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Dr. Jo
Dr. Jo, Dog Veterinarian
Category: Dog Veterinary
Satisfied Customers: 2727
Experience:  DVM from Iowa State University in 1994; actively engaged in private regular and emergency practice since that time.
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Below my dogs left eye near the outer corner under the eye

Customer Question

Below my dogs left eye near the outer corner under the eye lid is twitching. Its very subtle and you have to look close to see it. The actual eye is fine. The twitch can be seen in his whiskers to on the same side. Its only happening on one side and has been going on now for a couple days. Hes completely normal doesnt seem to be bothered by it. It basically looks like theres a heart beat visible in the spot. I can take a pic and circle the spot its happening in if that would help. Hes on a low dose of thyroxine for a slightly low thyroid (been on it for a month were still balancing levels), hes got A typical Pannus in both eyes as well as dry eye which is being treated with Optimmune (cyclosporine) and he sees the eye doc in May again. His kidney,liver, CBC panel came back normal 3-4 months ago as well as his exam showed nothing. His heart rate is fine (I checked) as is his temperature.
Submitted: 1 year ago.
Category: Dog Veterinary
Expert:  Dr. Jo replied 1 year ago.

Hello,

I'm Dr. Jo and I'm here to help you with your question about Lincoln.

I'm so sorry you're having this problem, but glad you're looking for the information you need. You may join the conversation at any time by typing in what you want to say then clicking REPLY or SEND. Then we can chat back and forth until you're satisfied with the information I've provided.

So I may know we're properly connected and that you understand how the website works (including that I'll need to earn your good rating in order to receive any compensation for helping you), please type in a short response below. You may rest assured you'll have my full attention and will receive a complete response once I know you're there.
Thank you.

Customer: replied 1 year ago.
I am here :)
Expert:  Dr. Jo replied 1 year ago.

Glad you're here.

(typing more)

Expert:  Dr. Jo replied 1 year ago.

I totally understand what you're describing as this heartbeat-like spasm of one of the little muscles around the eye. One of the things that is easy to overlook that can cause symptoms like this are some infectious diseases. Toxoplasma and Neospora are two common culprits. They could also be contributing to Lincoln's other ocular symptoms.

ANYthing that causes inflammation of the tissues around the eye can contribute to twitching, however.

You may also gain some piece of mind from learning that most toxins that cause muscle twitches around the eye would be expected to affect BOTH eyes.

(typing more)

Expert:  Dr. Jo replied 1 year ago.

In order to address the infectious disease possibilities for this twitching, you have a couple of options:

  • submit blood titers to look for toxo or neospora
  • do a therapeutic trial by taking clindamycin or a sulfa antibiotic for 4-6 weeks

This makes me really glad Lincoln is already in the care of an ophthalmologist. People who pursue that specialty are usually top-notch----really good vets.

Expert:  Dr. Jo replied 1 year ago.

While agents like toxo and neospora are among the most common infectious disease agents to cause eye twitching, other things are possible, too. Distemper myoclonus is another possibility. There is a way to test urine with a PCR for distemper. That's pretty rare, though.

I would also expect Lincoln to be more ill and show other symptoms if something else were behind this.

Customer: replied 1 year ago.
Here is a picture to show where the twitch is happening. I also notice OCCASIONALLY he will lose balance in his back end. I figured it was just his bad knees and hips. I will say he was on clindamycin for 3 weeks in July for an infection in his foot. He has also been vaccinated for distemper. Is it possible its just a muscle twitch that will eventually go away?
Expert:  Dr. Jo replied 1 year ago.

The most important piece of information I want to give you is that this twitchy spasm of eye muscles is NOT a characteristic symptom of anything in particular, nor is it expected to be associated with a serious illness. That's a huge relief

Opening your video now...

Expert:  Dr. Jo replied 1 year ago.

Good, clear picture... thank you...

Customer: replied 1 year ago.
I could try to get a video if that would help? Not sure if it would let me attach one
Expert:  Dr. Jo replied 1 year ago.

Yes, that area would be one of the little muscles around the eye. Most common causes for twitchiness here are:

  • chronic inflammation
  • infectious diseases (especially toxoplasmosis or neosporosis).

I think I have a good understanding of what you're describing, even without the video.

Expert:  Dr. Jo replied 1 year ago.

Does this help to answer your question today? I want to be as helpful as possible.

Customer: replied 1 year ago.
If it was infectious my other dog would be sick to? Shes not sick. Im living on a pension, I really dont have the money to do all this testing I was hoping it was nothing serious :(
Expert:  Dr. Jo replied 1 year ago.

With infectious agents like toxo and neospora, she might not be otherwise ill. These can be very minor. It's very reasonable to skip any testing and just try the antibiotic treatment to see if that solves the problem.

Expert:  Dr. Jo replied 1 year ago.

I'll clarify, too, that infectious does not equal contagious. No, it's not necessarily the case that your other dog would get sick too.

Expert:  Dr. Jo replied 1 year ago.

Have I been able to provide you with the information you're looking for today?

Expert:  Dr. Jo replied 1 year ago.

Please remember I am here for you and am happy to discuss your question until you are satisfied with the answer I've provided. You may return to this page at any time to review this information and/or post more. You may do so even after you've rated my response. I'll be notified of your response via email and will do my best to help you.

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(rating option enabled)

Expert:  Dr. Jo replied 1 year ago.

Please remember I am here for you and am happy to discuss your question until you are satisfied with the answer I've provided. You may return to this page at any time to review this information and/or post more. You may do so even after you've rated my response. I'll be notified of your response via email and will do my best to help you.

If you are satisfied with the information I've provided, please take a moment to rate my response. I've done my best to provide you with the most accurate, thorough and up-to-date information that is available, and your positive feedback is important to me. Without it, I receive no compensation for helping you.

If you are not satisfied, please let me know how else I may be of assistance.

Thank you for using our website.

(rating option enabled)

Customer: replied 1 year ago.
I am going to be honest, I do not like being pressured to leave a rating. I want to give this a few more days to see if anything changes as I may have more questions. After that, I will leave a rating.
Expert:  Dr. Jo replied 1 year ago.

My apologies. I can assure it was an error that the above message posted twice. It was not my intention, and I'm not even sure how it happened.

I hope things are going better. How is Lincoln today?

Expert:  Dr. Jo replied 1 year ago.

Please remember I am here for you and am happy to discuss your question until you are satisfied with the answer I've provided. You may return to this page at any time to review this information and/or post more. You may do so even after you've rated my response. I'll be notified of your response via email and will do my best to help you.

If you are satisfied with the information I've provided, please take a moment to rate my response. I've done my best to provide you with the most accurate, thorough and up-to-date information that is available, and your positive feedback is important to me. Without it, I receive no compensation for helping you.

If you are not satisfied, please let me know how else I may be of assistance.

Thank you for using our website.

(rating option enabled)

Expert:  Dr. Jo replied 1 year ago.

Oh my goodness! I just looked at this thread and saw the ratings prompt posted again. I am SO VERY SORRY. I do not know how this is happening and it is not my intention.

I really *am* interesting in finding out how Lincoln is doing, but I also understand that I would be really mad if I were in your shoes. I apologize.

Customer: replied 1 year ago.
Lincolns eye twitch stopped for a couple days thought the whiskers kept twitching. Now his one eye is back to twitching again. :(
Expert:  Dr. Jo replied 1 year ago.

Thank you for sending the update. I read your reply and quite literally scrunched up my face and said, "Hmmm."

The involvement of other facial muscles makes me open my mind to considering the possibility that this isn't just an eye issue, but perhaps a neurological issue.

Facial tics are not common in dogs, but can occur. They can be the result of infectious diseases, toxins, and other neurologic disorders.

I'm not certain if you're open minded about such things, but - as someone who is trained in tradition Western medicine - I can see a place for "alternative" therapies with a situation like this, that is... if diagnostic testing and therapeutic trials for infectious diseases (like those mentioned above) don't produce any results.

When you treat the "whole patient" instead of the problem in cases like this, it's not unusual to get a response. TCM (Traditional Chinese Medicine), acupuncture, laser... these are tools that I would not hesitate to reach for in a case like Lincoln's if I couldn't identify the cause through traditional medical approaches.

The place to start, though, is with a thorough physical examination, including an ophthalmic exam, and baseline blood work to look for any abnormal findings that could be related... especially electrolyte abnormalities (can cause tremors), and evidence of infectious diseases.

Is Lincoln still acting fine otherwise?

Expert:  Dr. Jo replied 1 year ago.

Ran a search on facial tics through my neurology boards and came across a few rare mentions of "limbic epilepsy". This syndrome can produce facial tics that last for days. If that turns out to be the case for Lincoln, it's not likely to interfere with his ability to enjoy life, but the neurologists would certainly like to hear from you. There's almost nothing known about this syndrome.

Customer: replied 1 year ago.
Yeah hes totally normal. Sleeps fine and dreams fine, eats, drinks and plays fine. I called the eye doc and the tech told me she would speak to the specialist but if I didnt hear back that means she wasnt worried about it and it was fine to leave till my next appointment in May. He had routine blood work in August that came back normal. Im starting to wonder if this is neurological because I have noticed he looses balance in the back end sometimes but I just thought it was his bad knees giving in but now that I think of it maybe its not. He was just recently switched onto a balanced raw diet and am hoping that helps some of his issues.Im really at loss because I do not want to destroy his gut by doing a course of antibiotics and I cant afford all this expensive testing and if I can afford an electrolyte panel it wont be till the end of January after all this Christmas stuff stops.
Expert:  Dr. Jo replied 1 year ago.

I understand everything you're saying...

I'm also sorry to have to confess that even the best-trained veterinarians are still pretty weak with neurologic disease. It's challenging and poorly understood. It's also really easy to spend a whole lot of time and money on advanced diagnostic testing that still doesn't change the prognosis or outcome.

With that in mind, it's really relieving to hear he's otherwise acting normally. That gives you the leeway you need to take some time.

I wish there was more I could do to help. I'll definitely back up your suspicion that this is neurologic disease. I'd take your observations on his hindquarter weakness seriously.

Customer: replied 1 year ago.
I cant afford to see a neurologist. So what can I do through my regular vet?
Expert:  Dr. Jo replied 1 year ago.

I apologize, but I'm not sure I understand your question. I understand seeing a neurologist isn't an option for you right now, but what are you wondering about your regular vet?

Expert:  Dr. Jo replied 1 year ago.

The reason I'm asking for clarification is because it seems like you're asking me what your regular vet can do for Lincoln, and - as much as I want to be helpful with providing you information - there is no way I can know what your regular vet is capable of doing for you.

Expert:  Dr. Jo replied 1 year ago.

The point I was trying to make earlier is that I'm relieved that Lincoln is otherwise acting fine so you don't have to feel like it's urgent to do all of this testing or pursue a referral to a neurologist while it's currently cost prohibitive to you. You're currently dealing with some changes that are very mild and subtle. You are absolutely NOT dealing with something in the realm of things that are simple or inexpensive to diagnose (and therefore treat). That means that if dealing with complicated and expensive things is not an option right now, your only choice is to wait and see what develops...

Either Lincoln will get better, worse, or he'll stay the same. If he gets better, great! This was a mild, self-limiting thing. If he doesn't, then you'll have to jump through the necessary diagnostic hoops to get some answers.

I feel I've been very inadequate at providing you the information you are looking for. I know you are in upsetting situation; it's always hard when medical care is unaffordable.

I am going to OPT OUT now to see if any other experts are able to help you.

Customer: replied 1 year ago.
Okay. My regular vet likely cant do anything other then bloodwork and xrays MAYBE an ultrasound but honestly thats a bit pricey. Hes a service animal and im on disability right now so its hard for me to afford lots of things. The most I could possibly do is put him down is symptoms start interfering with him having a happy life but that doesnt seem to be the case right now, and hopefully it never comes to it. I have every thing you have suggested written down, maybe another vet can give some input. Thanks
Customer: replied 1 year ago.
I notice now the muscle behind his ear is twitching as is the muscle behind the whisker he has near his lower jaw/throat. This is in conjunction with his eye lid twitch and whisker twitch. Hes still not bothered by it.
Customer: replied 1 year ago.
Its been well over 24 hours and I have no received a reply from another vet....