Bearded dragon eye problem

Question

Eye   QUESTION: Hi Mick,

I was researching my bearded dragons eye issue online and I came across one of your answers and the situation and picture looked very similar to the problem we are having now. I have already been several times to the vet and tried several treatments, and I need some advice regarding what you think I should do with my bearded dragon. I don't know if he is suffering, and I don't know what else to try

Information:

40 gallon tank, paper towels and reptile carpet, 30-40% humidity,  102 bask temp, ambient hot side 89, ambient cool side 75-76,  reptisun 10.0 24" tube, eats crickets, collards, kale, turnip greens, yellow squash. Eats crickets once a day, sometimes twice and eats greens every day. Greens and crickets dusted with calcium without d3 3-4 times a week, and once a week with herptivite.  This schedule was recommended by an exotics vet.  He is offered fresh water every day in his tank but he is also offered running tap water which he will drink from. He will also drink from his daily bath of warm water which I treat first for chlorine.  He defected typically twice a day, but was just treated for coccidia and now usually only once a day. He is still eating normally. The vet estimates he is 4-6 months in age. He is 10.5 inches long.  No other animals in habitat and captive bred, I assume, purchased from petsmart. Sheds every few weeks. Starting another shed now.

The issue:

About 3 weeks ago he started a shed and was rubbing his eyes on his fake wood branch. I assumed this was because he was trying to get the skin off his face. After his face shed, I noticed his left eye was swollen towards the front. 3 days later, the 3rd eyelid randomly popped out and then popped right back in. I rushed him to the emergency vet and they have him oral anti inflammatory drugs and antibiotic eye drops. The antibiotic eye drops have caused the entire membrane to now be exposed. It covers 100% of his eye. I took him to another exotics vet and they have him an anti inflammatory eye drop, which has made it worse again. He has now started to rub it on rocks and scratch with his back feet. I am still administering the drops, but they are beginning to burn him because it is becoming raw and blood tinged. The vet said the next step is to biopsy the tissue to check for cancer and or tuberculosis of the tissue. She said this will forever affect his eye as he needs his third eyelid. I have been rather distraught because I have never put a pet down, but I am contemplating it because I am considering the quality of his life at this point. When he eats his crickets, he spins in circles to see them because his left eye is completely obscured. I have tried using a sterile saline drop and it is not improving. I have read your posts here: http://en.allexperts.com/q/Reptiles-704/2013/12/bearded-dragon-eye-swelling.htm and bought him the ther kind of eye drops but am afraid to hurt him any further.

Would you have any advice for me? I am completely lost as to what else to do for him. I truly want to put him out of his misery but I cannot tell if he is suffering. Thank you so much for your time.

ANSWER: Number one - DO NOT allow a biopsy or some other such NONSENSE on this the veterinarian wants to do. This is ridiculous and that's their answer when they don't know what else to do, and it's needlessly costly and virtually never the concern at hand. There are other avenues to approach first that are more reasonable and less invasive.

This appears to be an inflammation of the nictitating membrane. Please cease all talk of euthanasia for this. That shouldn't even be on the table. I could find this guy a home and he could adapt even with one eye were he to lose the whole globe. Losing his life over an eye issue is an extreme suggestion. The only thing you need to do right now until I get back to you is to keep the eye flushed with saline, lubricated with the lubricant drops I mentioned previously and apply a non-medicated lubricant ophthalmic gel ointment over the tissues to keep the eye from drying out. Just a mineral oil/petrolatum/paraffin based gel. And keep him off substrates that can get in the eye. You stated the eye was 100% covered, but I don't see that in the picture. It looks about 50% -2/3rd.

I need to know exactly what the vet gave you to use previously. I have to have specifics. I can't stress that enough. It's not enough to tell me "drops". I have to know what they are. Cease using whatever antibiotic or anti-inflammatory drops it was until I can be informed what it is. An antibiotic drop is from what I can see unnecessary here and they tend to cause more problems than they solve and can make the eye prone to fungal or other types of bacterial infections with repeated extended use, as can steroid anti-inflammatory drops. Likely you were given non steroidal anti-inflammatory drops, but I need to know.

The most likely explanation for this condition is debris stuck under the nictitating membrane in the corner of the eye OR he has a blocked lacrimal duct. If you don't have a bottle of saline eye rinse, then get one. And if you can obtain a syringe of about 3-5cc with a about a 27g-23g needle then get that too. I would also like to see a better photo of the eye when you follow up.

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Also - A typical cox 2 NSAID is not going to be very helpful if the reason the tissues are distended is due to fluid blockage or retention either. If you have vitamin A or fish oil gelcaps in the house let me know, but DO NOT use them yet.

---------- FOLLOW-UP ----------


Eye  

Eye   QUESTION: The drops he is getting now as an antibiotic is ciprofloxacin opthalmic solution 0.3% and what they told me was the anti inflammatory is labeled as flurbiprofen sodium opthalmic solution 0.3%. Today I have been giving these as prescribed but rinsing his eye with a sterile saline solution as well. It dried up and then whenever I do this or put a drop in, it looks like it swells back up. The vet seemed to be certain that there was no debris in his eye and they used an instrument to pull it all back and check but I am sure it still could be a concern. They also said it could be some retained shed, but his shed seemed like it all came off to me. I will go try to find some of the gel you mentioned in the morning. I think this will help keep it moist. I will also pick up the vitamin capsules and wait for further direction.

I have attached a picture of his eye that is more current. The reason I mentioned euthanasia is because I have nowhere else to turn other than the vet, and I feel that the biopsy would only hurt him more. That's the only solution they are willing to try. I have contacted an area reptile rescue for any thoughts but they have not contacted me back, so I am just lost. Thank you very much for your help as I have nowhere else to turn. I would never want to do that but you must understand that I hate to see any of my animals be in pain and me feel completely helpless. I'm not an expert and I'm trying to do the best I can.

Answer
Well, you needn't worry about not having anywhere to turn. I am more than a reptile rescue. I am a rehabilitator, which is a a step above just a rescue. And more than just any rehabilitator, I am a content contributor for a well known veterinary website. This means, veterinarians follow my work and learn from what I do in treating reptiles. Veterinarians in general often aren't the best sources of information on reptiles, especially if they aren't board certified exotic/reptile such as with ABVP, or at least having certification of herpetological medicine continuing education through an organization such as ARAV. I typically caution anyone to take with a grain of salt what they are told by any vet who is not themselves a long time reptile keeper. It makes a difference.

If worst comes to worst, you can ship the dragon here via overnight for treatment as well. I do this from time to time, and there is zero need for euthanasia for this. It's possible the membrane needs needle aspiration to drain the retained fluid off and relieve symptoms, but it's unlikely you are going to get the average vet to be comfortable with such a thing, and I'm not sure I would trust them too either if they're handing you eye drops and sending you home. This is a procedure I have done however.   

It's also important that if you are going to continue with my advice, that the waters aren't muddied. No offense to this other reptile rescue, but unless they are rehabilitators, it's only going to add noise to the issue in my experience, so I would advise that once you begin the steps I will be laying out to diagnose and treat this condition, that you see the through.

Please cease the ciprofloxacin drops if you have given them for at least 3 days. This is unlikely to be infectious in origin at this time. Although it could turn so later if the fluid isn't drained off, if this condition was infectious in nature or if it was something that a cyclooxygenase inhibiting NSAID could help with, you would have seen some benefit - NOT exacerbation of the condition. The condition worsening after use of these medications is clear clinical evidence that they are not helping, and that it is not going to be curative to continue. Results should have been marked in 2-3 days if it was going to help at all. If you use too much of these medications, it hurts like hell and predisposes the tissue to further injury, and actually, an infection where there wasn't one to begin with. Yes, many antibiotics if used excessively where no infection exists, will lead to die off of some microorganisms in favor of others, or those that are resistant, and then you could have a really bad infection.

Once you cease the cipro drops, allow at least half a day to pass and use only the saline rinse, the carboxylmethylcellulose based drops, and/or a non-medicated ophthalmic petrolatum based gel to keep the tissue from excessive drying. Monitor the progress. If there is no reduction after approx 12hrs of ceasing the prescription medications, then you may try one small drop of the flurbiprofen and monitor for a change either way. If there is immediate benefit (within 1-2hr), then use sparingly, only as needed. If there is no benefit or the inflammation worsens again with the flurbiprofen now alone, then cease it completely as well. Do this as I have stated, by the numbers, and keep me notified of the progress.

The second photo wasn't very useful. It was too far away. Can you get a good one in focus closer than the first and with bright lighting?

When you get the gel caps (preferably fish oil which also contains Vit D), let me know the IU concentration. If there are more than one type, then get the type that has the lowest IU concentration of Vit A per gel cap.

I am not convinced there is not debris back there. That would include retained shed. Retained shed or a splinter from the branch is one of my leading theories here, along with an impeded lacrimal drainage. He was going into shed, he had shed around his eye that was bothering him and he rubbed his eye against a branch. Now he has clinical issues with the eye. The rational medical conclusion is that they are connected events. And most debris in my experience is driven to the rostral end of the eye, which is what is affected here, and it is difficult to find it sometimes. I use magnification loupes anytime I'm looking at a reptile's eyes. The fact that the nictitating membrane continues to swell with time is indication that fluid is either continuing to build under the membrane, or within it. Did either veterinarian look at the eye with a black light, magnification loupe, or even take a culture before deciding antibiotics were called for?

And did you receive my private message?