Cloudy bubble on eye

the3rdname

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(Sorry I couldn't get a clearer shot. He won't sit still when the camera's on him.)  So last night Rumi's eye was perfectly fine, he was perfectly fine, then this AM I noticed he was squeezing his left eye shut and would only open it a sliver. He does have Feline Herpes Virus, but I've never seen his eye bother him like this before. If he has a flare-up, he'll get a little bit of dark discharge at the inner corners at most. As you can see in the picture, there's no discharge at all. No weeping, either. Just a cloudy bubble that developed on the outer edge of his eye, quadrupling in size since this AM. I didn't even know it was there before. Also, third eyelid is protruding and pupil has that opaque look when light is shined on the eye.

Took him to the vet and they performed a fluorescein stain, didn't find anything. She gave us "Tobramycin with Dex" eye drops to be administered three times daily (1 drop) for seven days. Could be bacterial, could be an ulcer, etc. No firm diagnosis at this point. 

I've doubled his daily L-Lysine dose in case it is Herpes related. Just wondering if it looks/sounds more like a bacterial infection or Herpes ulcer, or something entirely different. 

A little background: Rumi has a serious autoimmune disorder called Immune Mediated Hemolytic Anemia (his immune system destroys red blood cells) and he's on a couple of powerful immunosuppressants: Prednisolone 10 mg. and Cyclosporine 25 mg. He also takes a few supplements: L-Lysine (for FHV), Shou Wu (Chinese herbal remedy rx'ed by his holistic vet for anemia), cordyceps and reishi (to balance the immune system), probiotics, and a tiny bit of vitamin C to enhance absorption of the medicinal mushroom complexes. As you can see from the pic, the anemia is under control (for now!). 

He had a small bout of diarrhea yesterday night (unusual for him). He has a sensitive digestive system, so goodness only knows what triggered it. I'm thinking it's probably unrelated, but part of me wonders if bacteria from kicking around dirty litter wasn't somehow transferred to his eye. 

Any input appreciated!
 

stephanietx

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It's possibly an eye ulcer which is common with feline herpes kitties.  He needs to get to the vet immediately to have it checked out.  Also, prednisone is not good for herpes kitties since it suppresses the immune system.  Since a herpes kitty's immune system is already compromised it makes the kitty more susceptible to illnesses and stresses the immune system.
 
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the3rdname

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It's possibly an eye ulcer which is common with feline herpes kitties.  He needs to get to the vet immediately to have it checked out.  Also, prednisone is not good for herpes kitties since it suppresses the immune system.  Since a herpes kitty's immune system is already compromised it makes the kitty more susceptible to illnesses and stresses the immune system.
Thanks for the reply! Yeah, those immunosuppressants are a necessary evil that can cause all sorts of complications. I was wondering if it could even be something rare that isn't likely to occur in healthy cats. 

We did see the vet yesterday and got the antibiotic/steroid drops. I was wondering if he maybe needed something different, but I guess it's hard to say when you aren't 100% certain of the cause.

Edit: Not sure if this is overkill or not, does anyone think a Herpes eye medication should be added? I'm wondering if I should ask for something else in addition to the antibiotic drops, or if it's better to wait and see if his eye improves over the next few days. 
 
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the3rdname

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The bubble on his eye burst and there was this mini waterfall of clear fluid. After he calmed down and I was able to get him wrapped in a blanket, I cleaned the area around his eye with an antiseptic cleaner for cats and did my best to get a look at his eye under the light. Third eyelid is covering half his eye, so it's difficult to see. There's some of that white substance that was inside the bubble on the surface of his eye, but no redness, swelling or pus. He's still keeping his eye mostly closed and is really cranky at the moment. I can't tell if he's in pain or just spooked because this weird thing happened to his eye and he's tired of being fussed with.

Edit: Just noticed the white substance is still contained in a bubble, but the bubble is about half deflated now. This is so strange! Does this sound familiar to anyone?
 
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stephanietx

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What kind of drops did the vet prescribe?  Most herpes kitties get idoxuride drops for eye problems.
 
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the3rdname

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What kind of drops did the vet prescribe?  Most herpes kitties get idoxuride drops for eye problems.
Thanks for keeping tabs on the situation, Stephanietx. It's much appreciated 
 They were Tobramycin with Dexamethasone drops, which we found out today was not at all what he needed. Spent the entire day at the emergency/speciality hospital so he could be evaluated by an opthamologist. He has a very rare (of course!) corneal disease called Acute Bullous Keratopathy. High doses of steroids can trigger it in susceptible cats, and worsen existing disease, so we're going to have to tweak his med dosages to bring that Prednisolone down. 

They gave him a few different eye meds, an oral antibiotic, and Buprenex. His eye pretty much ruptured, which is what the leaking fluid was. If it ruptures again he'll have to have a patch surgically implanted over the ruptured area so the eye can heal. The opthamologist is going to call Monday to check on him and we'll see her again in a week to reevaluate his condition. One more rupture and he'll have to have surgery Tuesday. *Fingers crossed* that it responds to meds and we don't have to resort to that. Even with surgery, there's a chance- a good chance- it will reoccur 
 Decreasing the Prednisolone will make that less likely. 

Thanks again!
 

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Oh wow!  I'm so glad you got him to a different vet and got a proper diagnosis.  How scary for all of you.  Hope the meds help as well as decreasing his pred.
 

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Thanks for keeping tabs on the situation, Stephanietx. It's much appreciated
They were Tobramycin with Dexamethasone drops, which we found out today was not at all what he needed. Spent the entire day at the emergency/speciality hospital so he could be evaluated by an opthamologist. He has a very rare (of course!) corneal disease called Acute Bullous Keratopathy. High doses of steroids can trigger it in susceptible cats, and worsen existing disease, so we're going to have to tweak his med dosages to bring that Prednisolone down.

They gave him a few different eye meds, an oral antibiotic, and Buprenex. His eye pretty much ruptured, which is what the leaking fluid was. If it ruptures again he'll have to have a patch surgically implanted over the ruptured area so the eye can heal. The opthamologist is going to call Monday to check on him and we'll see her again in a week to reevaluate his condition. One more rupture and he'll have to have surgery Tuesday. *Fingers crossed* that it responds to meds and we don't have to resort to that. Even with surgery, there's a chance- a good chance- it will reoccur
Decreasing the Prednisolone will make that less likely.

Thanks again!
Hi!
I am new to this site and found this post while looking for experiences of bullous keratopathy.

We also have a cat with IMHA, she takes both preds and cyclo and has had now three bullas in her eyes these past 1,5 months. I am really worried that they will continue to reoccur and would love to hear how your cat healed from BK and did it reoccur?

We are now tapering Atopica as cyclosporin has correlation to BK according to research.
 
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