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My 11 year old male Bengal cat has become plagued with Bullous

Keratopathy. He is now...
My 11 year old male Bengal cat has become plagued with Bullous Keratopathy. He is now affected nearly 100% of the time in one eye or both eyes. I give him Gentimicin Sulfate drops, Idoxuridine ointment, followed by Sodium Chloride ophthalmic ointment 3x day.

He is on Chlorambucil 3x week and 10 mg Prednisolone 7x week for small cell lymphoma (for over two years). He has been doing okay with the cancer treatment. (I also give him 200 mg. DHA from an algae source, Vit D, probiotics, and colostrum powder daily to help his immune system.) I was told that steroids may bring on the Bullous Keratopathy. Is the BK caused by a virus? I would really appreciate and would be thankful any suggestions to bolster his immune system against virus attacks.
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Answered in 1 hour by:
8/4/2012
Dr. Louis Gotthelf
Dr. Louis Gotthelf, Veterinarian
Category: Veterinary
Satisfied Customers: 2,438
Experience: 35 years owning a dog and cat hospital and a Pet Skin and Ear Clinic
Verified
Hi. I'm Dr. Gotthelf. I have been a vet for 33 years and I would like to use my experience to help you with your pet's medical problem.

I don't think that an exact cause of BK has ever been established in cats. I did read that the best treatment for this condition is a temporary surgery called a third eyelid flap to provide increased pressure to the corneal surface. Apparently, the incrfeased pressure on the corneal when the flap is in place will decompress the areas of swelling within the collagen in the cornea.

From the proceedings of the 23rd Florida Veterinary Medical Association,

Tammy Miller Michau, DVM, MS, MSpVM, DACVO

Acute Bullous Keratopathy

Acute bullous keratopathy is characterized by the presence of an area of acute edema in the cornea. The edema is so profound that the cornea looks like an erupting alien! Typically, the lesions appear as a circumscribed raised bullous area of edema, with the remaining cornea appearing normal. Frequently, the entire cornea is involved. The etiology for acute bullous keratopathy is unknown. The clinical and histopathologic findings suggest that a stromal defect is responsible for the condition. Treatment of bullous keratopathy consists of procedures that provide pressure or structural support to the bulla. Pressure associated with a third eyelid flap is reported to result in resolution of the bulla.
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Customer reply replied 5 years ago
Thank you very much for your answer, Dr. Gotthelf. My cat's veterinarian told me about the third eyelid flap surgery. But I'm guessing there might be limitations to the benefits of that procedure because 3rd eye flap can only be stretched so far over the cornea, I presume? The BK seems to alternate from one eye to the other. I was hoping there might be some medicine or eye drops that would heal the cornea.
The 3rd eyelid is long enough to be sutured over the entire eye. Another type of flap is called a conjunctival flap, but it is more painful to the cat because the entire eyelid has to be sutured closed over it.
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Customer reply replied 5 years ago
That is good to know that the 3rd eyelid is long enough to cover the entire eye. But is it possible--after the 3rd eyelid flap is in place--for the BK to occur on another location on the cornea? Or would the 3rd eyelid flap prevent any further outbreaks of the BK in the affected eye?
The third eyelid flap is a way of treating this condition, not preventing it. A bulla is like a mosquito bite that fills with fluid in the tissues. In the cornea, pressure will make the fluid go out of the tissue and allow the corneal surface to flatten.
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Customer reply replied 5 years ago
If I had the procedure done on my cat's eye, and the BK subsequently erupts underneath the flap, how would the medicines (Gentamicin drops, Idoxuridine, Sodium Chloride 0.5% ointment) be able to penetrate through the flap to reach the cornea?
One or both eyes now have this BK nearly 100% of the time...
The drops are probably not doing anything to help the BK. We really don't know what is causing it. I doubt that a bulla could form under the flap because of the increased pressure. That would prevent an eruption while the flap is in place.
Dr. Louis Gotthelf
Dr. Louis Gotthelf, Veterinarian
Category: Veterinary
Satisfied Customers: 2,438
Experience: 35 years owning a dog and cat hospital and a Pet Skin and Ear Clinic
Verified
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Dr. Louis Gotthelf, Veterinarian
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