Wednesday, January 23, 2013

1258. Follow-up hamster eyeball enucelation & eye salvage alternatives

tpvets_logo.jpg (2726 bytes)TOA PAYOH VETS
toapayohvets.com

Date:   24 January, 2013  
 
Focus: Small animals - dogs, cats, hamsters, guinea pigs & rabbits
The hamster has a popped out eyeball 
Dr Sing Kong Yuen, BVMS (Glasgow), MRCVS
First written: 22 January, 2013
Date:   24 January, 2013  
toapayohvets.com 
Be Kind To Pets
Veterinary Education
Project 2010-0129

1256. Hamster with a popped out eyeball. Follow-up update and surgical procedures info.

 
Jan 22, 2013

"She is going to die," the young lady wiped her tears as her 2-year-old female dwarf hamster was sleepy unlike others. The hamster just would not move when held on the palm of her hands. She took her out several times and this would stress out the sleepy hamster which had not eaten and drunk water in the past 2 days and was in great pain.

"Two days ago, the right eyeball just popped out," she said. "Before that there was a white spot in her right eye. I thought it was a cataract."

The hamster's shoulder skin stood up when pulled indicating severe dehydration. The protruded eyeball must be very painful as the hamster can't talk. She just sat still most of the time. The owner was quoted $400 by another vet to do surgery. "I don't have that much money," the student said. "Normally I charge $100-$250" for hamster surgery depending on how complicated it is and the time it takes.
 
Eyeball prolapse
 
After eyeball removal

PRE-OP DEXTROSE SALINE
"What are you injecting?" Dr Daniel saw me preparing a small injection of 0.05 ml in a 1-ml syringe and thought I was overdosing this hamster. "It is dextrose saline as he is so lethargic and weak."

ANAESTHESIA
"This is a very sick hamster," I said to Dr Daniel when we discussed anaesthesia. He proposed 1 drop of Zoletil IM. "The safest is just isoflurane gas," I said. "The vet needs to be very observant as it is hard to tell when the hamster is fully anaesthesized.

We put the hamster inside a plastic container infused with 5% isoflurane gas. "Count up to 10 and take out. Repeat," I said. Dr Daniel did say 1,2,3...10!" once. The dosage was not enough. He tried again. "Use the mask," I said. But the mask was not effective as it was too big. OK for the baby rabbit.

SURGERY
Basically enucleation of the eyeball is similar to that for the dog. I incise 4 mm on the lateral canthus. Then I clamp the base of the eyeball with forceps. The normal eyeball suddenly popped out and the hamster squeaked. I ceased the procedure and gave the hamster more case. I scrutinised the hamster inside the plastic container. Once he could not move, I quickly took him out within a second. Clamped the eyeball, excised the base with scalpel. Unlike the dog, it was not possible to ligate the optic stalk and blood vessels. Profuse bleeding. I swabbed. Then I cut off the upper and lower eyelids to create two wounds which I sutured with 6/0. The hamster wriggled and I stitched fast 3 interrupted sutures.

"Hold on to his front paws, the scruff of his neck," I said to him. The dwarf hamster is so small that there is no space for both of us. Finally, I sutured the eyelids. It was too cramped for the intern to take a video of the surgery. However she videoed 30 minutes post op and the hamster was busy cleaning himself. Surprisingly, the hamster became much more energetic after removal of the eyeball. It would be attribute to removal of pain and the dextrose saline. So, the owner was glad to see him as she took him home in the afternoon.

1 DAY AFTER SURGERY
On Tuesday, Jan 22, 2013,  I phoned the young lady. She was most happy. "The hamster drinks a lot," she said. "She is much more alive." It was good news.

2 DAYS AFTER SURGERY
Yesterday, Wednesday, Jan 23, 2013, the owner phoned me to say that there is a big hole. "Is it normal for hamster in such operations to have a big hole in the eye? What should I do? Can I send you the images of the eye by iPhone?" I said it was difficult to know what she meant and it is best to examine it as she thought there was a stitch breakdown exposing the eye wound.

She brought the hamster to the surgery in the afternoon. I was out and some driver had suddenly swerved into my parked car opposite the church and public library, damaging the right fore lamp area. So Dr Daniel examined this hamster.

"What happened?" I asked Dr Daniel.
"The swelling was due to the bleeding after removal of the eyeball. It has become a clot. The owner did not give the pain killer and the hamster scratches the eye area. But the hamster is normal, very active, eating and running. Is it possible that you did not snip off the eyelids but had just stitched up the eyelids?"

Dr Daniel was assisting me in this surgery to remove the eyeball but he was on the other side of the op table holding on to the hamster while I stitched up the "eyelids". As the hamster was a dwarf, he could not see me using a pair of scissors to snip off the upper and lower eyelids, as per standard operating procedure in eyeball removal surgery. In fact, it would be professionally incompetent not to do.

SNIPPING OFF THE UPPER AND LOWER EYELIDS

His palm is 4X in area compared to this dwarf and unlike the surgery in the dog or cat, he could not see much. He saw me using the scissors to cut off the 6/0 sutures after stitching the "eyelids". Actually, I had trimmed off the eyelids before putting in 3 stitches to close the eye. "I had cut off the eyelids, otherwise the eye would not seal off when the stitches dissolve," I said to him patiently.
 

EYEBALL REMOVAL SURGERY COMPARED TO THE DOG AND CATG

The surgery to remove the eyeball in the hamster can be completed in less than 5 minutes unlike in the dog or cat owing to the small size of the eyeball. The same principles of surgery apply to the hamster as to the dog and cat, only that the operation is on a miniature scale and the anaesthetic risk of death from isoflurane gas is 10x higher as it is difficult to monitor the depths of anaesthesia.   

SAVING THE EYE

This hamster had a "white spot" in the right eye earlier. The owner thought it was a cataract. This would be a corneal ulcer. The hamster would have scratched so hard that her right eyeball popped out permanently and caused great pain. In the dog and cat, it is possible to "save the eye" if it is not badly damaged or infect. This is done by doing lateral canthotomy (which I did in this hamster) to enlarge the ocular space, push back the eyeball, give antibiotics and anti-inflammatory, stitch up the upper and lower eyelids (tarsorrhaphy) and in 14-21 days review the eyeball and remove the stitches. In this case, the eyelids are not snipped off. An e-collar is then worn. All these are not possible for the hamster esp. the post-op care as the hamster hates the e-collar and will get rid of it in no time. The hamster may not eat after such a drastic surgery. So, removing the popped out eyeball is the practical option.  
 

Eye Injuries Are Emergencies in Hamsters. Consult Your Vet Immediately
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syrian eye injured prolapsed luxated fight with other hamster enucleation toa payoh vets singapore syrian eye injured prolapsed luxated fight with other hamster enucleation toa payoh vets singapore syrian eye injured prolapsed luxated fight with other hamster enucleation toa payoh vets singapore    
tpvets_logo.jpg (2726 bytes) 3785 - 3791. Enucleation of the eye in a Syrian hamster at Toa Payoh Vets performed by me. The 3rd eyelid is not so prominent in the hamster unlike in the dog.

This webpage is:
http://kongyuensing.com/folder7/201301123hamster_eyeball_enucleation_toapayohvets.htm
 
 
More info at: Dogs or Cats
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