HOOK "I apply the eye ointment & my Shih Tzu wore an
e-collar for the last 7 days," the couple said to me. "But the red spot is still
present. What's the problem and what is the solution, Doc? (SHOW VIDEO OF THIS
DOG IF ANY)
"A Be Kind To Pets" Educational Video Veterinary
Surgery Comes Alive To Vet Students & Pet Owners
What happened to the right eye of this active 4-year-old male Shih
Tzu? A red bulging spot persisted for over 2 weeks. As there
were financial budgets over medical expenses, I prescribed an eye ointment and
the dog was to wear an Elizabeth collar (e-collar) 7 days ago. At this stage,
any advice to perform eye surgery would be rejected by most Singapore dog owners
owing to the costs and so conservative treatment is recommended in this
However, the red bulging spot persists and this time, I advised
"Your Shih Tzu has a Descemetocoele," I sketched an
illustration of the cross section of the eyeball and cornea. (SHOW THIS
ILLUSTRATION of the 4 layers of the cornea - basement membrane, Descemet
membrane, stroma and epithelium).
"His cornea has been seriously
injured resulting in a very deep ulcer. However the cornea has not ruptured yet
or all liquid from inside the eyeball will flow out.
"The pressure of
the liquid inside the eyeball pushes out the Descemet membrane and from your
point of view, you see a red bulging spot. (SHOW THIS ILLUSTRATION OF CROSS
SECTION OF THE EYEBALL WITH BULGING LUMP). "
"The solution is to stitch up the eyelids so that the ulcer can heal without
the dog rubbing the eye as an ulcer is very painful. An exposed ulcer is
irritated by the dust, breeze and light and will not heal well if the dog keeps
rubbing his eye with his paw or against the wall or bed."
requires anaesthesia and there is always an anaesthetic risk of death on the
operating table. Do you accept the risk and approve the surgery?
much is the cost?" the wife asked.
"Around $400 for the anaesthesia,
surgery and hospitalisation."
"$400 just to stitch up the eyelids?" the
wife asked. "The cost involves more than just stitching up. There is the
anaesthesia cost, the hospitalisation for at least 3 days and the nursing
SOLUTION(WILL PROVIDE AN UPDATED ILLUSTRATION
AS THIS ONE IS FOR THE CAT)
The eye surgery called the 3rd eyelid flap &
tarsorrhaphy. This involves stitching up the eyelids to cover the ulcer so that
it can heal without dust or dryness causing eye pain. (SHOW THE ILLUSTRATION OF
THE SURGICAL PROCEDURE)
HOW THE EYE SURGERY IS
PERFORMED Elaborating on the surgery with script below.
Day 1. After the surgery. Eyelids stitched
up to let corneal healing take place. E-collar is worn. The dog is
hospitalised for at least 7 days as the owners will not be able to provide
good nursing care. The dog bites or moves during eye treatment..
3. A very high standard of veterinary care of the eye by the vet
Day 3. Dog has been sedated and blood clots removed. Twice
daily inspection & treatment of the eye is done.
Stitches loosen. In most cases, stitches break down between 7-10 days, due to
the eyeball movements
7. No more red bulging spot
White spot is a scar plugging the ulcer. Dog goes home
Day 7. A good surgical outcome in this case. The sclera is not
inflamed while the cornea healing is excellent. The owners are happy. E-collar
and eye ointment for another 30 days.
CONCLUSIONNo post-op complaint from the owner for the past
30 days. The white spot will remain on the cornea but has no significant effect
on the dog's vision. Good surgical outcomes are not guaranteed in all cases of
deep corneal ulcers (deep ulcerative keratitis).
EYE INJURIES ARE
CONSULT YOUR VET WITHIN 24 HOURS OF INJURY TO SAVE YOUR DOG'S
TIPS & ADVICES 1. Eye drops & e-collar as the treatment
will not give good healing as the dog wants to rub his itchy and painful eye all
the time. The Descemetocoele will rupture, leaking out liquid from inside the
eye. Bleeding and infection will occur as in one case (image, left).
2. Early treatment before the cornea ruptures
gives good healing results but many owners are reluctant to pay for the
anaesthestic and medical costs. So many vets prescribe eye drops and e-collars.
This was what I did for the case study before the eye surgery option is accepted
by the owners.
3. If the owner insists on bringing the dog home
instead of hospitalisation, the surgical outcome is usually poor (inflamed
sclera and cornea) as the owner is unable to apply eye drops and clean the eye.
Some dogs bite or shift their head during nursing or rub their eye and e-collar
against the wall and bed when they are at home.
4. Some vets are against the 3rd eyelid flap, saying
that the 3rd eyelid flap obstructs the application of eye ointment or drops as
it covers the eyeball. I make sure that the eyeball and the inside of the 3rd
eyelid is well irrigated and clear of debris before stitching.
5. Tarsorrhaphy (stitching of the upper and lower
eyelids) may be another procedure without the 3rd eyelid
6. A very high standard of veterinary nursing is
required. Good outcomes are usually due to excellent and experienced nursing.
The vet must examine the eye twice a day and not just leave the case to the
nurses who may not be experienced in nursing such cases. Sedation is required to
clean the eye area on Day 3.
7. Stitches loosen from Day 6-10 and are removed. Stitches can't stay for
long due to the eyeball movements and tension.
8. Horizontal mattress
sutures are advised. Practise placing horizontal mattress sutures to close the
skin during the sterilisation of the dog and cats and the vet will have the
necessary experience to perform tarsorrhaphy well. However, most vets will not
use horizontal mattress sutures for skin sutures in sterilisation.
all professions, practice makes perfect. If a vet does hundreds of horizontal
mattress sutures during sterilisations, he or she will have honed his skills
which prepare him or her for tarsorrhaphy. Tarsorrhaphy is not a common surgery
for most practices in Singapore and much success depends on good placing of the
horizontal mattress sutures.
P.S. BE KIND TO PETS EYE INJURIES ARE
EMERGENCIES SEEK EARLY VETERINARY CARE(show a
before and after tarsorrhaphy treatment case in a Pekinese)
SURGERY EXTENSIVE CORNEAL ULCER
SURGERY ULCER HAS HEALED
CLEAR CORNEA WITH FAINT WHITE
EARLY EYE SURGERY (TARSORRHAPHY) HEALS THE DEEP
CORNEAL ULCER PREVENTING RUPTURE & LOSS OF VISION IN THIS PEKINESE