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PART 2.
Monday, Sep 26, 2011

I review 47 images of the eyes of the fidgeting Miniature Pinscher whose owner reject injections and anaesthetics as a matter of personal preferences.

The green dye had stained the left eye 11-1 o'clock cornea a zigzagging green. I saw it. The owner saw it. But my camera techniques are lacking in that I can't capture the ulcer clearly in the operating room after application of the dye and doing hand-held. I had one respectable image. What I needed was a reflector but then Sunday was a busy day and I have not organised myself.

This morning at 8.30 am, I went through the 47 images again at home. Miniature Pinschers don't suffer from eye ulcers unlike the Shih Tzus and the Pekineses. She did have a small central eye ulcer scar of 3mm in diameter in 2006 when the owner first saw me and that was the only time I was consulted.

Clients in Singapore  doctor hop whether it is human or veterinary medicine but the vet must do his best in the diagnosis and bedside manners as well as in his receptionist services and other aspects. There are many factors involved in retaining a client's loyalty.

In any case, I was surprised that I had not seen the 3 melanomas on the upper eyelid at the 11-1 o'clock position. That is the cause of the ulcer which appeared just below these "melanomas." The 9-year-old spayed female dog felt irritated by these 3x3 mm lumps and must have tried to scratch them off. So, there was the zig zag upper corneal ulcer stained green. Vet 1 and I had not noted these melanomas as the dog kept moving. For me, the right eye was the main complaint and that was corneal degeneration/dystrophy. But the left eye was not normal as revealed by the green stain of ulcers.

The dog was moving. The owner did not want any sedation nor did I ask since she was not in favour of any injections or anaesthetics. She held the dog tightly. I muzzled the dog. Focus was on the right eye. The green ulcers in the left eye was picked up by the fluorescein dye. But what was the cause? I did say eye rubbing by the dog. The owner said: "I don't see my dog rubbing her eyes. Is the green dye poisonous?" Much of the time had been spent trying to flush away the green dye while the dog avoided by moving her head sideways. The owner tried to syringe the normal saline and said: "I wetted myself".

The owner had wanted a male vet to check her dog out. Was it Dr Jason Teo or myself she could not say. It was me 5 years ago and so it was OK with her as she did not want to go to the "referred vet". I said: "Vet 2 could be specialising in eyes and that was why Vet 1 refers you to her."

She asked if there are Singaporean veterinary eye specialists in Singapore. "Presently, there is none," I said.

The "melanomas" were small but could be seen clearly in the image. This shows that visual aids are good for reviews and help to diagnose. The right eye is likely to suffer from a condition called corneal endothelial dystrophy which is a opacity (lipid deposits) of the inner layer of the cornea due to aging.

I phoned the owner and told her about the eyelid melanomas which can be removed by surgery if she wished. Also, the corneal endothelial dystrophy may develop into an ulcer later. A blood test to check for hypothyroidism and hypercholesterol and lipids and a low fat diet of less than 8% had been suggested. She said that her dog is on a vegetarian diet and thanked me for the call. Later, I e-mailed to her two relevant images.