Cladosporium Infection

My cat (1 year old) has been getting lesions on his lips ever since I can remember. They seem to heal eventually but then come straight back. About a month ago we got a biopsy done and it came back as "Cladosporium" - a very uncommonly seen fungal infection in cats. The vet was initially was going to refer us to a specialist vet for treatment however decided that we should trial a 3 month course of fluconazole 50mg twice daily first. He has been taking the fluconazole for 3 weeks now with some slight improvement. However what I have noticed in the past 2 weeks is that his eyes have become quite watery and he is constantly squinting all the time. He doesn't try to itch his eyes (or the lesions on his mouth) and is acting normal behavioural-wise. Is this likely to be related to his infection? Would you suggest continuing with fluconazole for another 2 months or going straight to the specialist? From what I've read first line treatment is extensive surgical removal of the lesions and if that can't be done itraconazole is the treatment of choice. I've attached a photo of what his mouth is looking like at the moment. Thank you for your advice.  

Hello!  As with any pet on a medication, it makes sense to check the potential side effects.  Fluconazole does have side effects listed, but mostly they seem to relate to gastro-intestinal signs such as vomiting, skin lesions or even jaundice:  excessive watering of the eyes is not mentioned that I have seen.  This doesn't necessarily rule it out as a side-effect of the drug, but would seem unusual.  However, your concern was whether it could be part of the infection.  As a relatively unusual infection in the first place I do not know for sure;  however, your vet is likely to have done some reading about this unusual presentation and may know more than I do;  alternatively, they may be able to speak to the pathologist who diagnosed the condition.  In my experience, pathologists are very interested to receive follow-up information from the vets treating their most interesting cases and may be aware of some case studies.  More to follow.

That aside, I have to ask myself what I would do if any other cat owner called to say that their cats' eyes were watering excessively;  I would immediately advise checking the patient, because this can be a sign of eye ulcers, chemical exposure, upper respiratory tract infections, foreign bodies, lumps or bumps internally or other corneal damage.  Generally, unexpected ocular signs can be regarded as emergencies - and even though your cat has an unusual illness, they are also just as prone to other eye problems as any other cat and these ought to be considered too.   Best of luck and please do let us know how your boy gets on.