A vitamin A supplement should be added to the patient’s diet. All vitamin A doses are empiric and range from 5000-66 666 IU vitamin A palmitate per kg IM, SC, or PO every 1 to 2 weeks for 2 treatments.1,3 Injectable vitamin A has been associated with hypervitaminosis A; oral supplementation is preferred. Fat-soluble vitamin A is much less toxic than water-soluble vitamin A.
Broad-spectrum ophthalmic antibiotic ointments or antibiotic drops should be administered to lubricate and prevent secondary bacterial infection of the cornea, if compromised. In leopard geckos, solid cellular debris should be moisturized under the eyelids with saline and removed with blunt probes, hemostats, or fine forceps. The patient should be checked for ulcers using fluorescein staining, and eyes should be flushed copiously with saline. Similarly, eyes of chameleons should be flushed with sterile saline to remove thickened mucus and accumulated cellular debris secondary to xerophthalmia. Retained sheds around the eyes and feet and retained hemipenal casts should be removed with the patient under anesthesia.
If the patient has not eaten recently, nutritional support should be provided via fluid therapy and oral caloric supplementation. If the patient is eating, the quality of its diet should be improved. Owners should be instructed to gut load feeder insects with a diet containing vitamin A, at least 8% calcium, multivitamins, trace minerals, proteins, carbohydrates, and fat; to dust all insects with calcium before each patient feeding; and to feed multivitamins containing vitamin A—rather than calcium—twice a month.
Wild insectivorous reptiles eat hundreds of invertebrates (eg, insects, arachnids, mollusks, crustaceans), other lizards, mammals, and birds, so pet lizards should be fed as wide a variety of insects as possible; diet should not be restricted to crickets, mealworms, super or king mealworms, waxworms, and/or Dubia roaches. Reptile specialty stores and online vendors sell a wide variety of insects, including other cricket species (eg, black, field, banded), silkworms, black soldier fly larvae (sold as Phoenix worms), tobacco or tomato horn worms (sphinx or hawk moth larvae [sold as goliath worms or green giants]), butterworms, bean beetles, fruit flies, springtails, and wood lice, as well as wild-caught seasonally available insects (eg, moths, cicadas, flies, grasshoppers, katydids, bees [with stingers removed], cockroaches, crustaceans [eg, pill bugs, roly-poly bugs], mollusks [eg, snails, slugs]). Fireflies contain highly toxic lucibufagins and should never be fed to pet lizards.4 Some insectivorous reptiles will also eat neonatal mice, which are rich in vitamin A.
Patients should be re-evaluated every 1 to 2 weeks until they are eating readily and appear healthy. Body weight should be monitored to determine if nutritional supplementation is indicated, and dietary recommendations should be reviewed with the owners at each appointment to ensure they understand and have implemented the changes.