Tuesday, December 13, 2011

771. SOP for eye injuries at Toa Payoh for all vets

1. General examination of the dog and eyes
1. Detailed examination of the eye injury
3. Pupil examination - Pupillary light reflex - direct and consensual
4. Cornea examination - Fluorescein stain strip on both eyes and inform owner of the extent of the green stain



5. Record and illustrate extent of ulcers (green stain) and advices on treatment on the medical record.


6. Diagnosis - superficial keratitis, ulcerative keratitis, descemotocoele as shown in images below:
DESCEMETOCOELE

CORNEAL ULCER PERFORATION


7. Advices on treatment and costs
7.1 Extremely itchy eye. E-collar and eye drops. Eye irrigation of 3rd eyelid if acute conjunctivitis, under sedation is strongly advised.
7.2 Corneal ulceration surgery. Tarsorrhapy under general anaesthesia.


7.3 Corneal ulceration surgery. Tarsorrhapy and 3rd eyelid flap under general anaesthesia
7.4 Corneal ulceration surgery. Conjunctival flap. Needs 7/0 sutures under general anaesthesia



8. Digital images before & after treatment preferred or illustration to be recorded in medical record
9. Post-op warding in Toa Payoh Vets for 3 days mandatory for tarsorrhapy and conjunctival flap. Owners who insist on bringing the dog home are strongly advised not to and the "Against Medical Advice" instruction is to be clearly recorded in the medical record to avoid disputes of post-op stitch breakdown (see case study).

10. Pre-op preparation for surgery. Ensure area is shaved clean. Bigger facial area to be clipped short on both eye area. Eye-lashes to be clipped short.
11. Eye irrigation including 3rd eyelid flap wash must be done.


12. Sub-conjunctival injection of gentamycin may or may not be done.
13. Advices: Treat cause of corneal ulcerations. Protruding eyeball in the Shih Tzu, Pug, Pekinese ensures that such eye injury cases are common in the three mentioned breeds in Singapore and elsewhere. Another cause besides traumatic, is nasal fold hairs irritating the eyeball and nasal fold excision surgery is recommended.


Case studies at Toa Payoh Vets:
1. Perforated corneal ulcer in a pug
http://www.sinpets.com/dogs/20110315pug-male-7months-perforated-corneal-ulcer-deep-ulcerative-keratitis-toapayohvets.htm

2. Descemetocoele in a Shih Tzu
http://www.sinpets.com/dogs/20100660eye-injuries-rubbing-shih-tzus_dogs_singapore_ToaPayohVets.htm

3. Most of Dr Sing's case studies will be filed at:
Eye problems seen at Toa Payoh Vets:
http://www.bekindtopets.com/animals/20081201PAGE3_Dog_Surgery_Anaesthesia_Eye_ToaPayohVets.htm

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