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Ask Dr. Michael Salkin Your Own Question
Dr. Michael Salkin
Dr. Michael Salkin, Veterinarian
Category: Cat
Satisfied Customers: 28474
Experience:  University of California at Davis graduate veterinarian with 45 years of experience.
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My cat is 15 years old approx - we adopted her from a shelter

Customer Question

My cat is 15 years old approx - we adopted her from a shelter - and we've noticed a few things that we've chalked up to old age, but we aren't sure.
Her inner eyelid has been prominent since early November. Sometimes one pupil is larger than the other.
She's less co-ordinated; she stumbles a lot when jumping up on things, and loses her footing frequently.
She's also using her litter tray a lot more frequently. The spools are usually solid these days, but for a while we were concerned that she had diarrhoea.
Any ideas?
Submitted: 1 year ago.
Category: Cat
Expert:  Dr. Michael Salkin replied 1 year ago.
I'm sorry to hear of this with Tilly. The elevation of her third eyelid(s) can be a sign of Horner's syndrome if accompained by signs such as miosis (abnormally small pupil) and ptosis (upper lid droop). Cats occasionally have bilateral elevation of the third eyelids without other ocular abnormalities (Haw's syndrome). Infectious etiologies have been proposed for this syndrome when it occurs in conjunction with diarrhea but the condition is thought to be self-limitng when no other abnormalities are found.Unequal pupils (anisocoria) can result from unilateral Horner's. Anisocoria has quite a few possible etiologies, however. The two most common causes are the leukemia (FeLV) virus and the spastic pupil syndrome - a condition unique to cats in which owners report anisocoria, which may sometimes be transient and independent of ambient light levels. Clinically, cats with this syndrome appear to be healthy, are visual, and have no ocular abnormalities beside unusual behavior of the pupils. Unfortunately, most affected cats test positive for FeLV at the initial presentation but not all which confounds the diagnosis.Anisocoria also results from primary iridal (iris) disease - any inflammatory process causing miosis (an abnormally small pupil); and primary neurologic disorders involving cranial nerve III (and Horner's syndrome). I'm concerned that her lack of coordination is likely to be caused by an encephalopathy (brain disorder) which would be consistent with a cranial nerve III disorder as mentioned above. Unfortunately, brain tumor (meningioma, usually) is all too common in our advanced geriatric cats.Frequent use of the litter tray needs to be clarified, please. If she's stranguric - frequent attempts to urinate little or no urine - a geriatric bacterial urinary tract infection (UTI) is likely. If she's forming more urine instead, not only a UTI but also disorders causing polydipsia (increased thirst) and polyuria (increased volume of urine) need to be considered; renal insufficiency is most likely at her age. A diarrheic cat may well visit her box more often, of course. The initial database should involve testing for FeLV and a complete ophthalmic examination including menace response, dazzle, palpebral, pupillary light, and vestibulo-ocular reflexes. Fluoroscein staining of the cornea should be performed looking for corneal trauma and intraocular pressure should be measured (the elevated pressure of glaucoma will enlarge the pupil (mydriasis) and the lowered pressures of uveitis will make the pupil miotic). A senior/geriatric diagnostic panel of blood and urine tests plus blood pressure assessment should be considered as well. Please respond with further questions or concerns if you wish.Much of the above is beyond the capability of many generalist vets and so Tilly's vet may recommend referral to a board certified veterinary ophthalmologist. Please see here: www.acvo.org .
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Expert:  Dr. Michael Salkin replied 1 year ago.
Thank you for your kind accept. I appreciate it.
I can't set a follow up in this venue and so would appreciate your returning to our conversation with an update at your convenience.