Surgical diseases of the eye

Question 1

what should you ensure you do with the patient prior to surgery in order to protect the corneal surface from debris and hair?

Answer 1

apply a petroleum ointment

Question 2

what type of surgical prep solution should be used prior to eye surgeries?

Answer 2

diluted iodine 1:10-1:50 solution wiped around the edges of the eye and within the conjunctival fornices. Then, rinse with eyewash solution

NEVER use alcohol-based solutions like chlorhex and never rinse with water.

Question 3

________ is inversion of eyelid margins such that the outer, haired skin contacts the cornea or conjunctival surface.

Answer 3

entropion

Question 4

what are the secondary/acquired entropion types?

Answer 4

spastic – transient entropion due to painful eye or severe blepharospasm

Question 5

what are the clinical signs of entropion?

Answer 5

pain (squint, tearing, swelling, redness)
keratitis (pigment deposition +/- ulceration)

Question 6

how does entropion differ between large and brachycephalic breeds?

Answer 6

in large breeds, the lateral canthus is usually affected.
in brachycephalics, the nasal/medial canthus is affected.

Question 7

when is temporary tacking with minimal sedation and local anesthesia a recommended temporary solution for entropion?

Answer 7

in young animals that have not reached full maturity
in animals with spastic entropion

Question 8

what suture size and type is used for temporary tacking of entropion?
What pattern is used?

Answer 8

3-0 to 5-0 NON-absorbable suture
in a simple interrupted of horizontal mattress pattern.

Question 9

What is the permanent treatment for entropion?

Answer 9

hotz-celsus

Question 10

what are the 3 techniques for estimating the entropion correction needed to be made with hotz-celsus procedure?

Answer 10

1. rule of thumb technique using digital pressure
2. grasping with forceps
3. blood technique after initial incision made

Question 11

describe how to perform hotz-celsus to correct entropion.

Answer 11

an incision is made 1-2 mm from and parallel to eyelid margin
then the ends of the initial incision are joined with a ventral elliptical incision
the area of incised skin is excised with tenotomy scissors.

Question 12

what suture size and type is used to close hotz-celsus entropion correction? What pattern is used?

Answer 12

4-0 to 6-0 NON-absorbable suture in a simple interrupted pattern using a bisecting approached (Start at peripherals first, then divide in half twice).

Question 13

what is a common complication of entropion correction surgery?

Answer 13

overcorrection which can create ectropion which is MORE challenging to correct.

Question 14

If the entropion surgery involves lateral canthus, what should be included in the surgical procedure in addition to using the Hot-Celsus aproach?

Answer 14

lateral lid wedge resection

Question 15

in what circumstances would you perform a tarsorrhaphy?

Answer 15

proptosis
lagophthalmos

Question 16

______ is forward displacement of the globe and entrapment by the eyelids. This is associated with trauma and occurs in brachycephalic breeds with shallow orbits.

Answer 16

proptosis

Question 17

_______ is forward displacement of the globe without entrapment by the eyelids

Answer 17

exophthalmos

Question 18

_______ is an enlarged globe.

Answer 18

buphthalmos

Question 19

T/F: proptosis is most common in cats, mesocephalic and dolichocephalic dogs.

Answer 19

false – greater force is required for this to occur in these types of animals, and therefore there is a poorer prognosis

Question 20

what is the most important thing to do in a proptosis case?

Answer 20

lubricate the eye and then attempt replacement if possible.
the sooner the eye is replaced, the better prognosis.

Question 21

what are the best prognostic indicators for proptosis?

Answer 21

menace or dazzle
consensual PLR

pupil size or reflexes are NOT good prognostic indicators to utilize.

Question 22

what are 4 circumstances of proptosis in which you should consider enucleation as opposed to tarsorrhaphy?

Answer 22

1. ruptured globe
2. optic nerve avulsion
3. 3+ extraocular muscles severed
4. complete hyphema

Question 23

What is the first step to a tarsorrhaphy?

Answer 23

perform a lateral canthotomy using fine scissors.

Question 24

how do you go about replacing a proptosed eye during a tarsorrhaphy?

Answer 24

roll out the lid margins with forceps
apply pressure on the globe with the back of scalpel

Question 25

what suture type and size is used for closure of a tarsorrhaphy?
what pattern is used?

Answer 25

2-0 to 4-0 NON-absorbable suture in a horizontal mattress pattern.
ENSURE sutures are only PARTIAL thickness and are emerging from the lid margin and gland openings.

Question 26

what is the purpose of using stents in tarsorrhaphy procedures?

Answer 26

minimize pressure on the eyelids.

Question 27

why do we always leave the medial canthus open during a tarsorrhaphy?

Answer 27

for medication application

Question 28

During a tarsorrhaphy, the lateral canthus is closed in TWO layers, what are those layers and how does the suture differ?

Answer 28

1. tarsoconjunctival layer – absorbable suture
2. skin layer – non-absorbable suture

Question 29

what are some long-term considerations that should be discussed with owners about tarsorrhaphy procedures?

Answer 29

the animal will not look normal – strabismus, lagophthalmos, KCS, blindness
a second surgery may be required

Question 30

what are the 4 structures that need to be removed in an enucleation surgery?

Answer 30

1. globe
2. third eyelid and gland
3. conjunctiva
4. eyelid margins and meibomian glands

Question 31

In what instances would an enucleation be indicated?

Answer 31

1. blind, painful eyes
2. ocular congenital defects resulting in chronic issues
3. severe intraocular infections with sig globe destruction +/- source of systemic infection
4. extensive intraocular tumors
5. extensive intraocular inflammation gone uncontrolled or causing blindness
6. extensive trauma
7. end-stage glaucoma

Question 32

what are the 2 different approaches to enucleation and what is the difference?

Answer 32

1. subconjunctival – faster and less painful recovery
2. transpalpebral – for severe infections, large neoplasms; creates a large soft tissue defect.

Question 33

what suture is used for orbital cone during enucleation and what is the purpose?

Answer 33

2-0 to 5-0 simple interrupted absorbable suture to reduce dead space.

Question 34

what is the most common indication for wedge or house resection?

Answer 34

eyelid tumors

Question 35

in dogs, most eyelid neoplasias are (benign/aggressive), whereas the opposite it true for cats.

Answer 35

benign

Question 36

if the eyelid tumor is involving less than ____ of the eyelid length, then you can excise it using the wedge or house resection method. If not, you should perform a blepharoplasty.

Answer 36

1/3

Question 37

Wedge or house resections also have 2 layer closures. What are these?

Answer 37

1. tarsoconjunctival layer – absorbable suture
2. skin layer – non absorbable suture

Question 38

what is another alternative to wedge/house resection and blepharoplasty for removing a mass on the eyelid?

Answer 38

debulk with blade or scissors followed by cryosurgery to minimize its regrowth.
but this procedure is MORE likely to have regrowth.

Question 39

Finish the sentence:
if it is worth taking out…

Answer 39

it is worth submitting.