3 week old kitten with ruptured eye/melting ulcer, second opinion?

I have foster babies that are 23 days old today. One had an eye infection before her eyes opened, so the vet had me soak it until it was open just enough to get antibiotics in it. At their fist appointment the vet stained it and there was no ulcer and said to continue with drops until 14 days of treatment. They did not do a cytology to check whether it was bacterial because she said the treatment wouldn't change, to continue with the drops. So the 14 days finished, and a couple days later I noticed a white spot on the cornea. The foster coordinator talked to their vet and he said to continue with the drops, and as a long as the eye didn't appear enlarged like there was pressure that the drops is about all we could do.

So last night I put drops in, everything seemed ok. Still watching for any signs of pressure or bulging, nothing. She's eating, purring, playing, peeing, pooping. All good. Woke up this morning and during the first feeding noticed it was shut. Up till now there has been no gunk, so I peed her, fed her, and put her down to feed all the others and figured I'd soak it and do drops after everyone else was fed (at this point they are screaming at me to be fed). As I'm feeding another kitten I look down and there is a spot of blood on the towel and a smear of brown. I thought it was poop, so I'm looking at everyone's butts, and it turns out it was her eye. Put down the one I'm feeding and pick her back up to look, and touched the eye lid and more gunk oozed out. It's a light creamy colour tinged with pink. I thought it ruptured, great! Get hubby to snuggle her in his shirt while I quickly get everyone else fed, then I get on the phone.

Luckily my foster coordinator was at the vet when I called and he basically said whether it's ruptured or a melting ulcer, at her size the treatment isn't going to change and to continue soaking and cleaning and applying the drops. I asked if she should be on oral abx and he said no. She is still eating great, purrs when I pick her up, peeing, pooping, snuggling with her brother and sister, and everything seems fine.

I've had lots of bottle babies and admittedly have never had eye issues in such tiny babies aside from (which after googling surprises me seeing how common it is, especially with ferals), so I'm hoping the wise people at TCS can help me decide whether I should get another opinion. She is 397 grams and he said she is absolutely to little for surgery. If it is a melting ulcer, don't they usually do some kind of collagen drop in addition to the abx?

If what he says is the preferred route, I'll keep doing what I'm doing. If not, I'll take her somewhere else myself. I honestly just don't know and am hoping someone with experience can shed some light on this.

Thanks!

What is the name of the eye drop you are using?

We have dealt with many cases of herpes where there are corneal ulcers in very young kittens.

We use a combination of Idoxuridine (antiviral eye drop,) Tobramycin (antibiotic eye drop,) Cidofovir (antiviral eye drop,) OxyPol/Terramycin (eye ointment) and either Amoxicillin or Clavamox.

The company does not list an age/weight requirement for Clavamox. You just have to adjust the doseage for the size.

And, yes, you do have the option of making a blood serum eye drop that can be used on the ulcers. I suppose the only problem with this is extracting blood from such a young baby.

I'm using a polymixin/gramicidin suspension, but looking on the web it seems tetracyclines are more successful? The vet didn't want to use antivirals because she said they burn and in older cats you can use an e-collar to stop them from scratching the eye, but obviously an e-collar isn't an option for such a little baby.

Edited to add: I was also applying genteal lube ointment. The vet had me alternating between drops and the lube, and when I stopped the drops after two weeks she said to continue with the lube. Obviously I have not applied any of that since this happened.

I have used antivirals in cats for the last 3.5 years and have NEVER had to put an ecollar on the cat when using the drops.

The antivirals have literally saved several of our cats' eyesight (or at least have helped preserve what we could.)

I would agree that the Idox likely does burn a bit, but all cats/kittens do fine after just a few seconds after the drops are applied.

We recently took in 2 kittens with severe herpes infections.

After one week of aggressive treatment (including 4 nights at an emergency clinic getting above meds and breathing treatments) both kittens have their eyes open and can SEE. I don't suspect they will have any lasting problems visually.

I will post updated pics later today.

Awe poor babies. I didn't even ask about the anti virals because my vet made it sound like they aren't used in such small kittens. Are they the kind of thing that need a cytology done first to rule out bacteria? And can they be used if there is already damage to the eye (if it is ruptured?)?

Just wrote a long post which I accidentally lost by hitting the wrong key, so LONG story now very short (I actually posted this on another link some time ago).  GANCICLOVIR opthalmic gel, works VERY well on herpes ulcer of the eye, used it myself on my own ulcer, then used it on cat with same thing, both cleared up super fast, and it not only does not sting, it makes the eye feel better almost instantly. The U.S. product is called Zirgan and costs over $200 for a tiny tube.  Same can be had from Europe under the name Virgan, which you can order through Canada Drugs (they dont have it on their list but can get it if you ask for it.)  Our vet eye doctor had never heard of it but approved it.  It's only marketed as a human product but it's fine for cats and dogs as well.  You might be able to get a small sample tube from your eye doctor (that's how I started, but when I went to fill the prescription, I discovered Medicare would not cover it and I could not afford it!)  But it was working and I wanted more.  It cost me $48 through Canada Drugs (they got it from the UK, we can't get meds from the UK here in USA).  Medicare wouldn't cover Virgan here, only covered the idoxy which I got but didn't work, so I got the European Virgan.  I had no negative side effects and the 3-year-old cat had none either and we both healed quickly.  Ask your vet about it.

http://www.netdoctor.co.uk/eyes/medicines/virgan-eye-gel.html

http://www.bausch.com/en/ECP/Our-Products/Rx-Pharmaceuticals/Rx-Pharmaceuticals-ECP/Zirgan-ECP

I don't have any kind if relationship with an eye doctor, but I'll make some phone calls. I can't even get the vet to call me to talk about anti virals. Apparently nobody works a full day on Fridays anymore, WTH?

I have to completely agree with the others about antiviral drops. Oh my gosh, the number of kitten's eyes I have saved from using Idoxuridine and terramycin. Eyes that were almost gruesome, seemingly beyond hope, but with relentless efforts all turned out fine, eyesight intact, amazing.

Idoxurinde (Idox) comes in 2 strengths too, I found the slightly cheaper lower concentration is not nearly as effective as the higher percentage one.

While Idox might have a slight burning sensation, cats and kittens don't seem to mind it much so it can't be all that bad or I would see some drama after using it on them! haha

Cats are funny!

If you are friends or relations with any MD, he could probably call or write a scrip for you.  It takes awhile to get here but it was shorter than they said it would be. I think I got it in about a week.  I didn't mind the sting of the idoxy because the eye always itched and felt like there was something in it, so the sting was a relief, but the Virgan made that sensation go away and it felt like the eye was fine for awhile.  I used the idoxy for a week while waiting for the Virgan and when the doctor checked my eye, there was no change from the week before.  When I got the Virgan and started uing it again, the next weekly check showed the ulcer had receded a lot.  I don't remember exactly how long it took, but I do know I had some Virgan left over which is why I had some to use on the rescued cat right away while I ordered more (on my original prescription) from Canada Drugs. 

@Red Top Rescue  that is very interesting to me, I am going to look into this med.

I've had excellent success with Idox but of course in rescue am always open minded to an alternative!

Alright, I'm trying to either get the anti-viral, or am trying to get her in to see someone to get the anti-viral drops. Why does this stuff happen right before the weekend? Do you use them in addition to the antibiotics?

Now they can't get her in 'till Monday, unless I go to a new vet, which I hate to do. Trying to see now if they'll just give us the drops. Probably not. Grrr.

Yes, both the antibiotic and the antiviral are used together (wait about 15 mins in between to administer 2nd med, or alternate meds every 2 hrs.)

We're waiting at the vet now. I'll update when I get home. Thanks everyone for your input, really appreciate it.

Good that you were able to get it today instead of Monday. Sending vibes.

Still here. She said the whole eye is likely gone, and the cornea for sure. She also said they don't make a veterinary antiviral, the idoxy needs to be compounded? Is that right? Anyway she gave me a script for that and a different antibacterial till we can see the regular vet on Monday. She said the eye needs to come out before it spreads through the optic nerve to the other eye. I'm pissed the other vet didn't start the antivirals 2 weeks ago!

I'm so sorry to hear about this. =(
Yes, the Idox has to be compounded (we're lucky to have an eye clinic 15 mins away that keeps it in stock.)

If there is a "bright" side to this, it's that kittens adapt very quickly. This baby will do just fine and will never know the difference. (It's *us* who has to make the adjustment.)

And, I'm honestly not sure why your other vet is against using antivirals. Definitely need to have a good discussion about this.

So I got out to the car and looked at the script and it's not for the idoxy! ***? So I went back in and tracked her down and she said te idoxy has been discontinued so she have me a script for the replacement - viroptic (trifluinidine).

I feel like I'm getting the run around. LOL

 Ok... now that I'm home and everyone is fed and happy, I can actually get on my computer and post properly. I'm really frustrated!! This vet wasn't going to give me the antiviral either. All she could say was "oh, that's bad". Uh, yeah, I know that, that's why I'm here!! She said the eye needs to come out, but she's too young. Uh yeah, kinda gathered that, too. What should we do about it in the mean time? She didn't have an answer.

And... I can't find a compounding pharmacy that is open until Monday. At least not one that has the stuff to make it without sending it out (which will take longer than just waiting for the big place to open on Monday).

So I guess my question now is, what is the prognosis for an eye that has ruptured? She said there is virtually no cornea left, and from the blood in the discharge it's likely the globe of the eye has collapsed, although I couldn't really get a definitive answer out of her. Just "oh, that's bad". I'm not even exaggerating (don't even get me started on the fact that they were going to make me wait FIVE HOURS with 2 other kittens at home that needed to fed, and they refused to warm up my bean bag in the microwave... not my usual vet, obviously).

She changed antibiotics to the tobramycin. Is it possible that the tobramycin and the antiviral (when I can get it!) can at least preserve the eye and prevent a complete removal, even if she looses sight? Or once it's collapsed, that's pretty much it? Like I said, I couldn't get a straight answer out of her.