Newsletter Spring 2020
[Written by Dr Antony Goodhead]
It has been some time since our last practice newsletter. In this edition I am going to cover:
1. JAEH job offer
2. Two unusual and rare cases
3. Use of Pilocarpine 0.1% and 1% for neurogenic Dry Eye
4. How to contact us
5. New informative website
6. Smart Temperature monitoring of pharmaceuticals (Your nurses will be grateful)
Job OFFER
We have sent this out via SAVA, however, we would also like to provide you, our subscribers the opportunity to apply for this position. Closing date for applications is on the 10th of October 2020.
Following my long partnership with Izak since 1996, I am now the only practising full-time ophthalmologist working in our Johannesburg practice. Izak’s unfortunate, traumatic hijacking incident has left him injured and unable to practice veterinary ophthalmology and this has resulted in me needing to look for a new associate to assist me in this busy practice.
The Johannesburg and Cape Animal Eye Hospitals are now in a position to offer a post to a veterinarian who would like to consider veterinary ophthalmology as a career choice.
For this unique position, we are looking for an extremely enthusiastic, bilingual individual who would be required to make a contractual commitment to be trained in ophthalmology with a strong view of joining the business. We aim to provide on-site training whilst being employed with us at the Johannesburg branch. This training will follow an academic and hands-on, in-house program similar to the post-grad resident program. This opportunity comes with definite prospects of future potential joint ownership. Our 23-year-old business has been built on high standards, commitment to client communication, and professionalism and we are looking for a colleague who will fit in with our practice philosophies.
If you are interested in the possibility of pursuing ophthalmology as a career, please send a detailed CV and write a paragraph to motivate your application, to our practice manager [manager@animaleyehospital.co.za] or click here to apply online.
Share this articles' link with a friend: Job Offer
Have you ever heard of Ophthalmia nodosa? I had not until very recently.
It was not until recently that my Sunday evening international ophthalmology journal club of 23 ophthalmologists discussed an article about spiny cactus ocular trauma. It was just a week later that I encountered my own case and the first I have ever seen.
I was presented with a Staffie that had a worsening, painful corneal ulcer of over a week. On examination, there was an extensive central melting corneal ulcer present and on slit-lamp biomicroscopy, I located a single firm spike-like structure sticking into the dorsal conjunctiva. It was only under general anaesthetic that I then located about 20 such barbed spines. These were removed using fine forceps. The melting corneal ulcer was then treated with Crosslinking.
Ophthalmia nodosa is a cutaneous condition accompanied by inflammation of the ocular surfaces due to the lodging of caterpillar [setae] or cacti hairs [glochids] in the ocular surfaces.
Click here to download and watch the short clip we took when extracting the worm or use the link below.
Ocular filariasis:
There are a variety of worms that may affect the eye. Besides Angiostrongylus vasorum (the lungworm) that affects the pulmonary artery, right ventricle, and can enter the anterior chamber of the eye, there are also ocular larval migrans associated with Toxocara canis which is probably our biggest concern. The visceral migrans component is a problem in children playing in sandpits soiled by dog faeces. The migratory larva of Onchocerciasis can cause masses in conjunctiva as well as lead to uveitis, exophthalmos, and granuloma formation. These masses are usually treated with oral Pred and Doxy, as well as Ivermectin in horses. The granulomas could also be surgically resected in some cases.
Recently I was presented with a dog that had severe uveitis, hypopyon, and diffuse edema with a focal area of the ventral cornea showing a deep stromal lesion with what looked like a white fibrin plug bulging from the cornea wound. The patient was admitted with a view to trying to remove the fibrin / WBC corneal plug, irrigate the anterior chamber and then place a conjunctival pedicle graft over the corneal lesion. In theatre, using forceps, I grasped the plug and proceeded to remove a firm piece of the fibrin clot, and then on the second grasp, I pulled out a large worm [see video]. The anterior chamber was irrigated and a conjunctival pedicle graft performed to close the corneal wound. Topical antibiotics and oral NSAID were used for the uveitis component. This globe has done very well and remains visual.
Pilocarpine oral medication for Dry Eye [KCS]
The incidence of keratoconjunctivitis sicca [KCS] in North America can be as high as 1.52% of the canine population. It remains one of the most common ocular conditions seen by clinicians. There are many causes of KCS and one of the more unusual forms is neurogenic. Basal and reflex tearing are under the control of the autonomic nervous system and neurogenic KCS may be seen following the loss of the parasympathetic innervation to the lacrimal gland [which involves the facial nerve] and affects basal tear function or via neurogenic disorders involving the trigeminal nerve affecting corneal sensation. Neurogenic dry eye is often unilateral and the nares on the affected side are also very dry [xeromycteria] if the parasympathetic innervation is damaged proximal to the pterygopalatine ganglion. If the trigeminal nerve is involved one can see KCS, facial anaesthesia and xeromycteria. The latter results due to the denervation of the lateral nasal glands.
We are forever grateful for your business and the clients that you send to us. We are busy clinics and since there is now only one ophthalmologist at the Cape and Jhb hospitals it is even more reason for you to try and assist us so that we can continue offering you the best service. Please take note of the following logistics.
It is essential that all communication to work through the reception staff as they will know best how to direct or prioritize your call or enquiry. Email communication may only be dealt with by the Ophthalmologist after the day’s work in some cases.
Johannesburg: 011 465 1237
Ophthalmologist: Dr Antony Goodhead and occasional assistance by Dr Lo-An Odayar
Cape Town: 021 930 6632
Ophthalmologist: Dr Christie Boucher [Monday to Thursday]
Practice email: info@animaleyehospital.co.za
Appointments are made strictly through the reception staff by phoning and not via email.
Vets can download our “Veterinary referral doc” and email the patient details and history to reception@animaleyehospital.co.za or via fax: 011 465 2916.
Please note that you can refer your client to our website where they can download the “Client Registration Form” after making an appointment with our reception staff and email it directly to reception@animaleyehospital.co.za in preparation for their visit.
Website: www.animaleyehospital.co.za
We work strictly according to appointments. Please Do NOT send clients directly to us without the referring vet or the client first arranging and confirming availability with our reception staff. We also work on horses and frequently may be away from the practice when your client arrives unannounced at our door. We thank you for your cooperation in this regard.
Smart temperature monitoring for your pharmaceuticals.
New Website
Our Website has been revamped! What do you think?
Click Here to check it out?
Cacti within the Opuntia genus have 1‐3 mm, thin, heavily barbed, semi‐translucent spines - the glochids. In South Africa, the “Prickly Pear” is the classic example. Similarly, the small hairs, or setae, of certain species of tarantula and caterpillar could affect the ocular surface. In my patient, the glochids had to be carefully removed with Colibri forceps. Around each glochid, there was an inflammatory reaction and obviously, if these had been in the cornea this would have caused further problems.
It is thought that pilocarpine is most effective when there is secondary parasympathetic denervation as the peripheral cholinergic receptors have undergone an up-regulation and are more sensitive to the effects of cholinergic stimulation than other cholinergically innervated tissues.
A further treatment option for patients with neurogenic dry eye is the use of oral Pilocarpine eye drops. The use of systemic pilocarpine as a treatment for dry eyes relies on the lacrimal glands being more sensitive and responding before the cardiac and gastrointestinal systems are affected. This however results in a narrow therapeutic index for the drug. The side effects can be drooling, vomiting, regurgitation, diarrhea, and weakness.
The treatment regime involves the use of Pilocarpine 1% eye drops being applied to the dog's food at a dose of 1 drop / 5kg twice daily. The dose should be titrated up every 3-7 days until side effects are observed. Once observed, the dose is then lowered back to the last tolerated dose. The average time to full response with a Schirmer Tear Test of >15mm/min is about 24 days.
In these neurogenic cases, one should also use 0.1% Pilocarpine eye drops at 1 drop 3-4x/day. The average time to full response is about 6 months. When using the latter, some patients may show signs of blepharospasm, conjunctival hyperemia, and miosis. Some have also described success in cases of immune-mediated KCS.
[Ref: Veterinary Ophthalmology: 2020,23:341-346]
Contacting the Jhb and Cape Animal Eye Hospitals
For a long time we have tried to keep accurate records of the minimum and maximum temperature values of our pharmaceuticals. After trying many different thermometers, none were able to give any accurate data. Our practice manager (who also designed our new website) came up with an awesome idea and has created a smart temperature monitoring solution for our practices in Jhb & Cape Town. It sends monthly reports of the daily minimum and maximum temperatures from your pharmacy, fridges and freezers. It can also be set up to work from your mobile phone’s hotspot to use it in your car or bakkie’s coolerbox.
FEATURES:
Live monitoring on your smartphone with the third party app
Set alerts for minimum and maximum temperatures, to get sent to your phone and email address.
Notifies you when the device is offline (Load Shedding)
Automatically connects to a saved Wi-Fi profile.
Monthly reports with the daily - minimum, maximum and average readings emailed to your inbox every month
Contact: Ludwig at Cool Vet Spaces on 060 808 44 88 or info@coolvetspaces.com for a quote.
