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Dr. Rick
Dr. Rick, Board Certified MD
Category: Eye
Satisfied Customers: 7851
Experience:  Ophthalmology since 1994 with Retina sub-specialty interest
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My precious little dog has been receiving Tacrolimus eye drops

Resolved Question:

My precious little dog has been receiving Tacrolimus eye drops for tear production for 2 years, sometimes a drop in the rt. eye 2X a day. The eye now has a cataract forming very quickly. Could this med be the cause and what should I do?
many thanks for your time,
Lisa Didier
Submitted: 2 years ago.
Category: Eye
Expert:  Dr. Rick replied 2 years ago.

Dr. Rick :

Hi. I'm online and happy to answer your question today. I am a human eye surgeon and can assist you with this issue.

Dr. Rick :

Tacrolimus is a fairly powerful immunosuppressive drug but, the good news is that it should not contribute to the formation of cataracts in your dog.

Dr. Rick :

Unfortunately, with your pets severe dry eyes and anterior surface disease cataract surgery could be very risky.

Customer:

Ok, so what about the rt. eye which continues to get puss if I don't drop in neopolydex every day in the morning...and sometimes it gets icky even with that med.?

Dr. Rick :

The "icky" stuff may be more of the normal eye mucus that is building up rather then a sign of infection that needs treatment with the neopolydex. You might try using artificial tears and keeping it clean with a soft wash cloth instead of the ointment and see how things go.

Dr. Rick :

Is your dog being treated by a veterinary ophthalmologist?

Dr. Rick :

Are you still there?

Customer:

Yes...I have spent thousands on this lovely pet's eye problem. This vet said he would do cataract surgery on left eye for $5 thousand...luckly his assistant pointed out that tear duct production would limit success of surgery!
Whoa...I began to doubt the vet's wisdom

Dr. Rick :

Do you know that ophthalmologists get paid only $685, which includes free postop care for 90 days as well as free care the day prior to surgery, along with any anesthesia care given? I guess I should have stayed with my original plan and gone to Veterinary School lol!!

Customer:

Rt. eye is completely opecified like a black marble and rt. eye is getting that cataract due to treatment for that ulcer the vet missed upon 1st examination.

Dr. Rick :

I have to wonder, as a human eye surgeon, why a powerful immune suppressant is being used to treat a corneal ulcer and dry eyes......doesn't seem to add up to me.

Dr. Rick :

still there?

Dr. Rick :

I guess that you have stepped away from your computer. I'll switch over to the Q&A system. This system works a lot like 'text messaging' but an email is sent to each of us anytime something is posted to this thread. We can continue to work on your question there..... :)


 

Customer:

So right!!! The worse thing is not the money spent but my guilt in not making the right choices for this well trained and loving animal. I am now teaching him echo location so when we walk outside his tail is up and he walks without fear.

Customer:

Is there anyting I can do or drop I can give him for the dry eye (rt. eye) situation that is not powerful but will help with the puss?

Expert:  Dr. Rick replied 2 years ago.
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Expert:  Dr. Rick replied 2 years ago.
It was a pleasure to assist you with your question. Please let me know if I can do anything else to help you in the future. Positive Feedback and/or Bonus is welcomed and appreciated.
Customer: replied 2 years ago.

Is there any product besides Tacrolimus that will help with dry eye?

Expert:  Dr. Rick replied 2 years ago.
Yes. Artificial tears can help. They, however, don't last very long. In this case an ointment, such as refresh PM or lacrilube (there are many band names available)

In humans with dry eye issues as severe as what you are talking about with your dog I strongly recommend performing either a temporary or permanent lateral tarsorrhaphy. Since dogs, unlike humans, have a nictitating membrane this might be able to be sutured partway across the eye to protect it.

Have you considered traveling to a Veterinary Teaching hospital for a consultation with the Professors there?

Customer: replied 2 years ago.

You have been very kind and patient...I will check on ointment. Rocky had a "cherry eye" removed by his regular pet when eye vet said it would cost $1,600 to stuff gland back into lower lid. From that time on the "dry eye" problem has existed.
I understood that only 17% of tear production would be effected by removal of this gland. Again, I was sadly misinformed = his blindness in rt. eye.

 

Expert:  Dr. Rick replied 2 years ago.
I do not believe that tear gland tissue can be put back in place and expected to work.....I'd not even consider that option.

I'm sorry to hear about all the difficulties your pet has had. As an owner of multiple horses, cats, rescue dogs and a pet hedgehog I fully understand what you have been going through.

Let me know if there is anything else I can do to help you. :-)
Expert:  Dr. Rick replied 2 years ago.
I think just using artificial tears and lubricating ointment for that eye.
Customer: replied 2 years ago.

Bless your heart..you do understand how easily a person can get swept into accepting all that goes with loving our dear animal friends. I will take your advice and locate a teaching institution and see if they might help or at least offer better meds to deal with his advancing blindness.
If you don't mind, I have 1 more ? for you re a personal issue. This week I went to my long time eye doc (lovely guy) and he said I have large "floater" in drifting into rt. eye field of vision. I can read ONLY with rt. eye since childhood (I'm a professor who travels world on cruise ships lecturing on culture & history). Will this get worse, go away or remain simply a constant annoyance?
Again, many thanks for your time...and I am well satisfied even if you don't answer the above ?

Lisa Didier

Expert:  Dr. Rick replied 2 years ago.
First of all.....how can I sign up as your assistant? ;)

And, second of all, you are now asking a question right smack in the middle of my sub specialty of retina surgery, so let me tell you all about your floater:


You have a thick gel material in the middle of your eyes called the vitreous. Over time as it liquefies, this gel material collapses on itself, forms little clumps that you can see as dots, lines or bugs. As these clumps form the vitreous pulls away from the wall of the eye. In the process it can stimulate the retina -- causing the flashes that you may see.

It is recommended that you see your ophthalmologist to look at the retina to make sure there are no problems such as a retinal hole or tear. In most cases, there are no problems, but this exam is precautionary and allows for preventative treatment of any lesions that are found.

If you notice a sudden increase in floaters, flashes of light (like a lightning storm), or a shadow/veil in the periphery of your vision, this can be worrisome for a retinal detachment. You would need to contact your ophthalmologist promptly in that case.

What can you do about the floaters? Well, floaters don't go away, and they don't really get worse. Over time they tend to "sink" out of your central vision and you brain "filters" them out so you don't notice them so much anymore. They almost never cause significant visual problems except, of course, if they cause a secondary retinal detachment as discussed above. The only way to decrease or remove the floaters is with a major surgery called a vitrectomy. As a retinal specialist for almost 2 decades I've only done this procedure to remove floaters in a handful of cases.

As you can see, your ophthalmologist is correct -- you should be OK.

It has been a pleasure chatting with you this morning and I wish you the best of luck with your dog.

And, should you ever need an assistant to push the slide change button etc on one of your upcoming cruise ship lectures please keep in mind I am very skilled in these areas and should be available lol!
Customer: replied 2 years ago.

How wonderful having my own Doc..just like the president! But my Prince of 50 yrs. would pout if I took someone else.I have lectured on 50 cruises in 5.5 years and leave in less than a week for #51.

Almost ready to quit this "gig" after being stranded at sea on Azamar Quest in South China Sea for 3 days & nights: no air conditioning, forced to sleep with crew on open deck and SPAM sandwiches for 3 days!
But, if you ever want info re cruise lines (Azamara, Celebrity, Holland America or Princess), amenities, food, cabins...ect, don't hesitate to ask...no charge.
Kindest regards Lisa XXXXX@XXXXXX.XXX

 

Expert:  Dr. Rick replied 2 years ago.
Thanks Lisa. Take care and best of luck with your puppy.
Dr. Rick, Board Certified MD
Category: Eye
Satisfied Customers: 7851
Experience: Ophthalmology since 1994 with Retina sub-specialty interest
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