TCVM treatment of uncontrolled glaucoma in a cat

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TCVM treatment of uncontrolled glaucoma in a cat

Glaucoma is uncommon in cats and often difficult to treat. Unlike dogs, cats do not tolerate anti-glaucoma medical treatments well, especially when they are administered systemically. Eye-preserving surgical treatment has received little interest among veterinary ophthalmologists, probably because most feline glaucomas are associated with inflammations such as uveitis.1

Initial presentation

A four-year-old spayed female cat was presented in October of 2013 for TCVM evaluation of bilateral severe unresponsive glaucoma of four months’ duration. The cat had developed glaucoma secondary to uveitis, the right lens was luxated into the anterior chamber, and that eye was avisual. The left eye was still visual. The cat was in extreme pain. The owner reported that she hid under the bed, refused to eat, often refused to open her eyes, and was constantly rubbing her eyes with her paws.

Conventional treatments unsuccessful

The owner had sought treatment with her regular conventional veterinarian who confirmed the elevated pressure with a pen tonometer. This doctor treated the cat with Timolol eye drops which were poorly tolerated. After no success, the cat was referred to a board-certified ophthalmologist for evaluation and treatment.

The ophthalmologist attempted to treat the glaucoma, but the cat did not respond significantly and the owner had great difficulty administering medications to her. After two visits, the ophthalmologist recommended bilateral enucleation as the best option to control the pain and unresponsive elevated intraocular pressure. At this time, the pressure in the left eye was 40 mm, and the right eye was 59 mm. The owner declined bilateral enucleation, discontinued conventional medications, and sought treatment through alternative medicine in the form of TCVM.

Taking a TCVM approach

The cat was presented two weeks later for TCVM evaluation. Her tongue was red, her pulses were strong and fast, and both eyes had injected sclera – the typical red, angry-appearing glaucomatous eyes. The cat was squinting and periodically attempted to rub her eyes. She was obviously stressed and reluctant to have her eyes examined or her face touched. She was relatively cool-seeking for a cat, according to owner input.

The cat was diagnosed with a TCVM Excess pattern of Liver Fire Blazing Upwards. This was supported because the Liver opens in the eyes; and she had red painful eyes, a red tongue, strong and fast pulses, weak vision, and difficulty opening her eyes.2 The principles of treatment were to clear Liver Heat, nourish Liver Yin, and soothe and brighten the eyes.

1. Acupuncture

The treatment plan was formed with some trepidation as the cat had a history of being uncooperative. Nonetheless, local eye acupoints were chosen opportunistically from the following list using Korean hand needles:

  1. a. BL-1 and 2
    b. GB-1 and 14
    c. TH-23, ST-2
    d. Tai-yang (located 1 cun caudal to the lateral canthus and dorsal to the zygomatic arch)
    e. GV-20 and Bai-hui (located on the dorsal midline at L7S1) were needled with ½” 34-gauge needles in order to relax the cat, calm Shen, and have permission granted to continue needling.
    f. BL-18 (Liver association point) and BL-23 (Yin tonification point) were needled or aquapunctured with vitamin B-12.
    g. L IV-2 and 3 would have been very useful to clear Liver Heat; however, they were only rarely allowed by the cat.

Despite her history, the needles were surprisingly well tolerated.

2. Herbals

The Chinese herbal formula Ming Mu Di Huang (manufactured by Jing Tang Herbal) was chosen at a dose of 0.5 g once daily because of its ability to nourish Liver Yin, clear Heat, and brighten the eyes. This herbal formula is also indicated specifically for glaucoma. Despite her aversion to oral medications, the cat readily ate the powdered contents of the capsule in canned food.

English Name Chinese Pin-Yin Action
Rehmannia Shu Di Huang Nourishes Yin , Blood and Jing
Rehmannia Sheng Di Huang Nourishes Yin, cools Blood, clears Heat
Cornus Shan Zhu Yu Nourishes Yin
Lycium Gou Qi Zi Nourishes Liver Yin , benefits the eyes
Schisandra Wu We Zi Consolidates and nourishes Lung Yin
Angelica Dang Gui Nourishes Blood
Dioscorea Shan Yao Tonifies Qi, nourishes Kidney Jing
Moutan Mu Dan Pi Cools Liver
Poria Fu Ling Drains Damp, strengthens Spleen
Alisma Ze Xie Drains Damp, clears Kidney False Fire
Bupleurum Chai Hu Soothes Liver, clears Wind-Heat
Tribulus Bai Ji Li Clears Heat, brightens eyes

Treatment results

  • After just one week of acupuncture and herbals, the cat’s intraocular pressure dropped from 40 mm to 36 mm in the left eye, and from 59 mm to 47 mm in the right eye. Although she was still painful, it was at a reduced level. She was clearly more relaxed at her one-week follow-up acupuncture session.
  • At two weeks, the pressures had dropped to 30 mm in the left eye and 40 mm in the right eye. By this time, the cat was no longer painful and the Heat signs had improved significantly. Her pulses had nearly normalized and her eyes were much less red. Needling was even more acceptable to the cat at this time, presumably because the pain had decreased. The owner reported that she had discontinued hiding under the bed, was once again eating well, and was playing with her owners and toys. She no longer squinted or rubbed her eyes or feared having her face touched.
  • The cat continued to tolerate the TCVM treatment and steadily improved with continuous use of Ming Mu Di Huang and acupuncture every one or two months. By the third treatment, her eyes were no longer red, the tongue was a normal pink color, the pulses had completely normalized, and she was no longer cool-seeking.
  • At seven months, her pressures were near normal – 19 mm in the left eye and 26 mm in the right eye.
  • At her one-year follow-up TCVM evaluation in October of 2014, the cat still had a pink tongue, normal pulses, and resolved scleral injection. At this point, acupuncture was discontinued and the cat was maintained on Ming Mu Di Huang alone.
  • In September of 2015, the cat was doing extremely well with no signs of glaucoma or pain, and stable intraocular pressures. Weaning off the Ming Mu Di Huang was recommended, but the owner feared the possibility of the glaucoma returning. Because the formula was well tolerated and without side effects, it was continued at the same dose of 0.5 g daily.

This case demonstrates how well medical problems that are unresponsive to conventional treatment can respond to TCVM treatment alone. It was imperative for success that the cat tolerate acupuncture and willingly take her herbs. And as is the case with cats, it is best to ask for their cooperation and perform acupuncture only with their permission. Forcing or struggling with this glaucomatous cat would have only yielded more poor results. It is also noteworthy that few if any cases of TCVM treatment of glaucoma in cats have been published.

Almost three years after the initial conventional diagnosis of glaucoma, the cat presented with acute pain in the previously visual left eye. Examination revealed that the lens had luxated into the anterior chamber secondary to increased intraocular pressure, and the eye once again had the red angry appearance typical of glaucoma. The cat was distressed and fractious due to pain. The owner declined referral to a veterinary school for full evaluation and treatment because this course had been unproductive in the past. Instead, the cat was masked down with isoflurane, and her own blood without anticoagulant was drawn into an insulin syringe. Using aquapuncture, 0.1 mls of the blood were immediately injected into each acupoint, ST-1 and LIV-2, both indicated for Liver Heat. This technique is a common practice in TCVM and is effective for inflammatory disorders.3 Within 48 hours, the pain and redness in the eye resolved. The owner was advised to continue the herbal formula Ming Mu Di Huang and to periodically have the cat rechecked. Presumably, the eye pressure will increase again at some point, and the single technique of aquapuncture with the cat’s own blood will effectively control acute exacerbations.

TCVM treatment results  

Starting Pressure L 40, R 59 Very painful
At one week L 36, R 47 Little pain
At two weeks L 30, R 40 No pain
At seven months L 19, R 26 No pain
At 21 months L 17, R 29 No pain

References

1Gelatt, Kirk. Essentials of Veterinary Ophthalmology. Lippincott Williams and Wilkins 2000: 326-328.

2Xie H, Preast V. Traditional Chinese Veterinary Medicine Fundamental Principles, 2nd Edition. Chi Institute Press 2013: 320-321.

3Xie H Preast V. Xie’s Veterinary Acupuncture. Blackwell Publishing 2007: 333.