Nasolacrimal duct obstruction

[Reddogzz]

We don't have herp vets on this island and we have a law against taking chameleons off the island. My male Jackson was suffering from mouthrot. After 14 days of baytril + removing chunks of bacteria that appeared in the corners of his mouth, his mouthrot went away (visibly) but on the 13th day of treatment one of his eyes began to fill with fluid. Gentamicin drops were prescribed by a general vet. Knowing mouthrot was in that area, I had the fluid checked after three days, the fluid in his eye was green like I predicted. The vets here only have a catheter like the one ferretinmyshoes used on the cadaver, where she mentioned it was difficult to fit through the nasal passage in the mouth. We really need an experienced herp vet on the big island of hawaii, since we are not allowed to transport our chams.

if there is an infection in the Jackson's tearduct and the vets don't have the right tools, what are my options, can the tools be special ordered, would a human hospital have something the right size? What would I ask for?

I read something about surgery to remove a nasolacrimal duct blockage, how is that surgery done?

thank you all, your advice saved his female mate last year!

 

[JoeVet]

Its not possible to cannulate the nasolacrimal duct without surgically separating the eyelids. What the vets can do is to insert a 24 gauge catheter next to the eye and pinch the eyelids closed. Then gently flush with saline. The vet should see saline coming out the nose. The catheters are common in most practices.

Edit: If the mouth rot was confined to the corners of the mouth he may have infection/dysplasia of the temporal glands. Both this condition and the eye condition are thought to be related to vitamin A deficiency.

 

[Reddogzz]

we have been gut loading his crickets with carrots, kale, and sweet potato because I read that Jackson's are susceptible to vitamin overdose

so reptavite? how much for a Jackson's and how long to see a difference?

tyvm for the response!!!

 

[Reddogzz]

Its not possible to cannulate the nasolacrimal duct without surgically separating the eyelids.

The vet already made an incision on the eye to drain the fluid, she said something about it needing to stay open which is why she didn't want to use silver sulfate


Since there is an incision, do we have the cath put in through the incision while he is unconcious?

 

[JaxyGirl]

we have been gut loading his crickets with carrots, kale, and sweet potato because I read that Jackson's are susceptible to vitamin overdose

so reptavite? how much for a Jackson's and how long to see a difference?

tyvm for the response!!!

You should read the thread. It's pretty informative about vitamin A deficiencies and why gut loading might not be enough https://www.chameleonforums.com/viatimin-deficiencies-cameleons-143583/

 

[Reddogzz]

You should read the thread. It's pretty informative about vitamin A deficiencies and why gut loading might not be enough https://www.chameleonforums.com/viatimin-deficiencies-cameleons-143583/

Good thread! It is sad that a published article can have so much influence, people used to say there was no water on the moon and mars... but they were wrong. I will try giving him some meat.

I still am curious about clearing up the sinus/tearduct infection. Like if we have it flushed, will that get rid of the infection permanently?

 

[JoeVet]

I think the people who wrote about vitamin A overdose got confused with their medical terminology and mistakenly mistook hypovitaminosis as too much instead of too little. Hypervitaminosis A has not been reported in chameleons that I am aware of. Jacksons in Hawaii eat snails and small lizards which probably supplements the vitamin A they get from insects. Interestingly, the lizards found in wild jacksons in Hawaii were skinks, ground animals (also an invasive species). How much vitamin A they need is of great debate as you can see by the recent posts on here. Treatment of symptoms is a one time dose of 2000 units Vit A/100 gm body weight.

 

[JoeVet]

If there is an infection it is secondary to the epithelial dysplasia of the ducts and glands. Vitamin A is needed for epithelial cells to maintain their specialized surface structures such as villi. Without it they become similar to skin cells and produce keratin. Those impacted temporal glands and ducts that are full of paste material are likely full of keratin instead of infection.

 

[Reddogzz]

2000 units Vit A/100 gm body weight.

He averages 55g, does the Vit A have to be injectable solution or can it be oral such as a 2000 IU tab broken in half.

Also liverwurst/braunschweiger is 50% of our daily vitamin A and seems to have the highest % concentration compared to other meats would that be safe, it would be easy to spread on his lips so I know I could get him to eat it unlike the meat he just spit back at me seven times ><

 

[JaxyGirl]

He averages 55g, does the Vit A have to be injectable solution or can it be oral such as a 2000 IU tab broken in half.

Also liverwurst/braunschweiger is 50% of our daily vitamin A and seems to have the highest % concentration compared to other meats would that be safe, it would be easy to spread on his lips so I know I could get him to eat it unlike the meat he just spit back at me seven times ><

You can buy Vitamin A liquid gel caps from a pharmacy in the vitamin department. Squeeze out the gell,and put a drop on his feeder and give it to him that way. He won't even know it's there.
I wouldn't give him liverwursts. Try small pieces of raw shrimp, raw chicken or raw fish.

 

[Reddogzz]

OK I will try this right away!

 

[JaxyGirl]

Remember just a little vitamin A at a time. Make sure it's vitamin A (Retinol)
Try a (small) drop on his feeder once a day for 4-5 days. Carefully monitor him for improvements.

 

[JoeVet]

Dr Donoghue in Mader's book recommends 2000 IU / 30 gm BW, two doses 7 days apart. It is possible to overdose. Clinical signs would be lethargy, anorexia and in more severe cases sloughing of the skin. Its better to under dose than overdose.

 

[Reddogzz]

Dr Donoghue in Mader's book recommends 2000 IU / 30 gm BW, two doses 7 days apart. It is possible to overdose. Clinical signs would be lethargy, anorexia and in more severe cases sloughing of the skin. Its better to under dose than overdose.

6 days ago is when his eye started to puff up.

Yesterday morning the vet just made an incision on his eyelid to drain the fluid (greenish clear), but he was acting lethargic before that. I put 1/8th of an 8000IU Vitamin A (as Retinyl Palmitate) gel cap onto a superworm (as a treat) because he is about 55g. Yesterday night the incision reopened and clear/white+red blood came out, he was showing signs of pain by opening his mouth and hissing/breathing out air.

Today he is still lethargic (even more so) the eyelid is filled up again with fluid.

The vet wants to know if I want to have a nasolacrimal flush done using a cath tomorrow, honestly with the way our male is acting I don't know if he can handle the stress, the vet was also not sure if she has the right formula to knock him out and that there is not a 100% chance of clearing the passage because she does not have the right tools.

Please correct me if I am confused here:
Chameleon's eye is swollen -> try Rx drops -> drops don't work -> check the fluid -> green fluid -> vet does nasolacrimal flush with catheter to clear obstruction -> eye still swollen -> surgery is done to remove obstruction not cleared by flush.

1) Do I have the procedure flow chart correct?

2) Since I just gave him a one-time dose of 2000UI/100g weight yesterday does need anymore Vitamin A today or tomorrow?

3) Since the eyelid was cut, is there a different way to do the flush since, the vet probably can't pinch the eyelids around an oral syringe to flush saline through the tear duct?

Thank you all so much I will keep you posted on the progress

 

[kinyonga]

I know that the chameleon was put on baytril but was a culture and sensitivity test done to determine the best medication to treat the infection?

Was a culture and sensitivity test done to determine the best medication for the eye fluid?

What bacteria was involved in each case?

How do you know the gland is blocked?

Did you see this...
https://www.chameleonforums.com/question-about-nasal-passages-nasolacrimal-duct-101170/

 

[Reddogzz]

I know that the chameleon wqs put on baytril but was a culture and sensitivity test done to determine the best medication to treat the infection?

Was a culture and sensitivity test done to determine the best medication for the eye fluid?

What bacteria was involved in each case?

How do you know the gland is blocked?

Did you see this...
https://www.chameleonforums.com/question-about-nasal-passages-nasolacrimal-duct-101170/

Here we have to wait two weeks for a culture/sensitivity to arrive from the mainland, so I don't think it is wise to wait that long. He is off the baytril, but the bayrtil must have worked because his mouth rot healed. Unfortunately this other problem developed. His nostril is swollen and his eye puffed up. The vet perscribed amoxicillin but he already has been on two rounds (2x 14 days) of baytril (in the two months) so she said his liver might not make it, I don't want to take that risk. The vet didn't have a way to tell if it was blocked by bacteria/abscess or by inflammation except that the fluid was green in color.

I am still curious as to the procedure, is the next step surgery or tear duct flush and can the flush be done now that he has an incision?
Does he still need extra vit A today (since I just gave him 1000UI yesterday)?

 

[JoeVet]

I wouldn't give him anymore vitamin A. You should start to see improvement in a few days if that is part of his problem. It looks like the incision is where the skin turned black? I doubt that the duct can be accessed through that. A flush can be attempted if he is healthy enough for the anesthesia by closing the eyelids around the catheter. I'd rely on your vet to make that decision. Systemic antibiotics are a good idea with the best choice based on culture and sensitivity. Blood work to look for inflammation or other systemic disease may be helpful.

 

[Eric Adrignola]

You may see some lethargy, as baytril is very rough on them, primarily the kidneys. Keep him extra hydrated.

 

[kinyonga]

Keep him well hydrated to lessen the damage to the kidneys. What color was the pus from the mouthrot? Did the green exudate from the eye have a smell like ripe grapes?

 

[Reddogzz]

It looks like the incision is where the skin turned black? I doubt that the duct can be accessed through that. A flush can be attempted if he is healthy enough for the anesthesia by closing the eyelids around the catheter.

Still bloody, not black but dark red, vet said to keep the wound open in case the vet needs to access it?!?