Tuesday, July 29, 2014

1431. Talk to Vet Students in Yesin Vet University - Traumatic proptosis in a 15-year-old Chihuahua

DRAFT


Best of friends but 2 days ago, the cross-bred pounced on this 15-year-old Chihuahua. When the owner came home, the eyeball was dirty and the cornea was yellowish with pus (IMAGE).




Traumatic proptosis - Forward displacement of the eye with eyelids entrapped behind the eye, due to injury.

Video by Teri


TREATMENT
Dog is still eating
No injectable sedation as dog is so old
Atropine 0.2 ml IM and 0.2 ml SC
Anaesthesia gas isoflurane + O2 only.
Scissors cut lateral canthus 1 cm long, eyelids entrapped are released
2 catheter tubes  3/0 nylon
Inj pred + genta subconj.  Eye ointment into eye.
Push eyeball inward by pressing and pull stitches outwards
Stitched
Post op tolfedine + baytril

Dog woke up fast and made some vocalisation for 3 minutes. OK now.  4.30 pm

Try to save the eye by replacement of the prolapsed eyeball rather than take it out. Looks bad and had wanted to take it out.  . .











Eye injuries are emergencies and treatment is best done within 4 hours of injury. Now the dog has had rubbed her right eye severely till it looked horribly red and dry with pus.

"This is a very old dog. She may just die on the operating table," I informed the lady. "You have two alternatives. To replace the eyeball or to get me to remove it. I cannot guarantee that the dog will regain her normal vision as the eyeball looks infected with pus and so a second surgery may be needed to remove it if there is infection after replaement."

This procedure is "Informed Consent" and the lady must know the risks and sign the Consent to anaesthesia and surgery..

"What should I do?" the lady owner had to decide whether to replace or enucleate the eyeball.
"I can't decide for you," I replied. "If the eyeball had come out within 4 hours of injury, I will advise pushing it back to save her vision. But you waited too long. Over 24 hours and the eyeball looked badly infected with pus."

"What would you do?".
"If she is my dog, I would try to save the vision."

I could not guarantee that the replacement of the globe would result in the dog getting back her normal vision as the owner had delayed treatment by more than 24 hours.  Her big mixed breed dog had pounced on this 15-year-old Chihuahua and the eyeball had prolapsed. The diagnosis is traumatic proptosis.








Sunday, August 3, 2014. Stitches removed. Eyeball is white but had returned to the socket.  Owner informed. Vision is probably 10% but the dog has the eye.

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