Wednesday, September 18, 2013

1145. Corneal ulcer surgery - differences of opinions

Sep 18, 2013

I operated on the Cavalier King Charles, sewing up his eyelids while Dr Daniel was in charge of anaesthesia. "It is OK with me that your opinion is different from mine," I said to him.The dog was hospitalised one day and was scheduled for stitching of the eyelids this afternoon. Dr Daniel observed that the right dry eye has not accumulated much mucus as before and said that surgery was not necessary after all.

As you can see from the 2 images below, from afar, the right eye looks "recovered" but actually it is badly inflamed with blood vessels forming towards the central part of the cornea.






 

"The dog had been given medication to relieve inflammation and infection and so the right eye looks better with less sticky mucus. How long will this condition last, nobody knows.  I believe this dog's right eye is in a bad state and this surgery will help, but you deem the surgery unnecessary. Not every vet will have the same opinion and this is to be expected by me. Some veterinary text books and articles say that such surgeries should not be done at all as there is the risk of infections in a closed eye stitched up. You have read such articles and you have your opinion."



Vet text books and articles sometimes portray and advise incorrectly. The dog's right eye is dry and has blood vessels and a thick opaque film. Closing up the eye will enable better healing as there is no more wind, sunlight, dirt and dust irritating the eye. The left eye with a big ulcer will have better results.

We will wait 7-10 days to see. Taking digital images before and after operation will be part of my clinical research to substantiate my claim that this surgery is in the best interest of the dog. In theory, this right eye may recover with careful nursing but how many Singaporean dog owners have the time and patience and skill to apply eye drops, restrain the dog in a crate with it barking noises affecting neighbours or to ignore the dog's cries to come out from imprisonment inside a crate almost 24 hours a day?

I had once advised an owner with a Shih Tzu's big eye ulcer to do the conservative treatment of eye drops and e-collars. In the end, the most unhappy owner went to another vet for treatment. She had rejected my surgery advice owing to financial constraints or other reasons.

This vet phoned me for medical records. In severe corneal ulcerations, stitching the eyelids is the best form of treatment, in my opinion.


Tarsorrhaphy was done on Sep 18, 2013. I usually do the stitch-into tubing as seen in the right eye. Dr Daniel proposed no stitch through but insert stitch inside tubing as seen in the left eye. Both eyes look OK today.



Today Sep 19, 2013. Looks good on the dog. No infection
















   



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