Cat rubbing/squinting eye repeatedly - FHV?

[Persona9]

Background:
My 7 year old Exotic Shorthair cat started holding his right eye half-open one day in Aug 2020.
I took him to a local vet in the UK, who prescribed Piriton tablets.
2 days later, a milky dot appeared in his right eye and he also started breathing very heavily.
I suspected the Piriton tablets (or the stress of being given tablets) somehow triggered a FHV flare up but he was not tested.
(My vet didn't see the need to test as the treatment would be the same either way apparently.)

Treatment:
He had antibiotic eye ointments for about 4 weeks, together with Remend corneal repair gel.
After the first 2 weeks of treatment, he had stopped squinting and the milky dot had turned into a little dent.
But the dent was shown green in the fluorescein stain test so we continued for another 2 weeks but it was still shown green.
He then had a week of Ganciclovir eye gel, which made him squint again so we didn't continue.
I decided to take him to see a Feline Ophthalmologist, who advised there was actually no corneal ulcer present.
So I went home happily, thinking there would be no more eye drops and no more worrying about him.
A week later, he started rubbing this eye randomly, squinted for a week afterwards and then had two bright eyes again.
He kept repeating the pattern over and over - rubbing (mostly the right eye but sometimes the left eye as well), squinting and full recovery.
So I took him back to see the Ophthalmologist, who offered lots of possible theories (allergy, dry eyes, FHV, etc.) but no solution.

Question:
He's still repeating the pattern 3 month later so here I am - Has anyone known any cat like this?
The little dent is still there but he has two bright eyes wide open in between episodes.
After he rubs it, he squints that eye for a week and then he's good as new.
During the squinting week, he has no unusual eye discharge, his eyelids are not red and his third eyelid doesn't show either.
The only symptom is squinting!
Please help!

 

[tarasgirl06]

Background:
My 7 year old Exotic Shorthair cat started holding his right eye half-open one day in Aug 2020.
I took him to a local vet in the UK, who prescribed Piriton tablets.
2 days later, a milky dot appeared in his right eye and he also started breathing very heavily.
I suspected the Piriton tablets (or the stress of being given tablets) somehow triggered a FHV flare up but he was not tested.
(My vet didn't see the need to test as the treatment would be the same either way apparently.)

Treatment:
He had antibiotic eye ointments for about 4 weeks, together with Remend corneal repair gel.
After the first 2 weeks of treatment, he had stopped squinting and the milky dot had turned into a little dent.
But the dent was shown green in the fluorescein stain test so we continued for another 2 weeks but it was still shown green.
He then had a week of Ganciclovir eye gel, which made him squint again so we didn't continue.
I decided to take him to see a Feline Ophthalmologist, who advised there was actually no corneal ulcer present.
So I went home happily, thinking there would be no more eye drops and no more worrying about him.
A week later, he started rubbing this eye randomly, squinted for a week afterwards and then had two bright eyes again.
He kept repeating the pattern over and over - rubbing (mostly the right eye but sometimes the left eye as well), squinting and full recovery.
So I took him back to see the Ophthalmologist, who offered lots of possible theories (allergy, dry eyes, FHV, etc.) but no solution.

Question:
He's still repeating the pattern 3 month later so here I am - Has anyone known any cat like this?
The little dent is still there but he has two bright eyes wide open in between episodes.
After he rubs it, he squints that eye for a week and then he's good as new.
During the squinting week, he has no unusual eye discharge, his eyelids are not red and his third eyelid doesn't show either.
The only symptom is squinting!
Please help!

Hello P Persona9 and sweet cat, and welcome to TCS! Though I have no experience of this, I am posting in hope others will follow who do have helpful ideas/suggestions to offer. *PRAYERS* for your cat's health and wellbeing. Please keep us informed as to how he is doing.

 

[fionasmom]

Given that you have already tried to resolve this and consulted an eye doctor, I am not going to list possible causes because you have probably heard all of them. What explanation did the doctor give for the stain being present even though there was not a corneal ulcer? Or for the fact that the stain appears for some reason? Given that your cat recovers, I wonder if you have already come across the reason and it is something recurrent like allergies or dry eye, both of which can come and go. Does he have a blocked tear duct?

 

[Persona9]

Given that you have already tried to resolve this and consulted an eye doctor, I am not going to list possible causes because you have probably heard all of them. What explanation did the doctor give for the stain being present even though there was not a corneal ulcer? Or for the fact that the stain appears for some reason? Given that your cat recovers, I wonder if you have already come across the reason and it is something recurrent like allergies or dry eye, both of which can come and go. Does he have a blocked tear duct?

Thanks for your reply!
The first time the veterinary ophthalmologist said it could be just a false positive due to the stain not flushed out properly in the little dent.
The second time there was an ulcer as he rubbed his right eye a couple of days before the appointment.
As for the reason for him rubbing his eyes, the veterinary ophthalmologist said it could be allergy, dry eyes or FHV - basically anything causing discomfort in his eyes.

Unfortunately I still have no clue!
I haven't changed his food or cat trees since August so I really don't know what could be triggering a potential allergy and he's never had an allergy reaction before.
I have been giving him eye drops for dry eyes in the hope that he won't rub his eye again but it doesn't seem to have worked.
I still have a new tube of Ganciclovir eye gel and my last resort is to give that another go.
I'm not sure about the blocked tear duct - can you let me know how I can check please? Thanks!

Photos of him attached - he rubbed his right eye again on Tuesday

 

[Persona9]

Hello P Persona9 and sweet cat, and welcome to TCS! Though I have no experience of this, I am posting in hope others will follow who do have helpful ideas/suggestions to offer. *PRAYERS* for your cat's health and wellbeing. Please keep us informed as to how he is doing.

Thanks for your reply

 

[tarasgirl06]

Thanks for your reply!
The first time the veterinary ophthalmologist said it could be just a false positive due to the stain not flushed out properly in the little dent.
The second time there was an ulcer as he rubbed his right eye a couple of days before the appointment.
As for the reason for him rubbing his eyes, the veterinary ophthalmologist said it could be allergy, dry eyes or FHV - basically anything causing discomfort in his eyes.

Unfortunately I still have no clue!
I haven't changed his food or cat trees since August so I really don't know what could be triggering a potential allergy and he's never had an allergy reaction before.
I have been giving him eye drops for dry eyes in the hope that he won't rub his eye again but it doesn't seem to have worked.
I still have a new tube of Ganciclovir eye gel and my last resort is to give that another go.
I'm not sure about the blocked tear duct - can you let me know how I can check please? Thanks!

Photos of him attached - he rubbed his right eye again on Tuesday
View attachment 408162View attachment 408161

He's absolutely adorable! Hoping and praying the cause can be ascertained and that he gets successful treatment. Please keep us informed!

 

[fionasmom]

Okay, I can see why you are concerned as that is quite a squint, even if it does go away. What a cute little cuddly face he has.

Blocked tear duct is a long shot and the only ailment that I thought had possibly not been investigated. The vet has to check and I think that the test is to use the same stain but to see if it runs through the duct into the nose. If it does not, there is a blockage. Ganciclovir can take a while to work and can cause some eye irritation on administration, so you might retry it. Rediscuss its use with the vet before restarting it?

 

[tarasgirl06]

Okay, I can see why you are concerned as that is quite a squint, even if it does go away. What a cute little cuddly face he has.

Blocked tear duct is a long shot and the only ailment that I thought had possibly not been investigated. The vet has to check and I think that the test is to use the same stain but to see if it runs through the duct into the nose. If it does not, there is a blockage. Ganciclovir can take a while to work and can cause some eye irritation on administration, so you might retry it. Rediscuss its use with the vet before restarting it?

I would.

 

[Persona9]

Just an update as it's approaching a year since he started having this eye issue.

Unfortunately, I still have no answer and he still rubs his eye, squints and then recovers. We went for a different vet for a third opinion as well but to no avail. As he has no other symptoms and he does recover on his own, vets don't seem to have any idea of treatment. So far, we've tried Chloramphenicol, Isathal, Terramycin, Ganciclovir and any other OTC eye ointment/drops for cats available in UK market.
Nothing seems to have stopped him rubbing his eye or made him recover faster so I'm not giving him anything right now. Instead, he's been wearing an Elizabeth collar on and off for the past 9 months. When he's not wearing the collar, he doesn't immediately rub his eye either. The best record we've had was a whole week of him not rubbing his eye without a collar! But eventually he'll just casually rub his eye again.

Just as I was about to accept that he might have to wear an Elizabeth collar for the rest of his life with daily supervised grooming and playing sessions without the collar, he had his first episode of FIC at the end of April. One day he started going to the litter box almost every hour and there was a bit of pink urine before we took him to the ER vet. But we were just sent home with Metacam without any tests done. As he never had any urinating problems before, the ER vet believed it was just a stress triggered FIC flare up and there was no need to stress him out more by doing additional tests. 5 days later, he did completely recover - his appetite came back, and he went to the litter box 2-3 times a day with a little puddle of urine ever since. However, last week I took him to our usual vet for his annual vaccination booster, as soon as he got home, he started visiting the litter box very frequently and my heart sank. I didn’t want to take him back to the vet straight away as it was obviously a stressful event for him, and fortunately he recovered completely 5 days later.

I can’t help but suspecting that his stress has come from wearing the collar, frequent vet visits, numerous eye drops and me. As you can imagine, my mental health is like a rollercoaster with him and it has become more and more difficult to stay calm. I start wondering if I’m doing the right thing by keeping him with the collar. Would he be better off squinting without the collar, at least he’s happy?

 

[tarasgirl06]

Just an update as it's approaching a year since he started having this eye issue.

Unfortunately, I still have no answer and he still rubs his eye, squints and then recovers. We went for a different vet for a third opinion as well but to no avail. As he has no other symptoms and he does recover on his own, vets don't seem to have any idea of treatment. So far, we've tried Chloramphenicol, Isathal, Terramycin, Ganciclovir and any other OTC eye ointment/drops for cats available in UK market.
Nothing seems to have stopped him rubbing his eye or made him recover faster so I'm not giving him anything right now. Instead, he's been wearing an Elizabeth collar on and off for the past 9 months. When he's not wearing the collar, he doesn't immediately rub his eye either. The best record we've had was a whole week of him not rubbing his eye without a collar! But eventually he'll just casually rub his eye again.

Just as I was about to accept that he might have to wear an Elizabeth collar for the rest of his life with daily supervised grooming and playing sessions without the collar, he had his first episode of FIC at the end of April. One day he started going to the litter box almost every hour and there was a bit of pink urine before we took him to the ER vet. But we were just sent home with Metacam without any tests done. As he never had any urinating problems before, the ER vet believed it was just a stress triggered FIC flare up and there was no need to stress him out more by doing additional tests. 5 days later, he did completely recover - his appetite came back, and he went to the litter box 2-3 times a day with a little puddle of urine ever since. However, last week I took him to our usual vet for his annual vaccination booster, as soon as he got home, he started visiting the litter box very frequently and my heart sank. I didn’t want to take him back to the vet straight away as it was obviously a stressful event for him, and fortunately he recovered completely 5 days later.

I can’t help but suspecting that his stress has come from wearing the collar, frequent vet visits, numerous eye drops and me. As you can imagine, my mental health is like a rollercoaster with him and it has become more and more difficult to stay calm. I start wondering if I’m doing the right thing by keeping him with the collar. Would he be better off squinting without the collar, at least he’s happy?

It's your call, P Persona9 . Doctors of any kind, vets included, are human beings, and they are far from perfect. They are fallible. They certainly don't know everything. "Science" is proving theories. It is not perfect, either.
My family has always believed that a basically healthy being will heal naturally from most ailments. Sure, if you break your leg or you need eye surgery or something like that, by all means, get it done. Otherwise, leave well enough alone and absolutely try to limit the stress. We all know the cliche, "Stress kills." Never truer words said!
If the vets can't find a reason, that means they don't know. For me, 2+2 always equals 4. My conclusion from this? Leave well enough alone.
But yours may be different.

 

[WMM201]

You may want to ask your ophthalmologists if your kitty needs to wear a collar or not, especially if there isn't a corneal ulcer present and it is likely an unidentified irritation. If the eye doesn't have an injury or disease, then wearing the collar might not actually be protecting against anything since you said your kitty isn't constantly pawing at his eye without it. Have you been using a lubrication ointment for dry eye (and as a protectant against any small irritants)? Not a drop but something like Puralube vet ointment or Alcorn eye ointment? It could maybe help keep his eye more comfortable and reduce the squinting, again, assuming there isn't actually an ulcer. My cat is using these ointments because she has some serious corneal issues and I think they do help.

Would your vet also allow a small dose of gabapentin for both pain and sedation? It might help with the eye and also with the stress. Eye problems are so difficult, so sending you and your kitty many positive thoughts and wishes!

 

[fionasmom]

Thank you for posting the update; I am sorry that, while it is some good news, the problem is not resolved. It is your call as to what you think is best, but I did wonder, as was stated, if there is no irritation or injury visible in the eye and if he is following the "rub/squint/recover" pattern if not using the collar would be okay. Were you saying that from April until July he was basically okay, or am I misreading your time frame? Or was it only one week?

His ability to use an Elizabethan collar is very impressive. I have never owned an animal, dog or cat, who did not immediately act as if they were about to have a stroke in one.

 

[Persona9]

Thank you for posting the update; I am sorry that, while it is some good news, the problem is not resolved. It is your call as to what you think is best, but I did wonder, as was stated, if there is no irritation or injury visible in the eye and if he is following the "rub/squint/recover" pattern if not using the collar would be okay. Were you saying that from April until July he was basically okay, or am I misreading your time frame? Or was it only one week?

His ability to use an Elizabethan collar is very impressive. I have never owned an animal, dog or cat, who did not immediately act as if they were about to have a stroke in one.

Since last November, I've been putting the collar on him after he rubbed his eye (squinting and stained ulcer) and then taking the collar off after he fully recovered (no squinting and no stain). The longest time without a collar was a week

He never seems to care about the collar so I didn't even start to think it was stressing him out until the two episodes of FIC within 3 months.

 

[Persona9]

You may want to ask your ophthalmologists if your kitty needs to wear a collar or not, especially if there isn't a corneal ulcer present and it is likely an unidentified irritation. If the eye doesn't have an injury or disease, then wearing the collar might not actually be protecting against anything since you said your kitty isn't constantly pawing at his eye without it. Have you been using a lubrication ointment for dry eye (and as a protectant against any small irritants)? Not a drop but something like Puralube vet ointment or Alcorn eye ointment? It could maybe help keep his eye more comfortable and reduce the squinting, again, assuming there isn't actually an ulcer. My cat is using these ointments because she has some serious corneal issues and I think they do help.

Would your vet also allow a small dose of gabapentin for both pain and sedation? It might help with the eye and also with the stress. Eye problems are so difficult, so sending you and your kitty many positive thoughts and wishes!

At the first appointment with the ophthalmologist, she said there was no ulcer whatsoever and the little dent was nothing to worry about, which was only cosmetic and would just take time to fill it up itself.
A week after this appointment, my cat started rubbing his eye, squinted and then recovered for the first time.
2 months later, we went back for a second appointment, which was a few days after he rubbed his eye and was still squinting from it.
I asked the ophthalmologist the reason why he would rub his eye like this and she couldn't care less. This time there was an ulcer and she gave us some antibiotic eye ointment and sent us home. As for the collar, she said I could leave it on if it would stop him rubbing his eye.

I have tried several lubrication eye gels/drops (UK doesn't seem to have the ointment form) but none of them seemed to have helped.
He has two big bright eyes without any eye gels/drops, as long as the collar is on and then the pattern repeats itself.

Hope your kitty gets better and thanks for your positive thoughts and wishes!
I asked for gabapentin when he was having the first FIC episode but was told Metacam would do
I would definitely ask again now that even going to the vet is stressing him out.

 

[Persona9]

It's your call, P Persona9 . Doctors of any kind, vets included, are human beings, and they are far from perfect. They are fallible. They certainly don't know everything. "Science" is proving theories. It is not perfect, either.
My family has always believed that a basically healthy being will heal naturally from most ailments. Sure, if you break your leg or you need eye surgery or something like that, by all means, get it done. Otherwise, leave well enough alone and absolutely try to limit the stress. We all know the cliche, "Stress kills." Never truer words said!
If the vets can't find a reason, that means they don't know. For me, 2+2 always equals 4. My conclusion from this? Leave well enough alone.
But yours may be different.

I know what you mean and I'm edging towards leaving him be to be honest.
I guess my fear is that if I let him, he might get the ulcer infected and not recover.
And then I also fear that he would stay stressed with the collar and have more issues later, as he's turning 8 years old in September.

He has always been a very confident kitty and I've never seen him stressed out before.
I remember when we moved a few years ago, my two other cats were hiding under the sofa for a couple of days but he was walking around the house like he owned it!
I wish he could just tell me what I should do with him

 

[tarasgirl06]

I know what you mean and I'm edging towards leaving him be to be honest.
I guess my fear is that if I let him, he might get the ulcer infected and not recover.
And then I also fear that he would stay stressed with the collar and have more issues later, as he's turning 8 years old in September.

He has always been a very confident kitty and I've never seen him stressed out before.
I remember when we moved a few years ago, my two other cats were hiding under the sofa for a couple of days but he was walking around the house like he owned it!
I wish he could just tell me what I should do with him

When you say the opthalmologist "couldn't care less" I'm reading that to mean she doesn't care. I know care is $$$ and specialists are hard to find, but in my life, anyway, if someone "can't care less" about me or my loved ones, I will try my hardest to find someone who does. My loved ones are my life! And I need to be there for them.
I hope that if you decide to change doctors, that you can find someone good. Too often they are only in it for the money.

 

[WMM201]

P Persona9 I am sorry your vet ophthalmologist doesn't seem to care as much about your kitty's condition as she should. If there is no ulcer, there isn't anything to get infected. He can have the collar off, and if you see green or yellow discharge and constantly holding his eye shut, that's your sign that there is an infection and he needs treatment ASAP. Just in my opinion, compromising his overall quality of life for an issue that isn't really an injury is not great for the cat.

Human products can also be used for cats, from my vet opthalmologist recommendations (this is at a major veterinary college in the US). I don't know what brands are carried in the UK or same product under a different name, but a human dry eye ointment that has ingredients of white petrolatum and mineral oil (both in the same product) only can be used. Some vet eye lubrication ointments also have a small percentage (2%) of lanolin along with the petrolatum and mineral oil (this is the Alcorn ointment) so if you find a human product with the same profile, you could try that.

Edit to add, thanks so much for the well wishes for my cat! By the way, even when she had the corneal ulcers that have developed into sequestrums, she was not rubbing her eyes often and the vet ophthalmologist never recommended a collar for her to wear. It's an ongoing issue for poor Mumu and unless there is green or yellow discharge and holding her eyes shut or constant pawing, the vets just want her eyes lubricated constantly and to have a pain medication a needed.

 

[WMM201]

https://www.amazon.co.uk/dp/B01CAQ3UPI/?tag=

this ointment has the ingredients I was referring to, P Persona9