Nasolacrimal duct obstruction

[Reddogzz]

What color was the pus from the mouthrot? Did the green exudate from the eye have a smell like ripe grapes?

The mouthrot WAS hard chunks of off-white that would appear in the corners of his mouth, it smelled terrible. Last month he had mouthrot, I used baytril for 14 days and 90% cleared up but we discovered had missed some of the puss and when we discontinued the baytril the infection started to worsen, we removed the pus and put him on reptaid, the infection stopped worsening but it did not get better. We put him on another 14 days of bayril and the infection disappeared, but on the last day the eye swelled. The vet put him on amoxicilin and Gentamicin. We were told by another vet (on a different island) that it might be best to wait on the amoxicilin until we know if the wound is infected. Our normal vet then lanced the eyelid and the electric green/clear fluid came out, the vet looked surprised by the color but said it could be an infection.

UPDATE:It has been a few days since the vitamin A, he is still lethargic and still not himself, If I don't interact with him, he will stay in one spot for hours (where usually he climbs all over the place). He will flirt/peruse the female, and he will fight himself in the mirror, after which he starts walking around on his own a bit more.

What should I do at this point? The vet has not done a flush before on a chameleon (and doesnt usually do them on other animals either) so she said she cannot promise anything. JoeVet mentioned earlier that it can be preformed if my cham is healthy enough for the anesthetic, but the vet isn't willing to knock him out (she does not have the right anesthetic). She would be attempting the flush for the first time with him awake. I would prefer do the flush myself using pure saline eyedrops + oral syringe... if its not totally out of the question? It would save him stress (he turns black when riding in the car)... Is that at all possible?

 

[kinyonga]

So after the second round of baytril you didn't use any meds...or you did??

 

[Reddogzz]

So after the second round of baytril you didn't use any meds...or you did??

After the second round of baytril the vet started him on amoxicilin + gentamicin for eyes, but he was really really bad off, dark color and everything, so I dropped the amoxicilin on the second day, he is only on the gentamicin eyedrops right now

 

[kinyonga]

Sorry to hear he was not doing better...however if you don't find out what's going on and treat it its not going to get better. Have you emailed some of the vets on this forum to see if they have advice?

 

[Reddogzz]

if you don't find out what's going on and treat it its not going to get better.

I really appreciate all the support, thank you so much!!!

I realize that there could still be an underlying problem that the previous antibiotics did not cure, it could also be that an abscess from the previous problem is still blocking the tear duct. Even if I did the culture/sensitivity and got the results 2 weeks from now, my vets office already said they have a policy of only prescribing oral antibiotics. Since no other vets here will see chameleon's I feel stuck.

If any herp vets feel like moving or taking a last minute vacation to the big island, let me know!

UPDATE
His eye is still puffy but he is slightly more active, he moves about 1 ft/hr on his own.

JoeVet mentioned that a vet closes the eyelids around the oral syringe and pushes the saline in, but I cannot imagine being able to do that with the chameleon awake. When vets flush a nasolacrimal duct, do they usually knock the chameleon out? Can it be done otherwise?

Have you emailed some of the vets on this forum to see if they have advice?

Do you mean sending a PM through the forum, or actual email? I am not sure which vets are the most active here.

Thanks again for all your help!

 

[JoeVet]

Just to again be clear, I do not treat client animals in practice so my knowledge is from the literature and both lay and veterinary forums and the little bit of reptile pathology (slides) I get. There are other active vets who visit here occasionally and know much more than I. You can PM them through the forum or if they have an email listed use that.

That said, chameleons are usually under anesthesia for a NLG flush using a small gauge catheter. Care must be taken because the eye is delicate. I would not do this procedure with an oral syringe and certainly would not try this on an awake animal.

Did you get the results from the culture? If it is infection treatment is usually longer term in reptiles, several weeks or longer. A cbc may help to determine if it is inflammatory and serum chemistries can look for other metabolic problems.

 

[Reddogzz]

I sent ferret a message, but I don't know of any of the other vets on these forms. Thank you all so much!

 

[Reddogzz]

UPDATE:

His eye is much larger, I called around, nobody is willing to knock out our chameleon for the flush. They said that the Jackson's chemeleon's duct is too small to probe.

The vet is willing to give him a local anesthetic for pain, but he will still be awake, the vet will try to irrigate his eye and squeeze the inflamed area.

 

[Reddogzz]

UPDATE:
Took him to the vet, they did the flush, it only made the swelling worse. I stopped the gentamicin drops yesterday (did not seem to be working after 14 days) and start him on amoxicillin (rather than Baytril) since the problem showed up while the Baytril was already in his system (thus if there is a bacteria it may be resistant to Baytril). I am seriously considering giving him a drop of Reptaid once or twice a day in addition to the antibiotic. Recommendations? (he is 50-55g)

Is there a way to use my gram scale to make sure that he is getting enough water? My biggest concern is that if I add the reptaid he could quickly become dehydrated. I need to know a for sure way to prevent that from happening.

He eats mealworms if I rub his gums gently with a Q-Tip and place the worm into his mouth when he starts tasting. We are using warm (< 100 degrees F compresses next to his eye), also does not seem to help. He is more active today surprisingly I think the vitamin A deficiency was the core problem prior to the infection.

(OLD PICTURE) BELOW: DAY 1 of Eye problem that appeared on the 14th day of treating mouth rot with Baytril

(NEW PICTURE) BELOW: from Sep 13th ~2 WEEKS after treating with Gentamicin eyedrops, fluid check (vet made an incision on the lid), and saline flush (vet used local anesthetic and a catheter)

I was told that since we send cultures over to the mainland and so much time passes, the results are not as reliable, but I wonder if that is really true. That theory seems to agree with what a vet was saying in this youtube video. In the video the vet states he didn't do a culture/sensitivity because it too much time would pass over the weekend. The comments by the owner also show that the treatment worked, that the infection did not include a blockage.

https://www.youtube.com/watch?v=qNgADFonFMc


I could really use some advice right now because my vet said its time for me to "start experimenting" since she does not see any more options. If you have any recommendations on the reptaid + amoxicillin please let me know, I was just reading how another member decided against using "baytril" and reptaid together but the cham didn't make it... Since my guy is still active I want to do the best thing for him

Blessing to you all!

 

[JoeVet]

These are such frustrating cases. These swollen eyes are as common on the veterinary boards as on these keeper boards. The prevailing theory is still vitamin A related and you have already given a dose. Maybe repeat in a week. A systemic antibiotic is probably a good thing. Fortaz (Ceftazidime), or oral Baytril are good first choices. Oral antibiotics are usually continued for a 2-3 weeks. I'm not sure you're going to get a good answer and its going to be a wait and watch and hope it heals before it breaks kind of thing.

 

[kinyonga]

Joevet..Correct me if I'm wrong...if it is Vitamin A related if there's a blockage or infection as a result of the deficiency it will have to be corrected still before things will be back on track...right??

I've seen too many of these eye issues go unresolved in the end sorry to say.

The increased swelling could be from the "fooling around" done with the eye area I believe.

 

[Reddogzz]

I just started him on amoxicillin yesterday so he has had two doses, should we switch to baytril?

My vet won't give us fortaz.

What about the use of Reptaid with something else?

 

[JoeVet]

In reptiles, an antibiotic like amoxicillin is best combined with an aminoglycoside such as gentamicin or amikacin.

 

[JaxyGirl]

I just started him on amoxicillin yesterday so he has had two doses, should we switch to baytril?

My vet won't give us fortaz.

What about the use of Reptaid with something else?

Hi I'm so sorry that you're going through this with your Cham it must be so frustrating! Your Cham is exhibiting classic signs of vitamin A deficiency. Nascplamcrimal duct obstruction is classic and so is stomatitis (mouth Rot)
And other symptoms including lethargy lack of appetite associated with the deficiency. I did a thread on it https://www.chameleonforums.com/viatimin-deficiencies-cameleons-143583/

Vitamin A deficiency is a huge problem in all reptiles and it pretty much accurs for the same reasons whether it's a chameleon, gecko, turtle and others. http://www.geckotime.com/vitamin-a-deficiency-in-leopard-geckos/
From the research I did I came away eith the same conclusion across the board and that is you can treat the symptoms with antibiotics but if the under cause isn't addressed then the lizard won get better.

One of the reasons that I started this research and the tread (wich I didn't mention at the time. It would have been horrible if my Cham got worse) was because I had recently purchased a femal 7 month nosy be Panther that had the beginnings of eye problems in one eye. I got her in August. From the moment I got her, her left eye seemed very sensitive and she would keep in closed a lot. I figured it got hurt during shipping. Two weeks later she wasn't opening it at all and there was a light crust on her eye. She showed no symptoms of MBD what so ever. No curvature of the limbs. But over time she did start to seem lethargic. Her grip not as strong as it should be and she had a tremor in her gate. Then I noticed that her gums was becoming swollen on the left side ( same side as her closed eye) the mucus in her mouth was becoming thick. And I noticed when she shot at feeders her tong wasn't as strong as it should be .There was no nasel discharge her coloring looked normal. Other wise she was drinking and eating. Her fecal looked normal.
So I started doing warm compresses on her eye and moisturizing eye drops and it didn't work. Looking at her she seemed normal with no signs of sickness besides her one eye.
So what was I supposed to do. Take a Cham to the vet that looked fine except for a sensitive eye?. So I decided to do research and what I came up with was vitamin a deficiency. This is what I did:
I went to the drug store and bought some 4,000iu Preformed Vitamin A liquid gels. I think they are Natures Choice.
My Cham loves wild grasshoppers. So every day for five days I injected a wild grasshopper with a drop from the vitamin A liquid gel and fed it to her. (It's important to do a little at a time so you don't over supplement) I also continued putting a warm compress on her eye daily to clean out any discharge and then I would follow it up with moisturizing eye drops. And because her eye was very raw and irritated on the outside I would gently massage a drop of pure vitamin E oil on the skin. I watched closely for any improvements in grip, opening of the eye, reduction of swelling of the eye, change of mucus in her mouth etc and as soon as I saw improvement I stopped the vitamin A supplements. During this time period I didn't give her any additional supplements and I gave her as much outside sun time as possible. It's important to keep them very well hydrated and feed as much gut loaded feeders as they will eat with no dusting. A week later her eye is open and clear, her strength is back the lethargy is gone. Her mouth is normal. She is alert and active. Her gate is smooth and her tongue is nice and strong. From this experience I decided that I am going to give both my chams a feeder injected with a drop of vitamin A once a month. Anyhow that's my story. I hope it might shed some light on your situation.

 

[ferretinmyshoes]

Good evening all. Eye issues are one of the most frustrating problems in chameleons, hands down. The theory of vitamin A deficiency is that when there is insufficient vit A you get squamous cell hyperplasia, in other words thickening of the cell lining of areas like ducts and tiny passages in the respiratory system or related to the eye. So when an already tiny passage gets thickened it can get obstructed easily. So vitamin A can help those cells return to normal, but no one really knows how long that takes and it may only be part of the problem because if any scarring or infection has occurred that can take much more effort to get back under control.

In the pictures of the necropsy I posted I had threaded the catheter all the way through the nasolacrimal duct - this is not how you flush the duct however. That was only for demonstration purposes and is not feasible for clinical application. Trying to do that would more likely than not cause more harm than good. But nasolacrimal duct flushing is actually not very complicated and I always do it on awake animals. It only takes a few minutes and it is very common to see the eye get larger at first after flushing. I always tell people that is possible before I do the flush because otherwise it's a little distressing to see it get larger! With some of these guys I repeat flushing 1-2x a week for several weeks to clear it out. I have also used ophthalmic ointment with a steroid to try to help reduce inflammation topically. Systemic NSAID like metacam is something worse considering as well. But infection must be treated, and as Joevet said, amoxicillin is really not effective alone in reptiles. Fortaz is on back order right now, much to the superb annoyance of myself and other reptile vets.

You can give reptaid if you want. The way I think of reptaid is "well it most likely won't hurt, but who knows if it will help". It's a supplement, not a medication, and no studies have been done on it to prove its efficacy for any problem.

I wish I had an easy fix for this kind of issue but that's simply not the case. I've been able to fix a good number of these, but there are others that just didn't respond to all the tricks.

 

[Reddogzz]

Thank you all for your advice. I will continue to make sure that he gets vit A and sunlight, with plenty of water.

 

[Reddogzz]

UPDATE:
WOAH! About 30 small flea looking bugs but much smaller (visible under a 10x lens) came out of the green fluid leaking from his eye. What is the treatment procedure for parasites?

So these bugs look so small even under a jeweler's lens. I can see them move and they look like arthropods? How do you treat something like this? They appear to be in his eye!

 

[JoeVet]

There are no insects that would live in the eye like that. There are insects that live in the lungs but they are pretty large and most people mistake them for worms. I'd be more interested in the fluid. It should be cultured and cytology would be fun. Can you post a picture of what you see? Is the fluid draining on its own?

 

[Reddogzz]

There are no insects that would live in the eye like that. There are insects that live in the lungs but they are pretty large and most people mistake them for worms. I'd be more interested in the fluid. It should be cultured and cytology would be fun. Can you post a picture of what you see? Is the fluid draining on its own?

So I looked under my geology microscope and can identify the bugs as mites the microscope camera was not working but it is 100% mites. They were swarming into the wound. I soaked him in a watered down Iodine solution which killed off most of the mites crawling on him (found them floating in the solution).

Since his eye is just getting bigger, it is causing the incision that the vet made a week ago to get larger and larger. I dabbed the incision with iodine and then sealed it with some triple ointment. We washed down his cage in the washing machine (I am not sure if that will kill the mite eggs)

Just when you think that his eye can't get any larger... It makes us so sad to see him like this. Ferret mentioned that their eyes get larger after a flush but it kept growing all yesterday and today, I wonder how long the mites have been irritating it, could that be why his eye kept getting larger instead of shrinking?

Fluid was draining ONLY from the incision (green fluid) and only about 1 drop every 3-4 hours.

Should I switch to baytril from amoxicillin?

 

[jajeanpierre]

So I looked under my geology microscope and can identify the bugs as mites the microscope camera was not working but it is 100% mites. They were swarming into the wound. I soaked him in a watered down Iodine solution which killed off most of the mites crawling on him (found them floating in the solution).

Since his eye is just getting bigger, it is causing the incision that the vet made a week ago to get larger and larger. I dabbed the incision with iodine and then sealed it with some triple ointment. We washed down his cage in the washing machine (I am not sure if that will kill the mite eggs)

Just when you think that his eye can't get any larger... It makes us so sad to see him like this. Ferret mentioned that their eyes get larger after a flush but it kept growing all yesterday and today, I wonder how long the mites have been irritating it, could that be why his eye kept getting larger instead of shrinking?

Fluid was draining ONLY from the incision (green fluid) and only about 1 drop every 3-4 hours.

Should I switch to baytril from amoxicillin?

You really need to take the bugs to your vet.

I wonder if the green fluid is whatever the vet used to flush the wound. I can't think of anything in a chameleon other than bile that would be green, even an infection.

Don't change the medications on your own based on lay opinions or vets offering opinions over the internet on an animal they have never seen. Really, you need to go back to your vet with everything. By all means share with your vet the advice others have offered, but don't change things based on internet opinions.

I also worry that what you are doing to the eye will permanently damage it. Iodine near an eye? I don't think that's a good idea, plus I think the iodine solution will be too strong for a chameleon. The only antibiotic ointments you should be using near the eye would be antibiotics specifically for eyes.