Ocular conditions

Question 1

Define entropian

Answer 1

Eyelids roll inwards causing the eyelashes to irritate the eye

Question 2

What are the clinical signs of entropian?

Answer 2

Excess tear production

Epiphora (overflow of tears down the face)

Conjunctivitis

Corneal ulceration

Question 3

Why should an entropian animals eyes be assessed prior to pre-med?

Answer 3

ACP will make the eyelids droop

Question 4

Describe surgery for entropian

Answer 4

Slivers of skin are removed to turn the eyelid out

More than one surgery may be required

Question 5

Define ectropian

Answer 5

The eyelid is oversized and bags/ droops open exposing the conjunctiva

Question 6

What are the clinical signs of ectropian?

Answer 6

Appearance

Conjunctivitis

Chronic keratitis (inflammation of the cornea)

Question 7

Describe surgery for ectropian

Answer 7

As before the eye should be assessed prior to any pre-med being given

Slivers of skin are removed to ‘take up the slack’ of the eyelid

Question 8

Describe post-op care for entropian and ectropian

Answer 8

Buster collar must be applied immediately on recovery

Use of cold compresses if indicated to reduce swelling

Question 9

Describe distichiasis

Answer 9

A whole row of extra eyelashes inside the normal lashes

Question 10

Describe ectopic cillia

Answer 10

One or two abnormally positioned eyelashes

Question 11

What are the clinical signs of distichiasis and ectopic cillia?

Answer 11

Epiphora

Conjunctivitis

Blepharospasm (spasm of the eyelids, blinking lots)

Corneal ulcer

Chronic keratitis (corneal inflammation)

Question 12

Describe surgery options for Distichiasis and Ectopic Cillia

Answer 12

Can simply pluck extra lashes away under sedation, but they will grow back

Electrolysis gives longer lasting results but again will grow back

Delicate surgery performed at referral centres to remove the eyelash roots

Cryotherapy can be used

Question 13

Describe eyelid tumours

Answer 13

Marginal tumours are common in older dogs

Cause irritation by rubbing in the surface of the cornea

Removed by excising a wedge of the eyelid margin

Patient interference should be prevented immediately on recovery

Question 14

Describe cataracts

Answer 14

Increase in the opacity of the fibres or capsule of the eye lens.

Primary or secondary condition

Can be left untreated or removed at referral centres

Question 15

Describe cataracts surgery

Answer 15

Phacoemulsification technique is used

Needle vibrated by ultrasound and this breaks up the cataract

Particles are then aspirated

Alternatively the lens is removed

Question 16

Describe ‘blue eye’

Answer 16

Older animals will have a ‘blue’ colour to the lens of their eyes

Occurs as a result of the aging process

Not a cataract the animal can still see

Senile nuclear sclerosis, a natural aging process

Question 17

Describe first aid for a prolapsed eyeball

Answer 17

Prevent the eye from dehydrating

Use of saline, ophthalmic ointment or water soluble jelly to prevent this

Prevent the animal traumatising the eye

Question 18

Describe surgery for a prolapsed eyeball

Answer 18

Lateral canthotomy is an incision at the lateral canthus to extend the eyelids

Eyelids sutured together for approx 2wks to prevent reoccurrence

Question 19

Describe post-op management for a prolapsed eyeball

Answer 19

Buster collar to prevent self trauma post operatively

Question 20

Describe corneal damage

Answer 20

Most common corneal damage is ulceration

Blepharospasm

Epiphora

Pain

Animal may rub at the eye

Question 21

Describe treatment for corneal damage (ulcer)

Answer 21

Medical treatment in the form of regular eye drops and NSAID can normally heal an ulcer

Ulcer gently debrided using a cotton bud to remove any loose tissue

Question 22

Describe a third eyelid flap

Answer 22

3rd eyelid pulled closed over the eye and sutured in place

Acts as a bandage and prevents the eyelid irritating the ulcer

Eye drops are still applied

Question 23

Describe a conjunctival flap

Answer 23

A pedicle of conjunctivia is sutured to the cornea, covering the ulcer

Again acts as a bandage, but this method also supplies nutrition the ulcer to encourage healing

Question 24

Describe a punctate ketatotomy

Answer 24

Sedation and local anaesthetic eye drops are required

Gently debride the ulcer

Ulcer being debrided with cotton buds

Sterile hypodermic needle is used to scratch grid lines on the surface of the damaged area

Stimulates healing in tissues that have become dormant

Question 25

Describe enucleation

Answer 25

Enucleation is indicated if the eye is too damaged to save as a result of –

Gross trauma

Neoplasia – of the eye or behind the eye

Untreatable glaucoma

Irreducible prolapse

Cosmetic appearance is of a concern to many clients prior to this surgery

More time and reassurance may be needed prior to surgery to ‘council’ these clients

The animal will tolerate enucleation well and in some cases improves their quality of life

Question 26

Describe surgery for enucleation

Answer 26

Many techniques are available

Commonly a Trans Palpebral Enucleation is performed

Eyelids are first sutured together using a continuous suture

Eye is then removed by dissection of the conjunctiva

Optic nerve and blood vessels are clamped and carefully ligated

An ‘emovet’ pad sometimes required - encourages haemorrhage to clot

Oculocardiac reflex can occur. A stimulus to the eye pressure, manipulation or traction gets transmitted to the vagal nerve and onto the heart.

Causes profound bradycardia, arrhythmias or asystole

Critical to monitor the heart very closely/continuously throughout the procedure

If any signs are noticed to a change in the heart the surgeon must be notified immediately so they can re consider their surgical technique

Question 27

Describe post-op care for enucleation

Answer 27

Buster collar

Observation for haemorrhage

Question 28

Describe cherry eye

Answer 28

Describes the protrusion of the tear gland associated with the 3rd eyelid

Occurs due to a weakness of the glands normal attachment

Question 29

Describe surgery for cherry eye

Answer 29

Surgery involves replacing the gland into its normal position and suturing in place.

Better success with surgery if it is carried out as soon as possible