Sunday, January 16, 2011

306, Divine play on the vet? puppy eyelid granulomas

If you believe in Divine Powers playing fun and games with vets, this case must surely be one of them.

The puppy was purchased with no obvious eyelid growths. Then the puppy started rubbing her eyes all day long as 3 large eyelid growths appear. Why? There is no rational explanation. Tearing stained the left lower eyelid.

Electro-excision is the cure. As the puppy is a high anaesthetic risk, two vets prescribe eye drops. Vets seldom do anaesthesia in puppies, not even once a week, as there are usually no indications. The same applies to Toa Payoh Vets and I am sure for the other 40 veterinary practices.

But these eye drops would not reduce the large inflamed granulomas and will not resolve the puppy's problem of itchy eyelids and continuous scratching. A puppy in distress worries the owner as a puppy can easily die if not treated. What to do?

"Give an eye ointment and ask her to come back one month later," my assistant suggested. I said: "The lady had seen two vets and had got an eye drop. This growths need to be cut off. Preferably by electro-excision. However, the puppy may die under anaesthesia and then we get a big problem. Some owners demand compensation. New puppy deaths are extremely emotional and unpleasant."

I did not further stress the lady by requiring her to sign the consent form for anaesthesia as I noted that she had many questions with no answers from the vet. Why did the eyelid growths occur? What is the cause? Will a new eye drop work? What is the best drug? Why is the paw itchy? For the paw itchiness, I could tell her the cause was ringworm. Will the itchiness disappear with this Surolan ear drops given by Vet 2?

So, I used electro-surgery, a bit of Zoletil IV and isoflurane gas to excise 3 eyelid granulomas (histological confirmation). Then 7 days later, the owner returned. "The puppy is still scratching the eye (despite wearing an e-collar). I found a tick in the face." Therefore the tick must be from the vet. It was likely but it is hard to prove its origins. So I said: "It is possible that the tick came from the grooming as the puppy was clipped bald all over."









"What to do with the open wound? One stitch had come off," the owner pointed to the medial canthus (see picture). The correct method would be to re-stitch under anaesthesia. But that would mean another risk to be taken. Eye drops again? It would not help. I noted a 4th eyelid swelling on the upper eyelid to the right of the previous one. "There is a 4th eyelid growth," I said. "It is best to remove it as it may be the cause of eye rubbing."

This time, I just gave isoflurane gas and excised the big granuloma. Stitching should be from muscle to upper eyelid edge rather than lower eyelid edge to upper eyelid edge to prevent ectropion. The puppy went home with no complaints for the next 10 days. I hope all would be well.

Through my 30 years of small animal practice, I had not encountered this problem in such a young puppy. So, was it Divine play? It is hard to say. I doubt other vets all over the world encounter such a problem. The eyelid granulomas appear some days after purchase, as if by magic.

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