Case history

BB is a 17 year old Burmese female who presented with almost complete loss of vision.  Due to language difficulties taking a direct history was not possible but some collateral information was obtained from her carers.  They had been away for three weeks and during that time placed her in care. Upon their return they noticed that she was disoriented, distressed and her pupils were midriatic and unresponsive to light.

BB has a past history of mild kidney disease affecting her distal tubules causing her pass large volumes of dilute urine.  Her continence remains good.  She eats a low protein, low potassium diet prepared specially for her to preserve remaining kidney function.  Her carers believe that she may have an obstetric history including some births but are not certain of this.  Her hearing has been deteriorating over the last 6 months and she is now almost completely deaf.  Otherwise her history is unremarkable save for chronic coryza.

On examination BB was attractive, well-groomed and of lean body habitus.  Her carers report her appetite as good though she has been losing weight over the last 6 months.  She was anxious and difficult to settle.  She was afebrile, well hydrated, and mildly tachycardic.  Her intraocular pressure was estimated to be normal though not formally measured.  Her lenses were clear, but observation of the retinas was difficult due to her non-cooperative nature.  BB was referred to a ophthalmologist the following week.

On examination by the ophthalmologist, BB's retinas were detached with significant areas of haemorrage and scarring.  Her blood pressure was difficult to measure precisely, again due to her lack of cooperation, but was certainly above 200 systolic.  A diagnosis of hypertension, either primary or secondary to kidney failure, was given.

BB was prescribed amlodipine 1.25 mg/day and asked back for review in a month.  Some degree of vision recovery is expected if the retinas can re-attach, although the scarring is irreversible.  The ophthalmologist's view was that she was otherwise in excellent health for such an old cat and her prognosis was good.