UC Davis’ Pioneering Nasolacrimal Endoscopy & Stenting Procedure Successful in First Cat
January 6, 2016
Kinako was the first cat treated for a blocked nasolacrimal apparatus utilizing UC Davis' pioneering procedure.
VMTH "Case of the Month" - January 2016
Kinako, an 8-year-old female domestic shorthair cat, was continually troubled with build-up of tears in her left eye, sometimes resulting in infections. Her owner took her to see their veterinarian, who attempted to flush the tear duct of that eye several times, but to no avail. While the situation was not life threatening, Kinako’s owner did not want her to suffer needlessly for the rest of her life. Kinako’s veterinarian suggested taking her to see the specialists in the Ophthalmology Service at the UC Davis veterinary hospital.
Drs. David Maggs and Ann Strom suggested that if a CT scan revealed an obstruction in Kinako’s tear duct, then she undergo a new procedure pioneered at UC Davis to permanently reopen the duct. This new, minimally invasive approach to nasolacrimal obstructions had already shown great promise in one horse and a number of dogs, but had not yet been performed in a cat. The lacrimal system is responsible for the generation and drainage of tears. The drainage portion of the system consists of several important structures collectively known as the nasolacrimal apparatus (NLA). This frequently becomes blocked and sometimes infected, leading to discomfort, tear staining and discharge from the eye, resulting in skin inflammation. However, the NLA is made up of such small ducts that access to the obstruction can be extremely difficult.
Thanks to advances in equipment and technique, a multidisciplinary team of clinicians from UC Davis’ Ophthalmology, Internal Medicine, Soft Tissue Surgery, Anesthesia, and Diagnostic Imaging Services are now having unprecedented success treating NLA blockages.
With cameras now small enough to fit into the tiny drainage ducts, clinicians utilize endoscopy (as well as CT and fluoroscopy) to identify and bypass or remove NLA obstructions. Whether the obstructions are caused by a scarred duct or a foreign body, temporary stents can usually be placed so as to reopen the duct from eye to nose.
As they had done before for the equine and canine patients, the UC Davis team came together to successfully unobstruct and temporarily stent Kinako’s left nasolacrimal passage. Following the surgery, the stent was left in place for two months to allow adequate time for the duct to heal in an open position. Although Kinako initially had some persistent ocular discharge caused by an infection in the tissue around the eye, this cleared with antibiotics, and Kinako’s left eye no longer shows signs of build-up or excessive tearing, and her nasolacrimal duct remains clear.
About three months following surgery, Kinako’s owner reported that her left eye demonstrated what he defined as a complete resolution of signs.
To date, UC Davis has treated 15 dogs, two cats, and one horse with this pioneering procedure that now offers a minimally invasive alternative for referring veterinarians who have been faced with treating NLA obstructions using conventional, more invasive and typically less successful methods.
Importantly, many of the cases referred were considered particularly challenging since they were referred to UC Davis by local ophthalmologists who were unable to treat them using conventional methods. Because of this initial success, general practitioners and ophthalmology specialists are recognizing UC Davis’ unique approach to effectively treat this condition, and a clinical trial is underway at the veterinary hospital to evaluate the procedure so that this can become the standard-of-care for this otherwise frustrating disease complex.
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About the Veterinary Medical Teaching Hospital
The William R. Pritchard Veterinary Medical Teaching Hospital at the University of California, Davis—a unit of the #1 world ranked School of Veterinary Medicine—provides state-of-the-art clinical care while serving as the primary clinical teaching experience for DVM students and post graduate veterinarian residents. The VMTH treats more than 51,000 animals a year, ranging from cats and dogs to horses, cows and exotic species. To learn more about the VMTH, please go to www.vetmed.ucdavis.edu/vmth. Timely news updates can be received on its Facebook (www.facebook.com/ucdavisvetmed) and Twitter (www.twitter.com/ucdavisvetmed) pages.
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