Eye irritation in cats treated with cidofovir for herpesvirus

Abstract

OBJECTIVE: To determine the frequency and clinical characteristics of local ocular adverse reactions to topical ophthalmic cidofovir administration in cats with presumptive feline herpesvirus-1 (FHV-1) keratoconjunctivitis. ANIMAL STUDIED: In total, 140 cats treated with cidofovir. PROCEDURES: A retrospective search of electronic medical records was performed for cats treated with topical ophthalmic cidofovir and examined by the Cornell University Ophthalmology Service between 2021 and 2023. Signalment, clinical findings, and diagnostic assay results were recorded for cats that developed local ocular adverse reactions attributed to cidofovir administration. RESULTS: During the 3-year study period, 140 cats were treated with topical ophthalmic 0.5% cidofovir solution, and 6 cats (4.3%) were suspected to have developed a local ocular toxic reaction to the medication. A distinct ocular toxicity clinical syndrome was observed that included persistent blepharospasm, ocular discharge, conjunctival hyperemia, chemosis, and rapidly progressive conjunctival melanosis. Repeat diagnostic evaluations for FHV-1 were negative in the cats, and conjunctival cytology revealed mixed eosinophilic and neutrophilic inflammation with epithelial cells heavily laden with pigment granules. Cats developing ocular toxicity were treated with cidofovir for a median of 32 (range: 23-62) days. Clinical ocular lesions resolved within approximately 3 weeks after discontinuing cidofovir in all cats. CONCLUSIONS AND CLINICAL RELEVANCE: Although uncommon, local ocular toxicity associated with cidofovir administration can develop in cats and may clinically mimic persistent FHV-1 infection. Progressive conjunctival melanosis is a suspected clinical marker of local ocular cidofovir toxicity in cats. When possible, restricting the duration of cidofovir administration to ≤ 3 weeks may be advisable.