Eye Infection - the medication trials - opinions?

Hi guys/gals,

So, my little fluff muffin has an eye infection. 

Tried so far:

(1) TobraDex eye drops (antibiotic)  - no improvement for 2 weeks

(2) Tetracycline eye ointment (broad spectrum antibiotic)  - no improvement for 2 weeks

(3) L-Lysine powder (mix in wet food)  + Ocuflox Opthalmic eye drops (antibiotic) - about to start for 1 week, then call back Vet for appointment.

He also did a Tonometry test (eye pressure test for both eyes). Result was same pressure reading for both = good.

(4) If above fails, then appointment with Ophthalmologist

The Vet. thinks at this stage it's a virus + 2ndary bacterial infection.

For those with experience in this department, does this Vet. procedure look pretty standard? The reason I'm asking is, the 'Professional fees' can be rather steep.  I mean...charge for Tonometry test fine, but additional 'Recheck consultation' fee was on the steep side. Both of which took less than 10-15 minutes combined I'd say.  Anyway, that's another issue. 

We've had good success with Gentamicin drops for our cats. 

If there's any drainage, ask the vet to do a culture and sensitivity test to find out what you're kind of infection you're dealing with (bacterial or viral) and which medication will best treat it.  I've got a herpes kitty and she has had eye infections previously and we've never had to go to the eye specialist.  I'm not sure why you would need to see an eye specialist so soon. 

How much Lysine were you giving her?  The flare up dose is 500mg twice a day and it can take up to a month to see any significant impact and improvement.  Make sure you give it twice a day so it will stay in your kitty's system.  Since it's an amino acid, it will pass through the kitty's system and out when they urinate. 

The other suggestion I would make is a second opinion visit to another vet in your area, rather than immediately to the specialist. 

Hi Stephanietx, no there's no eye drainage at all.  The eye is just reddish/inflamed.  

I have not been giving him Lysine prior to today.  I was prescribed Lysine and Ocuflox today.  I was told to dose, as per jar instructions - 250mg, twice daily. 

It can take upwards a month using Lysine, to see an improvement at double (flare up) dosage? 

So, the Tobradex (antibiotic) was at Vet visit #1.   

The tetracycline (antibiotic) was at Vet visit #2. 

The Lysine + Ocuflox (antibiotic) was at Vet visit #3...today. 

I'm not opposed to a 2nd opinion. If what you say is correct about taking an entire month for Lysine to have a discernible impact, then I'm having an uneasy feeling about the Vet. wanting me to come back in 7 days. 

Aside from medication questions, if you've felt that the vet fees are high, maybe check around. My vet only charges $25 for a recheck. ($45 for initial visit.)

Oh wow, yes that's the difference.  You guys south of the border have reasonable Vet. rates.  $25 for a 'Recheck'? Nice...over double that for my Recheck.  

I'll definitely hunt around for others in my city: there's quite a few.  Otherwise, I may start taking trips with my cat to the U.S. just to spite the Vets here.  Make a shopping day of it. 

Based on some posts here and general net search, I'm satisfied that giving 1,000 mg (500mg x 2 / day) L-Lysine daily is not going to be harmful, and may in fact speed up the recovery rate. 

Hmm, wonder if I can just use Lysine you can get at any pharmacy and just break open the pill? 

I bought a bottle of 500mg Lysine tabs at CVS for $7. Crush them up. Put 1 in morning feeding, 1 in evening (thanks to advice from this site). Saw almost miraculous recovery in just over a day. He's still not top shape, but he was lifelessly lethargic 2 days ago.

After the flare up has gone down, I'm going to continue w/ 250mg twice daily as a maintenance dose. I spoke with my vet about it today, and she was all for it.

When you say recovery - are we talking like sneezing, raspy meows or blood shot eye?     

Lysine tabs - thanks - I'll take a look around.  From all I can tell, the powder I was sold just has added flavouring to make it palatable.  It's reasonable $, but I'm not about to shell out another consultation fee when the time comes to buy another jar of it.  

He has a bad herpes flare up and respiratory infection. Eyes matting shut, terrible sneezing fits, lethargic. After a week on 500mg a day, little improvement, after 1000mg for a couple of days, no more sneezing and has "life" again. Not quite playful yet, but wandering around and interacting again.

So, I just checked out some Lysine tablets in a drug store. There's some other additives (wish I wrote them down), that I'm not sure about safety wise for a cat. 

Marc999 said:

 
So, I just checked out some Lysine tablets in a drug store. There's some other additives (wish I wrote them down), that I'm not sure about safety wise for a cat. 

Click to expand...

When I run out of the Now Brand l-lysine powder  (look on Amazon)   I use the ones I get at Walmart. The main additive they have is cellulose, plant pulp, and some cats have problems with it. I have been using the 1000mg generic tabs for 2 years now with no problems.

Back to my original query, here's the order that the Vet. has had me go through:

(1) Tobradex - 2 weeks.

(2) Tetracycline - 2 weeks. 

(3) Ocuflox - 1 week (going on 4th day, almost seems worse) 

Additional -Fluroscein stain test = no scratch, Tonometry (eye pressure) test = no problem. 

The Vet. thinks it's a virus with bacteria secondary.   All of the above are antibiotics. 

If that's the case, why would a Vet. prescribe 3 antibiotics in a row (2 weeks apart).

I understand the purpose of an antibiotic is prevent the 2ndary bacterial infection from taking hold, due to the decreased immune system caused by the primary virus.  Yet - why wouldn't I have just stuck with Tobradex.  Why even bother to try other antibiotics? 

Wouldn't an anti-viral med. make more sense, or is it darn near impossible to determine which virus it is? 

I'm essentially asking anyone with similar experience, as this feels like I'm chasing my own tail (pun intended). 

At this stage - the recommendation is an ophthalmologist, if no improvement by the end of the week.  Well - heck, I'm now seeing the 3rd eyelid. I think I'll have to get in there sooner as the meds. and L-lysine (500mg x 2 /day - for 4 days) are doing squat. 

Some things just don't respond well to a certain med, so you've got to try something else.  It's somewhat of a guessing game a lot of the time, especially if there's been no testing done to determine what's going on.  Now that you're seeing the 3rd eyelid, I'm wondering if she's not got a little upper respiratory infection going on, too.

Marc999 said:

 
Back to my original query, here's the order that the Vet. has had me go through:

(1) Tobradex - 2 weeks.

(2) Tetracycline - 2 weeks. 

(3) Ocuflox - 1 week (going on 4th day, almost seems worse) 

Additional -Fluroscein stain test = no scratch, Tonometry (eye pressure) test = no problem. 

The Vet. thinks it's a virus with bacteria secondary.   All of the above are antibiotics. 

If that's the case, why would a Vet. prescribe 3 antibiotics in a row (2 weeks apart).

I understand the purpose of an antibiotic is prevent the 2ndary bacterial infection from taking hold, due to the decreased immune system caused by the primary virus.  Yet - why wouldn't I have just stuck with Tobradex.  Why even bother to try other antibiotics? 

Wouldn't an anti-viral med. make more sense, or is it darn near impossible to determine which virus it is? 

I'm essentially asking anyone with similar experience, as this feels like I'm chasing my own tail (pun intended). 

At this stage - the recommendation is an ophthalmologist, if no improvement by the end of the week.  Well - heck, I'm now seeing the 3rd eyelid. I think I'll have to get in there sooner as the meds. and L-lysine (500mg x 2 /day - for 4 days) are doing squat. 

Click to expand...

Different antibiotics are prescribed for two reasons:

- first reason is that the previous antibiotic is not working. Not all cats respond the same to same drugs, so through trial and error you have to find something that works. I have one cat allergic to Gentomicin, another cat allergic to Cavasan, another cat that takes all of them like a champ.

- the second reason is that the bacteria becomes immune to the antibiotic so, in order to prevent that, you have to use different ointments and such. All of my vets said that Tobradex shouldn't be used for more than 2 weeks in a row, and this is probably the rule with most ointments/drops.

I have never had anti-viral medication prescribed to my herpes virus kitties. They were treated with injections and pills only when they had fever (well just Harley actually), the rest was all topical - so only eye drops and eye ointments.

If the eye is red and swollen, your kitty might also need an anti inflammatory ointment. I know Tobradex has both antibiotic and antiinflammatory, but I do not know about the others.

L-lysine is not used as a treatment. It helps the kitties who have upper respiratory viruses keep the virus at bay and prevent it from replicating - but it does not make the virus go away or heal the kitty. My guys are on a maintenance dose or 500 mg/day (250mg in the morning and 250 mg in the evening) and 1000 mg/day during flare-ups. So yes, they still have flare-ups even on the lysine (truth be told, one flare-up since June 2013).

I've had great luck using an ointment made by Falcon.

Neomycin and Polymyxin B and Dexamethasone Opthalmic Ointment.

I'm thinking the Vet said that it is a triple antibiotic with steroids.

1/4 inch on the eye twice daily for a few days. One time Motly (maine coon) had an eye which the rim was bloody red raw looking and swollen shut. I was sure he was going to lose the eye. This was on a Sunday morning. I dosed him twice with this stuff and by Monday at the vet his eye looked completely normal. The change was so drastic and so fast that it was almost miraculous. 

I also use it from time to time as Motly has one eye that tends to partially close a few times a year. (I think it is pollen).

ps. tiny tube (3.5 grams) cost $16 at Vet but lasted a long time.

Hazmat said:

 
I've had great luck using an ointment made by Falcon.

Neomycin and Polymyxin B and Dexamethasone Opthalmic Ointment.

I'm thinking the Vet said that it is a triple antibiotic with steroids.

1/4 inch on the eye twice daily for a few days. One time Motly (maine coon) had an eye which the rim was bloody red raw looking and swollen shut. I was sure he was going to lose the eye. This was on a Sunday morning. I dosed him twice with this stuff and by Monday at the vet his eye looked completely normal. The change was so drastic and so fast that it was almost miraculous. 

I also use it from time to time as Motly has one eye that tends to partially close a few times a year. (I think it is pollen).

ps. tiny tube (3.5 grams) cost $16 at Vet but lasted a long time.

Click to expand...

Neomycin and Polymyxin B and Dexamethasone Opthalmic Ointment.  This is commonly called "NeoPolyDex".  I know of folks who've had good results with it, too.

Hazmat said:

 
I've had great luck using an ointment made by Falcon.

Neomycin and Polymyxin B and Dexamethasone Opthalmic Ointment.

I'm thinking the Vet said that it is a triple antibiotic with steroids.

1/4 inch on the eye twice daily for a few days. One time Motly (maine coon) had an eye which the rim was bloody red raw looking and swollen shut. I was sure he was going to lose the eye. This was on a Sunday morning. I dosed him twice with this stuff and by Monday at the vet his eye looked completely normal. The change was so drastic and so fast that it was almost miraculous. 

I also use it from time to time as Motly has one eye that tends to partially close a few times a year. (I think it is pollen).

ps. tiny tube (3.5 grams) cost $16 at Vet but lasted a long time.

Click to expand...

Yes, interesting price difference once again.  I can almost guarantee I'd pay ~ 2 - 2.5x that, for each antibiotic.  That's just the way it goes here. 

I'll mention that one to my Vet, to see what he thinks. 

The sclera (white of the eye) is still blood shot-ish.  The iris is darker color as well.  Some form of Uveitus likely - which unfortunately could mean any manner of ailments. The good news is the pressure test (tonometry) was fine for both eyes.  This checks for glaucoma.   That tells us, that whatever this is, can likely be controlled with some manner of medication; surgery unlikely.  The trick (@$35-40 a pop medication + recheck consult fee) is finding the right one  

As far as I'm concerned - it's time for the ophthalmologist, enough of this guessing game.   

But I will mention that NeoPolyDex and see what he thinks. 

SORRY, somehow a whole block got deleted in the middle of that post, l just noticed when it posted.  Let me try again:

The NeoPolyDex is great as long as there is no active ulcer present.  The steroid reduces the inflammation -- however, if there's an ulcer present, the dexamethasone prevents healing.  You already had the fluorescine (sp.?) stain so he doesnt have an ulcer so the NeoPolyDex is good to take down any swelling and inflammation.  We've also used phenirmine maleate 0.315% and naphazoline hydrochloride 0.02675% ophthalmic solution (generic Visine-A) recommended by our vet.  That also shrinks the swelling and removes the redness, burning and itching.

There is a great discussion in another thread on this site, and many people recommend the use of bovine lactoferrin (which you can order on Amazon).  People have had good results with it so I have just ordered some to try in our shelter.  ($18 for  a one-month supply; I ordered 2 and got free shipping.)    

Here is a link to that discussion.

http://www.thecatsite.com/t/267703/stubborn-herpes-infection-add-lactoferrin-in-addition-to-lysine