Surgical diseases of the eye Flashcards
what should you ensure you do with the patient prior to surgery in order to protect the corneal surface from debris and hair?
apply a petroleum ointment
what type of surgical prep solution should be used prior to eye surgeries?
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.
________ is inversion of eyelid margins such that the outer, haired skin contacts the cornea or conjunctival surface.
entropion
what are the secondary/acquired entropion types?
spastic – transient entropion due to painful eye or severe blepharospasm
what are the clinical signs of entropion?
pain (squint, tearing, swelling, redness)
keratitis (pigment deposition +/- ulceration)
how does entropion differ between large and brachycephalic breeds?
in large breeds, the lateral canthus is usually affected.
in brachycephalics, the nasal/medial canthus is affected.
when is temporary tacking with minimal sedation and local anesthesia a recommended temporary solution for entropion?
in young animals that have not reached full maturity
in animals with spastic entropion
what suture size and type is used for temporary tacking of entropion?
What pattern is used?
3-0 to 5-0 NON-absorbable suture
in a simple interrupted of horizontal mattress pattern.
What is the permanent treatment for entropion?
hotz-celsus
what are the 3 techniques for estimating the entropion correction needed to be made with hotz-celsus procedure?
- rule of thumb technique using digital pressure
- grasping with forceps
- blood technique after initial incision made
describe how to perform hotz-celsus to correct entropion.
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.
what suture size and type is used to close hotz-celsus entropion correction? What pattern is used?
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).
what is a common complication of entropion correction surgery?
overcorrection which can create ectropion which is MORE challenging to correct.
If the entropion surgery involves lateral canthus, what should be included in the surgical procedure in addition to using the Hot-Celsus aproach?
lateral lid wedge resection
in what circumstances would you perform a tarsorrhaphy?
proptosis
lagophthalmos
______ is forward displacement of the globe and entrapment by the eyelids. This is associated with trauma and occurs in brachycephalic breeds with shallow orbits.
proptosis
_______ is forward displacement of the globe without entrapment by the eyelids
exophthalmos
_______ is an enlarged globe.
buphthalmos
T/F: proptosis is most common in cats, mesocephalic and dolichocephalic dogs.
false – greater force is required for this to occur in these types of animals, and therefore there is a poorer prognosis
what is the most important thing to do in a proptosis case?
lubricate the eye and then attempt replacement if possible.
the sooner the eye is replaced, the better prognosis.
what are the best prognostic indicators for proptosis?
menace or dazzle
consensual PLR
pupil size or reflexes are NOT good prognostic indicators to utilize.
what are 4 circumstances of proptosis in which you should consider enucleation as opposed to tarsorrhaphy?
- ruptured globe
- optic nerve avulsion
- 3+ extraocular muscles severed
- complete hyphema
What is the first step to a tarsorrhaphy?
perform a lateral canthotomy using fine scissors.
how do you go about replacing a proptosed eye during a tarsorrhaphy?
roll out the lid margins with forceps
apply pressure on the globe with the back of scalpel
what suture type and size is used for closure of a tarsorrhaphy?
what pattern is used?
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.
what is the purpose of using stents in tarsorrhaphy procedures?
minimize pressure on the eyelids.
why do we always leave the medial canthus open during a tarsorrhaphy?
for medication application
During a tarsorrhaphy, the lateral canthus is closed in TWO layers, what are those layers and how does the suture differ?
- tarsoconjunctival layer – absorbable suture
- skin layer – non-absorbable suture
what are some long-term considerations that should be discussed with owners about tarsorrhaphy procedures?
the animal will not look normal – strabismus, lagophthalmos, KCS, blindness
a second surgery may be required
what are the 4 structures that need to be removed in an enucleation surgery?
- globe
- third eyelid and gland
- conjunctiva
- eyelid margins and meibomian glands
In what instances would an enucleation be indicated?
- blind, painful eyes
- ocular congenital defects resulting in chronic issues
- severe intraocular infections with sig globe destruction +/- source of systemic infection
- extensive intraocular tumors
- extensive intraocular inflammation gone uncontrolled or causing blindness
- extensive trauma
- end-stage glaucoma
what are the 2 different approaches to enucleation and what is the difference?
- subconjunctival – faster and less painful recovery
- transpalpebral – for severe infections, large neoplasms; creates a large soft tissue defect.
what suture is used for orbital cone during enucleation and what is the purpose?
2-0 to 5-0 simple interrupted absorbable suture to reduce dead space.
what is the most common indication for wedge or house resection?
eyelid tumors
in dogs, most eyelid neoplasias are (benign/aggressive), whereas the opposite it true for cats.
benign
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.
1/3
Wedge or house resections also have 2 layer closures. What are these?
- tarsoconjunctival layer – absorbable suture
- skin layer – non absorbable suture
what is another alternative to wedge/house resection and blepharoplasty for removing a mass on the eyelid?
debulk with blade or scissors followed by cryosurgery to minimize its regrowth.
but this procedure is MORE likely to have regrowth.
Finish the sentence:
if it is worth taking out…
it is worth submitting.
