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New Bolton Center Kennett Square, PA
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Ryan Hospital Philadelphia, PA

Ophthalmology Stories

Sight for Sore Eyes

By: Ashley Berke

Elsa always had runny eyes. The two-year-old cat had been rescued as a kitten by Penn Vet student Jennifer Bortree. Elsa was treated at the time for feline herpesvirus (FHV-1), one of the most common causes of upper respiratory infections in cats. Among other symptoms, FHV-1 infection often impacts the eyes.

Although Elsa was diagnosed with FHV-1 as a kitten and treated daily, her eyes never fully recovered. “She’s had runny and squinty eyes her whole life,” said Bortree.

Elsa as a kitten
But everything changed for Elsa one day when Bortree attended a lecture by Penn Vet ophthalmologist Dr. Stephen Gross.

“Dr. Gross was explaining different eye issues when he mentioned distichiasis, an abnormal growth of the lashes,” said Bortree. “He said it is often misdiagnosed as herpes and that, in order to see the extra row of eyelashes, one would have to roll back the animal’s eyelids.”

Bortree went home after class and did just that. Lo and behold, Elsa did indeed have an extra row of eyelashes rubbing against her eyes.

Solutions in Sight

Bortree scheduled an appointment for Elsa right away with the Ophthalmology experts at Penn Vet’s Ryan Hospital. After discovering that Dr. Elaine Holt, Clinical Associate Professor of Ophthalmology, would be overseeing the appointment, Bortree went to speak with her about her findings following Dr. Gross’ lecture. 

“My initial response was: ‘Really?’ While distichiasis is common in dogs, it is quite uncommon in cats,” said Holt. “I have only seen it [to this degree] in cats twice in my career.”

Elsa's eyes had always been runny.During Elsa’s appointment in early March, Holt confirmed the diagnosis of distichiasis. Distichia originate from the Meibomian glands, which are found within the eyelid. The extra row of lashes along the upper lids of Elsa’s eyes had irritated the ocular surface and would need to be removed.

Holt recommended cryotherapy.

At surgery, Elsa’s upper eyelids were everted with the aid of a special forceps to expose the underside of the lid. A cryo (freezing) probe was then applied directly over the Meibomian glands adjacent to the distichia, or extra lashes. The tissue was frozen for about a minute and allowed to thaw. A second freeze was then applied to the same area. The distichia were then easily pulled from the lid margin with a fine forceps. This procedure was repeated, where necessary, along the lid margin in both eyes. Approximately 50 distichia were removed from each of Elsa’s upper eyelids.

The distichia, or extra lashes, were removed from Elsa's eyelids.“The purpose of this procedure is to damage the hair follicle, preventing the lashes from growing back,” explained Holt. “There can, however, be as much as a thirty percent regrowth. Although some of the lashes that regrow may not be as long or as irritating as the lashes we removed.”

As a veterinary student, Bortree learned a lot from the experience. The classroom to clinic connection was particularly valuable, she said. “Learning something in class and then seeing it in person makes it less abstract and more applicable.”

But because Elsa was her cat, Bortree was too anxious to observe the surgery. “It would have been a really cool surgery to watch, but I can be a nervous Nellie and a bit of a hovering mom,” she said. That, too, was a learning experience. “Understanding what it’s like to be on the other side is helpful when considering the client perspective.”

Seeing Clearly

Elsa recovered well from surgery. “Her eyes were open and appeared comfortable quite quickly after surgery,” said Holt. “And I anticipated Elsa would only get better and better as the swelling associated with the cryotherapy subsided.”

Today, Elsa’s eyes are “clear and bright,” according to Bortree. “I can’t believe the change in her!” she said.

Elsa’s eyes are now clear and bright.“Elsa never opened her eyes much, and I thought that was just a result of the herpes. But now you can actually see her eyes and it’s amazing.”

With her newfound sight, Elsa is living life to the fullest. “Things are more interesting to her now. She’s more adventuresome. She really enjoys hunting flies. Overall, she’s much more excited about life,” said Bortree.