It has still been very steady at work which is great for a change. I have had a very interesting case load from routine general anaesthetics and dentals to working up a parrot with a non-weightbearing lameness to a behavioural consultation dealing with inter-dog aggression within the same household. Ah my line of work definitely never gets boring.
If anything, my poor brain cells are usually swamped with high energy demands and threatened with information overload.
When my brains are struggling with a very challenging and obscure case, I often consult with my colleagues at work or even contact one of the many available and brilliant veterinary specialists in my region. In the past two weeks, I have picked the brains of so many great minds ranging from a Gribble’s pathologist to a surgery specialist, to an emergency intensive care veterinarian and a medicine specialist to even a bird specialist I must say I can’t imagine life without internet. It is just so easy to email specialists the history including x-rays and laboratory results of a patient in a matter of a few clicks. I just love being able to discuss cases more frequently with veterinary specialists and learning from them and giving clients the best possible advise and treatment options.
I have plenty of cool cases to share with you. I will, however, control the urge of overloading you with too much information and stick to discussing my overdue and much-anticipated two eye cases. I of course have some really gory pictures to share today so please consider yourselves warned! Now before I dive into the grit of it, I would like to be clear on something:
If your pet has a sore eye, no matter how simple the condition may appear to you, you should get a vet to have a quick look.
Eyes are very delicate and if not treated early, your pet risks losing its vision. There is no point just bathing your pet’s eye with salty water or using left over eye ointment. Some of these ointments contain cortisone and are contraindicated if your pet has a corneal ulcer as they delay healing. If your pet contracts eye issues afterhours, don’t hesitate to call out a vet because it is important to do so for your pet’s sake! Have you ever had conjunctivitis or an eye injury? If you have, you would understand how painful it can be and would not want your pet to endure that for a long period before getting it treated.
Now let’s start with the story of Sky, the 4 month old female Burman cross kitten, that presented to me afterhours a few weeks ago. When the owner called me, she said: ‘The eye is hanging out, I don’t know what happened, oh my god’. I instructed her to bring her in immediately for me to examine. I usually try to get more information but I could tell the poor owner was very distressed.
The voice in my head said: ‘Most likely it is a grass seed in the eye causing it to swell and appear bulging and so it will be straightforward to treat’.
See I can never predict what is in store for me because some owners downgrade the emergency and others exaggerate it and some actually describe it exactly as it is. Obviously none of these clients are purposely mis-informing me of the plight of their pets; they are just genuinely concerned about their much-loved pets, otherwise they would not have called me.
I arrived at the clinic and got all my ophthalmology equipment ready (local anaesthetic eye drops, fluorescein stain, ophthalmoscope and a wood’s lamp). Little did I know that most of the equipment would be deemed unnecessary in this examination. The owner arrived and laid ‘Sky’ on the table and I was actually startled! The owner had not exaggerated at all.
This poor kitten’s eye was bulging and two to four times its normal size and she was in a world of pain.
‘Sky’ when she first arrived. She was in shock.
My adrenaline spiked through the roof and I realised I needed to act FAST. I did not have time to get too much history and simply needed to put on my surgical hat and press on. I admitted ‘Sky’ to the hospital and told the owners I will do my best to save the eye but the prognosis was very guarded at that stage. I called my colleague Dr. Alana Anderson to help me out as she only lived 5 minutes away. I gave ‘Sky’ much-needed pain relief in the form of the premedication/sedative.
I then quickly put her under full anaesthetic to fully examine her eye & determine the probable cause.
Sky’s eye continued to swell under general anaesthetic.
I could not find any puncture marks indicating she had been attacked by a dog which caused the eye to prolapse. Her oral exam revealed a suspect sinus behind her last molar. I probed the sinus and drained a small amount of pus. I was suspicious of a penetrating wound injury. I then performed a lateral canthotomy to facilitate replacing the eye globe in its correct position. To my utter dismay, it was impossible to reverse the prolapse. The more I tried to gently replace her globe, the more damage I caused. I had to think fast and on my toes.
The only other option left was to do a tarsorrhaphy to protect her eye. I had to be careful not to penetrate her bulging eye with every suture I put in. It felt like I was suffocating her bulging eye. She recovered okay but was still very uncomfortable. I topped her up with lots of pain relief and took her home with me. She slept in a cage right beside my bed. I dragged extra pain relief with me in case I had to give her more during the night. I simply couldn’t stand to see her in any more pain.
Thankfully she slept most of the night but occasionally would bump her eye and meow her little heart out.
This was ‘Sky’ getting pampered in my lap at home. So precious, right?
The next morning, I discussed the treatment options with her owner. We had to re-anaesthetize her to reassess her eye and based on that either proceed with an eye enucleation or try to push it back into its normal position again.
When I examined her eye this time around, the swelling had come down a bit but her eye was still bulging.
The owners were happy for me to try to preserve the eye well aware it may only be for cosmetic reasons and she may well need to undergo a 3rd anaesthetic if we can’t control the pain or the swelling in the next couple of weeks. I repeated the tarsorrhaphy and started her on aggressive medical therapy. She was sent home with eye drops that decrease the intraocular pressure and hardcore pain relief and antibiotics.
‘Sky’ recovering from her second anaesthetic with her repeat tarsorrhaphy.
I checked up on her a few days later and found out she was travelling really well, maybe a bit too well. She was apparently running around and acting like her kitten old mischievous self. She was booked to see me again in 2 week’s time.
I was beyond excited to see her on her revisit appointment. I can’t say she shared the same sentiment.
This is ‘Sky’ right before we took out her sutures.
Unfortunately in spite of all my efforts, I was unable to save her eye. It was resorbed and not functional.
I am hoping to re-examine her eye in another month or so to see if there is any further developments. The good news is she didn’t require any further surgery and was perfectly well otherwise.
Sky & I posing for a picture. I love her white socks!
Now it is time to move on and talk about ‘Spot’, the 4-year-old male desexed Welsh Corgi, that I examined on a Saturday morning.
The owners were worried about his swollen eye that developed overnight. On examination, I discovered his eye was perfectly fine but it was pushed forward because there was something behind it. I recommended he undergo a general anaesthetic so I can perform an oral examination.
‘Spot’ with his bulging eye & his compressed 3rd eyelid.
‘Spot’ put under general anaesthetic to allow me to do my oral exam.
Can you appreciate the red blister/pimple behind the last upper molar that I circled?
This is quite a common finding in grass seed season. A grass seed can penetrate behind the last molar and leads to an abscess formation. It is a tricky spot to get an abscess and the result is pushing the eye forward while the pus builds up behind the eye. See the pus has nowhere to go as it is a tight area and so the result is a pushing the eye out of the way! Thankfully the treatment is usually straight forward and consists of establishing a drainage site for the pus and hunting for a foreign body.
All this is done blind and it is in a delicate spot where the nerves and blood vessels of the eye all live.
You must probe with utmost care and avoid causing any damage. Thankfully, I managed to pull out a bristle of a grass seed that was still stuck in the gums. I then extended the sinus to facilitate the drainage of pus. I decided not to perform a tarsorrhaphy as I was fairly confident the swelling will reside and the problem had been solved. ‘Spot’ recovered very well from his anaesthetic and posed for quite a few photographs. This dog is by far one of the friendliest, obedient and forgiving Corgis I have ever met. I instantly fell in love with him.
‘Spot’ joining me on the bench.
‘Spot’ drooling pus which indicated my drainage site was still working.
‘Spot’ always ready to please.
‘Spot’ shaking his tail nonstop.
I booked him in for a revisit a week later. He made an astounding recovery. Check out the pictures of his revisit below.
‘Spot’ back to normal and still very eager to please.
And voila I have finally shared these interesting eye cases with you. Fire away any questions you may have and I hope it was worth the wait.
- Fetching a stick turns ugly… (rayyathevet.com)