tpvets_logo.jpg (2726 bytes)TOA PAYOH VETS

Date:   22 August, 2010  
Focus: Small animals - dogs, cats, hamsters, guinea pigs & rabbits
A SECOND OPINION ON ENUCLEATION OF THE EYE - "eyeball must be taken out," said the first vet
Dr Sing Kong Yuen, BVMS (Glasgow), MRCVS
First recorded: 26 November, 2000
22 August, 2010 
Be Kind To Pets
Veterinary Education
Project 2010-0129
"The vet recommended taking the eyeball out!" shouted an excited Mrs Hartono in a high pitch voice over the phone, shattering my ear drums.  The left eyeball had prolapsed, and was noticed by the observant servant who informed her. Mrs Hartono kept beautiful Pekinese dogs but this was the first to become a one-eyed dog if she adopted the recommendations of the veterinary surgeon.  

It was two days before Christmas and on the eve of her departure overseas for a ski trip at Vail in Colorado.  Would the young Pekinese lose its eye if it was not operated on? The corneas of two eyes were damaged and blood was coming out from the eye tissues.  The right eye had a small corneal ulcer earlier but there was no serious problem till now. The left eye now has a very big hole in its cornea and this was the eyeball recommended to be removed. 
Pek eye corneal ulcer Pekinese - eye corneal ulcer.  Less than 24 hours.
The right eye had a 2 mm wide ulcer.  Acute conjunctivitis.  The Pekinese was tranquilised by  intramuscular injection and put under general anaesthesia using gas More than 8 mm wide corneal ulcer in the left eye.  Red liquid blood swirled around the lower inside of the eyeball, below the cornea at 4 - 6 o'clock  

It is a very emotional issue for owners all over the world.  Removal of the eyeball means that the dog will be one eyed and what happen if the other eye becomes blinded?   

Just being told of the news could evoke so much sorrow for most lady owners.  It is permanent blindness and affects the owner as if she herself is affected.    

"Can you save the eye?"  Mrs Hartono was seeking a second opinion as her daughter was very upset on hearing the news of the need to remove the eyeball surgically. 

There was no guarantee of success in such a case but if the corneal injury occurs in less than 24 hours, the chances of success in saving the eye from being removed surgically
are much higher. 

Pekinese - eye-lids stitched up. Eye-lids stitched up to promote ulcer healing.
Upper and lower eye-lids stitched up to cover the ulcer and let it heal without being irritated by drying wind and dust.  This surgical procedure is called tarsorrhaphy Antibiotic injection into the eye conjunctiva after shaving off the hairs around eye-lids. Pekinese at the end of anaesthesiA

The after-operation nursing and the costs of nursing are very important in determining a successful outcome.  The veterinary anaesthesia and treatment of the eye by stitching up the eye-lids cost S$200, but the nursing costs can be 3 times and most owners will prefer to bring the dog home soon but don't know how to care for the eye.

Nobody knew what caused the serious corneal ulceration in the Pekinese.  Could it be the cats as she was fond of barking at them and maybe one of them took several swipes at the Pekinese eyes?   The left eyeball had prolapsed (come out from its socket).  Red blood bleeding inside the eye could be seen.

The Pekinese went home on January 15, 2000. "It is very thin," said Mrs Hartono when the dog came home.  The Pekinese was "blind" for 14 days as it could not see.
It was not interested in the food at the veterinary clinic.

Day 23. Before going home. Clear eyes.

Day 23 after surgery.  The stitches were removed on day 14.  The right eye ulcer had healed and is a small white spot. The left eye ulcer is still healing. Small  blood vessels migrate to the centre of the ulcer bringing in the repair cells. There was no infection of the inside of the eyeball now.

2 days at home, its left eye became redder although its right eye was normal.  The dog had rubbed its left eye although it was wearing the Elizabeth collar. 

Spot lights in the house, wind, air conditioning, dust from the garden and bright sunlight all irritate deep eye ulcers which are still healing.  Healing takes several weeks of good nursing care and keeping the eye away from breezes and lights. 

Pet owners need to be extra vigilant in nursing an eye corneal ulcer in an animal whether it is a dog, rabbit or race horse.  The continual scratching of the injured eye due to severe itch aggravates the injury and sometimes lead to the rupture of the cornea, with the whole liquid contents of the eye ball leaked out.  In such cases, the eyeball collapses and eye-sight is lost.  The bacteria and fungi get inside the eyeball causing pus to be formed, a condition called hypopyon

Enucleation or the removal of the septic eyeball will be the only solution in such cases. 
If an eye ulcer injury occurs less than 24 hours, appropriate veterinary treatment using the method above may save the eye.  Even if the eyeball pops out of the socket, a common condition of Pekinese,  earlier veterinary treatment may save the eye.   

The deep ulcerative keratitis of the left eye of this Pekinese needed prolonged nursing and it will take more than 2 months of careful nursing before the defect can be covered by scar tissue. 

Unfortunately, most owners feel sorry that the dog need to be kept in a dark place and to wear the Elizabeth collar. Therefore, the owner will remove the collar for an hour or so.  That is when the dog scratches its itchy eye and the ulcer deepens.  

Eventually, its septic eyeball needs to be removed by the vet as the dog could not tolerate anymore the continual itch and pain. There are cases where the owner does not seek veterinary treatment and the eyeball collapsed and degenerated into a shrunken mass.

In this Pekinese, the eyeball was not removed as the ulcer healed satisfactorily. But it took a long time and lots of nursing care by Mrs Hartono's maids. The Pekinese had the best Christmas present - the eyeball.

Enucleation - The removal of the prolapsed eyeball is a recommended procedure in Veterinary Ophthalmology books but sometimes it may be possible to save the eye-ball if the owner is willing to spend money and time to get the treatment and nursing done.  

3 cases of corneal ulcers

Eye corneal ulcers need extra-vigilant nursing care.Case 1: Eye injury in a rabbit.
Sometimes, rabbits do get eye ulcers but such cases are rare and usually due to fighting. This rabbit had a left eye ulcer 20 days ago. The ulcer did not heal even though it was treated with eye drops at home.  The rabbit was observed wanting to hide under the bed. The most likely reason was that its ulcerated eye was sensitive to bright light and wind and it was afraid of more eye drops. It was warded and given an Elizabeth collar to prevent it from scratching.  The ulcer healed and became a white spot after several days.

Case 2:  Will it be too late for the mobile phone girl to save her Shih Tzu's eye?

Case 3:  The Fox Terrier with an eye ulcer


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