mm Hg for the right eye and 35 mm Hg for the left eye. Pupillary light reflexes were slow and incomplete in the left eye and were normal in the right eye.

On slit-lamp examination, diffuse corneal edema and keratic precipitates were noted in both eyes. Additionally, marked aqueous flare was noted bilaterally along with pars planitis in the right eye and rubeosis iridis and posterior synechia in both eyes. Pigment deposition and inflammatory changes affecting the anterior lens capsule were noted bilaterally. An inferior bullous retinal detachment was noted in the right eye. Fundic examination of the left eye was limited because of the anterior segment changes.