Cat Eye/optic Nerve Problem: Dilated Pupil, Bulging, Droopy Eyelid, Discharge

[mayadot]

My 14 year old friend, Nub, just had a rapidly escalating eye problem. One of his pupils became enlarged all of a sudden on Tuesday, and we took him to the ER, who referred us to an ophthalmologist. We went yesterday and she performed more tests and saw a lesion on the back of his eye, as well as that his eye was slightly bulging. She didn't find any ulcers, scratches, or inflammation inside of the eye, and the pressure in the eye was high (something like 21 or 22), but she said that she doesn't think it's glaucoma as that usually starts at 25. His symptoms in addition to the dilated pupil/bulging include a droopy eyelid and some discharge, and the eye doesn't seem to move very well.

The doctor's diagnosis was that it seems that there is something on the optic nerve that is pressing on the eye, which could either be infectious-based or a mass. Based on his age, she seemed pretty convinced that it's a mass, but prescribed some antibiotics anyway (though she seemed like she was just doing that to make sure she ticked all the boxes, or something, like she doesn't have hope that it will work).

We have an appointment with an oncologist next week, the next steps would be to do an MRI (which requires general anesthesia) to see what's going on, but I haven't decided yet whether I'll pursue that, since if it is a mass, I'm not sure it's best for him to put him through treatment at this point (surgery or radiation, most likely).

My questions are:
1. Has anyone had an older cat with these symptoms (basically something going on with the optic nerve) that didn't turn out to be a mass but actually an infection? Should I abandon all hope or try to remain optimistic?

2. Has anyone pursued treatment for a mass? If so, how did it effect your friend's quality of life? Was treatment successful? For how long?

3. Has anyone dealt with something like this and not pursued further treatment? If so, how long did you let your cat friend live with their symptoms? How did you make a decision about that? It's so difficult to tell because on the one hand he is still somewhat active, bringing me toy mice, snuggling me in the bed, going on furniture, etc., not acting like a completely sick or miserable cat. But on the other hand, I can tell that he has pain/discomfort and is not super happy, and I've seen him shake his head and paw at his eye. I'm not sure how to find the balance between allowing him (and me) to tolerate some pain or discomfort with aging and making sure he's not suffering.

Any feedback on any of these things would be much appreciated. Thanks so much.

 

[Furballsmom]

Hi! I'm so sorry to hear this!
I have no experience but wanted to ask if there have been any pain meds prescribed for him?

 

[white shadow]

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Hi mayadot.

Well, no matter what you will do in the near or mid-term, right away pain management needs to be assessed and implemented.

I'd be having this addressed immediately. When it comes to pain, there is no room for "balance", when the pain and discomfort can easily be addressed.

As well, if the pain is left unaddressed, he's likely to damage the eye, on top of the existing condition.

Your own Vet is able to provide pain relief now.
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[mayadot]

Thanks both and yes, we're doing the best we can with pain management. It's difficult because Nub has a paradoxical response to Buprenex/Burprenorphine (it makes him agitated and restless and kind of bounce of the walls), so I'm not sure if it's a good idea to give it to him. I have tried giving him Tramadol once but it was impossible to get him to swallow it, and I was told that it's so distasteful to cats that it's not realistic to get him to take it. What we seem to be left with is Gabapentin, which I am giving him. It does help him sleep, but he gets wobbly on it and doesn't seem all that happy either. If you have any suggestions for other pain management solutions, I'd be very happy to hear them, as this was all the vet offered (NSAIDs aren't really an option for him because he has elevated kidney values).

 

[white shadow]

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I wonder if the dosage of the buprenorphine might explain her 'problem' with it.

Your post is ambiguous to me, though. Are you giving her any pain meds right now?

There's a good coverage of painkillers for kidney-cats on the 'Tanya' site...it's here: Tanya's Comprehensive Guide....Painkillers Coices

Meloxicam can be used safely if it is very carefully dosed....that's explained there in Tanya's piece.

You might consider sharing that link with your Vet.....did you know that this site has received international recognition from Veterinary specialists and organizations? See the bottom of the homepage.
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[fionasmom]

I completely agree that there is nothing wrong with bringing up questions about meds and their alternatives with the vet. They are there to help you and your friend, not to simply dictate what is to be done. Right now I am facing something very similar with my dog and have been referred to an optomologist as well. There may be a mass behind the eye...nothing else to say and he is evidently not in pain. As he is a Cushings dog and a melanoma amputee, I am not anxious to add eye surgery to his list of experiences. I think that you are right....you need to remain optimistic and devise a huge list of questions for the specialist....there are no stupid questions. Once you have some answers you will know what to do.

 

[Saber_Wing]

My girl had a mass behind her right eye. Her symptoms were very similar to your friend, Nub's. Her eye didn't dialate, but it was bulging, and toward the end, she could only walk in a certain direction. The mass was pressing against a part of her brain that inhibited her control of her other side. So, it's possible this is the same problem, just with the mass positioned slightly differently.

I ended up doing the MRI, and they found it. The doctor said there was going to be no beating the cancer, even with surgery or radiation, so I opted to put her on steroids to reduce the swelling, then let her go when they didn't help anymore. They helped for a few weeks, and it gave her some quality of life back before I finally had to say goodbye.

This doesn't mean there isn't any hope at all for your baby. I hope it is an infection. But this story sounds very familiar to me. I lived it.

Much love either way, and best of luck If things do turn out for the worst, I'm here if you have questions, or need to talk.

 

[Saber_Wing]

When it's time, you'll know. I know that's vague, and probably frustrating, but it's instinctual. I couldn't have timed it better. She started to decline, I called to make the appointment (it was an in-home euthanasia), and the next day, she couldn't even walk anymore. She had seizures. She wasn't aware anymore. If yours progresses similarly, you'll know.

 

[mayadot]

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I wonder if the dosage of the buprenorphine might explain her 'problem' with it.

Your post is ambiguous to me, though. Are you giving her any pain meds right now?

There's a good coverage of painkillers for kidney-cats on the 'Tanya' site...it's here: Tanya's Comprehensive Guide....Painkillers Coices

Meloxicam can be used safely if it is very carefully dosed....that's explained there in Tanya's piece.

You might consider sharing that link with your Vet.....did you know that this site has received international recognition from Veterinary specialists and organizations? See the bottom of the homepage.
.

Thanks white shadow. I am giving him Gabapentin now to manage the pain, it's just that it makes him really out of it, makes it hard for him to walk, and makes him sleep most of the time. If he sleeps and feels comfortable in the short term then I don't mind that he's out of it, but in terms of quality of life I wouldn't want to see him like that all the time, as he doesn't do much besides sleep, eat, and use the bathroom. I hope that makes sense.

I will speak to the vet about the Meloxicam, thanks so much for that resource.

 

[mayadot]

I completely agree that there is nothing wrong with bringing up questions about meds and their alternatives with the vet. They are there to help you and your friend, not to simply dictate what is to be done. Right now I am facing something very similar with my dog and have been referred to an optomologist as well. There may be a mass behind the eye...nothing else to say and he is evidently not in pain. As he is a Cushings dog and a melanoma amputee, I am not anxious to add eye surgery to his list of experiences. I think that you are right....you need to remain optimistic and devise a huge list of questions for the specialist....there are no stupid questions. Once you have some answers you will know what to do.

This is very helpful, thank you fionasmom. I have been asking so many questions but there are so many variables and so many uncertainties that it has left me feeling overwhelmed.

Nub has small cell lymphoma in his intestines, which he's been living well with for a little over 3 years. He has been doing great and is still stable, so he's not exactly 'sick,' but he is 14, has arthritis in his back... If this had happened at a younger age I think I would have been much more secure in a decision to try treatments, but at his age these treatments hit him harder and it's so hard to reconcile decisions about how much discomfort he'll have to tolerate for treatment vs. how much more time he'll get.

 

[mayadot]

When it's time, you'll know. I know that's vague, and probably frustrating, but it's instinctual. I couldn't have timed it better. She started to decline, I called to make the appointment (it was an in-home euthanasia), and the next day, she couldn't even walk anymore. She had seizures. She wasn't aware anymore. If yours progresses similarly, you'll know.

I'm so so grateful for your comments and support, thank you Saber_Wing.

I was able to get an earlier oncologist appointment and we met yesterday, but there still aren't many answers without doing the MRI. The oncologist said that it could potentially be a mass that could be treated with radiation, or something on the optic nerve that could be removed surgically, which may or may not damage the eye.

It could also of course be a mass that is untreatable, as I'm so sorry happened to your friend. But if it's one of the previous options, I don't know how much putting him through treatments and things is too much, or what he would choose if he had the option. The oncologist made radiation sound not that bad, but I don't know enough about that to know how hard it is on them. The surgery sounds more intense/invasive, but the oncologist was like "many cats live without an eye" which is true, and if he was 2 years old I would probably opt for that... but he is 14 and already has another form of cancer (small cell lymphoma, but he's continuing to do great on that and they can live several years with it). So these decisions are extremely difficult. I believe that if it's truly treatable he could live well maybe a couple more years, if everything else goes well, but even if I do the MRI, I may not know how treatable what he has is or how much trauma he might suffer from pursuing treatments.

And then in terms of the bigger decision... I guess what I'm most afraid of is that I won't really "know." I think he is unhappy right now, but not miserable. However, every pain and discomfort he has is so hard for me to see, that it's so hard to know where to draw the line. I hope that makes sense.

Thanks again so much for your kind words and just taking the time to write. It means a lot to hear from someone else with this experience.

 

[Furballsmom]

I have often read on this site that cancer treatments aren't as hard on felines as on humans.

Forgive me for asking but if the eye, which is bulging, is removed wouldn't that relieve the pressure? If he is shaking his head and pawing at his eye, can something be done to help ease his discomfort?

 

[mayadot]

I have often read on this site that cancer treatments aren't as hard on felines as on humans.

Forgive me for asking but if the eye, which is bulging, is removed wouldn't that relieve the pressure? If he is shaking his head and pawing at his eye, can something be done to help ease his discomfort?

That's good to hear about cancer treatments, thanks. Have you heard that about radiation in addition to chemotherapy? He has been on chemotherapy for about 3 years for small cell lymphoma in his intestines (a slow moving and relatively treatable form of cancer), and I can absolutely confirm that he's done great on it, but I don't have any experience with radiation and how that affects them. The radiation treatments are done under light general anesthesia and are 2 treatments a week for a few weeks, so that's much more stress for him than giving him a chemotherapy pill at home, but perhaps aside from the anesthesia he won't feel much? I don't know.

Depending on what's going on behind his eye, it may be an option to remove the eye or even to do eye surgery that may not require it being removed, and if he was a younger, healthier cat I think I would hesitate less for that option, but considering he's a 14 year old who already has small cell lymphoma, I'm afraid that maybe putting him through the trauma of surgery, healing from surgery, and relearning to live with one eye might be adding more suffering than makes sense for him at this stage in his life. I hope that makes sense

 

[white shadow]

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Reducing the dosage of the Gabapentin would certainly reduce the sedative effect. I wonder if you could find that point where the pain is controlled without too much sedation....? It seems like a worthy discussion to have.

Like you, I'd rather have a woozy, comfortable cat than seeing him in pain.

I used Gabapentin as one of three pain control drugs when Stryker was in hospice care. The other two were buprenorphine and Metacam. He was perfectly at peace and pain-free for several months. This protocol is known as "multimodal" pain management. It uses different acting drugs to target different pain receptors. And, one of its features or results is that the amount of each drug is reduced. Stryker was completely "himself" throughout that period.

I don't know if this will provide an understanding, but here is a chart showing 3 different classes of drugs - one is chosen from each class to provide wide spectrum pain management:

LINK:
Focus On Pharmacology | Management of Chronic Pain in Cats​

I think I suggested earlier that the 'euphoria' effect from the bupe may be related to the dosage that was used.

Speaking of Metacam, just by coincidence I was listening to a presentation earlier today by a Board Certified Anesthesiologist in which she indicated that the use of Metacam has been under re-review over the past few years and is now considered an integral part of modern pain management protocol. I took from that that it is very likely we will see a feline Metacam come onstream in the US and the whole black box listing business relegated to history. Metacam has long been licensed for cats in other major jurisdictions.

So again, the Metacam, carefully dosed according to those protocols, is both safe and effective, even in cats with kidney disease.
.

 

[white shadow]

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Two quick points.....I think we posted about the same time there.

I'd bet that, were you to try the buprenorphine with the Gabapentin on board, that you wouldn't see the agitation......the sedative effect balancing out the other.

And, considering what you wrote in that last paragraph on whether/not to do surgery etc.....well, from having read other peoples' accounts of post eye removal recovery, it's very straightforward. There's no "adjustment" for the cat - they just carry on as if nothing's happened. So, while it's normal to opine over it all, it doesn't seem to mean a hill of beans to the cat.

There was a point with Stryker where a full leg amputation might have been viable and we came very close to that point. I was sweating bullets over the prospect of what I perceived as a horrific surgery and an unimaginable post-surgery recovery period. Then, as I explored it further, those concerns were not borne out in fact. I really needed to clear away the apprehensions and consider the facts without emotion clouding the picture. Clear thinking....easier said than done, but doable.

With Nub managing his current condition well, then that needs to be removed from the calculation. The use of worst case descriptors like stress/trauma/re-learning/suffering (remember, there's no physical suffering with the right pain management, and no psychological suffering as cats lack that capacity)...those descriptions cloud clear thinking. Not helpful.

I think my brain is fried. I'm gone.
.

 

[Furballsmom]

white shadow did a marvelous, concise and clear job of expressing what I am thinking as well (even with a fried brain, bless you ) regarding removing Nub's eye.

Regarding your question/concern about radiation, I spent some time reading through thread discussions about cancer kitties on this site.

The most I'm seeing is that now and then a cat will develop a skin "rash", if you will, from the radiation therapy which can be eased greatly with a chamomile tea-bag wash. Every cat is different and radiation doses are different, but cats in general seem to tolerate both forms of therapy (chemo and radiation) well, separately as well as in conjunction.

Of course you will, but continue your indepth discussions with your team--you are warriors together in this fight, and you need to be able to see a path more clearly, if this is at all possible.
Ask what they would do if it were their cat, and find out why they'd do it that way.
Hopefully you will be able to determine the best course of action from all the input/feedback.

 

[fionasmom]

Asking what they would do is an excellent question and it also works with human oncologists, surgeons, etc. It can really reframe things. I also agree that there is no psychological issue with illness which does not involve pain in the case of an animal. My GSD (now deceased) completely accepted the fact that for the last two years of his life his rear legs were paralyzed and got on with his life in his cart and harness. A friend of mine with a tiny chihuahua just completely radiation to the brain for a tumor and it was seemingly smooth and pain free, although I have never given an animal radiation. I did have 6 weeks of daily radiation myself and to be honest, with a qualified staff and radiation oncologist, the biggest issue was getting there every day. Your baby is very lucky to have someone like you who is looking out for his welfare so carefully.

 

[mayadot]

.
Two quick points.....I think we posted about the same time there.

I'd bet that, were you to try the buprenorphine with the Gabapentin on board, that you wouldn't see the agitation......the sedative effect balancing out the other.

And, considering what you wrote in that last paragraph on whether/not to do surgery etc.....well, from having read other peoples' accounts of post eye removal recovery, it's very straightforward. There's no "adjustment" for the cat - they just carry on as if nothing's happened. So, while it's normal to opine over it all, it doesn't seem to mean a hill of beans to the cat.

There was a point with Stryker where a full leg amputation might have been viable and we came very close to that point. I was sweating bullets over the prospect of what I perceived as a horrific surgery and an unimaginable post-surgery recovery period. Then, as I explored it further, those concerns were not borne out in fact. I really needed to clear away the apprehensions and consider the facts without emotion clouding the picture. Clear thinking....easier said than done, but doable.

With Nub managing his current condition well, then that needs to be removed from the calculation. The use of worst case descriptors like stress/trauma/re-learning/suffering (remember, there's no physical suffering with the right pain management, and no psychological suffering as cats lack that capacity)...those descriptions cloud clear thinking. Not helpful.

I think my brain is fried. I'm gone.
.

Thank you for all of this, white shadow, it is very comforting to hear that there are options to combine pain meds.

As for the Gabapentin, I think he's on the "lowest" dose (25mg), at least as prescribed by veterinarians, but i know it's possible to just be more sensitive to a medication, so I'll try a lower dose still. Combining the Gabapentin with the Buprenorphine might be a very good idea.

It's also helpful to hear that cats manage surgeries, etc. well, but having seen Nub deal with things like anxiety and phobias, I'm not sure I could confidently say that cats experience no psychological suffering. I understand what you mean though, that I need to look at what's in front of me rather than imagine worst case scenarios, and that's a good reminder, thank you for that and thanks so much for the resources.

 

[mayadot]

white shadow did a marvelous, concise and clear job of expressing what I am thinking as well (even with a fried brain, bless you ) regarding removing Nub's eye.

Regarding your question/concern about radiation, I spent some time reading through thread discussions about cancer kitties on this site.

The most I'm seeing is that now and then a cat will develop a skin "rash", if you will, from the radiation therapy which can be eased greatly with a chamomile tea-bag wash. Every cat is different and radiation doses are different, but cats in general seem to tolerate both forms of therapy (chemo and radiation) well, separately as well as in conjunction.

Of course you will, but continue your indepth discussions with your team--you are warriors together in this fight, and you need to be able to see a path more clearly, if this is at all possible.
Ask what they would do if it were their cat, and find out why they'd do it that way.
Hopefully you will be able to determine the best course of action from all the input/feedback.

Thanks so so much for taking the time to read through threads about radiation, Furballsmom. I can't tell you how helpful that is as it is already difficult to manage regular life together with researching and thinking about how to proceed with Nub. It's very helpful to know that radiation can be well-tolerated.

I have tried talking to the doctors and in the past I've had good results with asking what they would do, etc., but for some reason this time it hasn't worked out so well. Part of the issue is unfortunately that we just moved to a new state so are dealing with new doctors who don't know him or I well. But also it seems that this particular problem can be caused by so many different things and there are so few clear answers that the doctors seem more hesitant to say anything concrete. For example, it could be a bacterial or fungal infection, but I was told that even if it's bacterial, antibiotics may not work, and even if it's fungal, antifungals may not work, and blood tests can be done to see if it's one of those things, but the blood tests might show a false negative. It is unbelievably frustrating and makes things much harder than they have been with previous health decisions for him, even with his small cell lymphoma,

Thanks again and for the words of support, they are invaluable.

 

[mayadot]

Asking what they would do is an excellent question and it also works with human oncologists, surgeons, etc. It can really reframe things. I also agree that there is no psychological issue with illness which does not involve pain in the case of an animal. My GSD (now deceased) completely accepted the fact that for the last two years of his life his rear legs were paralyzed and got on with his life in his cart and harness. A friend of mine with a tiny chihuahua just completely radiation to the brain for a tumor and it was seemingly smooth and pain free, although I have never given an animal radiation. I did have 6 weeks of daily radiation myself and to be honest, with a qualified staff and radiation oncologist, the biggest issue was getting there every day. Your baby is very lucky to have someone like you who is looking out for his welfare so carefully.

Thanks fionasmom for sharing those very personal experiences, I'm really grateful to be able to hear them, they help give me a clearer picture of what to expect. Thank you.