Red under gills, one eye bigger than other, looks like a bubble?

[mygoldfishmylife 51]

Test Results for the Following:

* Ammonia Level(Tank) 0

* Nitrite Level(Tank)0

* Nitrate level(Tank)20

* Ph Level, Tank (If possible, KH, GH and chloramines) ?

Other Required Info:

* Brand of test-kit used and whether strips or drops? API test kit, but they expired 2 years ago  

* Tank size (how many gals.) and how long has it been running? 55 gal, 6 years

* What is the name and "size of the filter"(s)? 1: marineland emperor 400  2: AquaClear 70

* How often do you change the water and how much? Once a week, ~60%

* How many days ago was the last water change and how much did you change? Two days, 60%

* How many fish in the tank and their size? 2, both are a litter bigger than a foot 

* What kind of water additives or conditioners? Prime 

* What do you feed your fish and how often? Flakes, once a day

* Any new fish added to the tank?no

* Any medications added to the tank? No

* List entire medication/treatment history for fish and tank.Please include salt, Prazi, PP, etc and the approximate time and duration of treatment. Nothing in the main tank as of the last 4 years or so, but I have quarantined this fish 2 years ago when he first started showing signs of a cloudy eye. I treated him with only 2 days of prazi and salt and maracyn, until someone on here told me to just let it be and its not bothering the fish and its not contagious unless it pops. It hasnt popped and I put him back in the main tank, but now I noticed his eye looks like it is enlarged and I see some red again around the gills and a bit on the frontal part of the head.  

* Any unusual findings on the fish such as "grains of salt," bloody streaks, frayed fins or fungus? Red gills and a little but on its head, one eye looks like a bubble and the other is and cloudy

* Any unusual behavior like staying at the bottom, not eating, etc.? Eats and swims well

[Arctic Mama 3,625]

Hi there!  Long time no see

It does look inflamed now, I agree.  I would begin treating in quarantine with a gram negative antibiotic like Kanamycin for two weeks and see if the redness subsides at all.  It looks infected but could possibly be a tumor or necrosis behind the eye, too.  Tough to say.  If it doesn’t respond to treatment we can move on to trying some other things.

Just impeccably clean, warm water in quarantine, a nice air stone, and a two week course of your gram negative antibiotic.  Let me know if you need more explicit instructions.  No salt or other additives for now

[mygoldfishmylife 51]

I have been away for a while thanks to healthy goldies  I will try that and update you on the progress in 2 weeks, thank you Arctic Mama! What could be causes of a tumor? I've had 2 other fish with tumors as well, seems like an unfortunate common theme in my tank....

[Arctic Mama 3,625]

Honestly I don’t know.  Water source, poor breeding or line genetics, age, who knows?  It really varies.  I’ve never had a fish with a tumor in two and a half decades of fish keeping, but have friends like you who have had several in the last few years. It seems mostly random.  
 

An infection still seems more likely with the redness and eye cloudiness though

[mygoldfishmylife 51]

I can't find Kanamycin anywhere unless I order it online. I have API Fungus Cure and Maracyn 2. Would I be able to use one of those instead? 

[Arctic Mama 3,625]

No; neither of those is really suitable.  Just order it online as quickly as you can.  In the meantime, if you have methylene blue you can run it in the hospital tank at 1/2 teaspoon per ten gallons to help stem any worsening infection or secondary topical infections.  It’s a good first line medication if you’re waiting for others.

[mygoldfishmylife 51]

I have been treating with kanamycin for 2 weeks, but it seems to havent been getting any better. I am also having trouble keeping the water clear with just an air stone. He is in a 10 gal Q tank. I've been doing water changes every 2 days and adding a new dose of Kanamycin. What do you think of those pictures?

[Arctic Mama 3,625]

I’m sorry it isn’t really looking better.  If you still want to try treating we can find a broader spectrum antibiotic combo, but I rest don’t think that’s going to help if there has been zero improvement in behavior or visual symptoms.  I think this is more a case where keeping the fish comfortable and euthanizing when it is obviously suffering makes the most sense.  I wish I had better news.

[koko 14,339]

The one thing that caught my eye is his gills. One photo shows his gills are swollen and I might be seeing white in there.
If so I think we have paricites

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[Arctic Mama 3,625]

30 minutes ago, koko said:

The one thing that caught my eye is his gills. One photo shows his gills are swollen and I might be seeing white in there.
If so I think we have paricites

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He looks both emaciated and somewhat inflamed through the head, I feel like his thin body and completely swollen head are causing that gill exposure. I would have thought parasites but it doesn’t sound like there has been any exposure to anything in years, unless I’m misunderstanding?  So flukes are about all that would grow slowly or low dormant that long and they wouldn’t explain the eyes.  You think maybe it’s two things?

A round of prazi or even Seachem Paraguard probably wouldn’t make things worse than they are, but I’d be really surprised if it helped.

[koko 14,339]

He looks both emaciated and somewhat inflamed through the head, I feel like his thin body and completely swollen head are causing that gill exposure. I would have thought parasites but it doesn’t sound like there has been any exposure to anything in years, unless I’m misunderstanding?  So flukes are about all that would grow slowly or low dormant that long and they wouldn’t explain the eyes.  You think maybe it’s two things?
A round of prazi or even Seachem Paraguard probably wouldn’t make things worse than they are, but I’d be really surprised if it helped.

I think I would do a Prazi and salt round. If it was me

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[Arctic Mama 3,625]

That is certainly an option.  OP, you want to try what @koko suggests and see if there is any improvement?