Tuesday, July 27, 2010

144. Eyeball prolapse. The Shih Tzu's left eyeball pops out

Tue July 27, 2010. Back to work after visiting Penang yesterday to talk to a swiftlet farm consultancy with my mentor who is interested in this cloak-and-dagger business. I presume the underworld has a hand in the swiftlet and bird nest production business but then where there is money to be made, the triads will be there.

At 3 pm after finishing perineal hernia in a Shih Tzu that cried during defaecation, I was surprised to see a lady in her 30s waiting in my reception. She was early for her appointment. She showed me her female Shih Tzu with a green left eye.

"Her left eyeball popped out after 5 pm yesterday as I saw her at that time and she was OK," lady owner said. Another dog had jumped onto this Shih Tzu. The eyeball pops out <24 hours. I could see that the dog had been rubbing eye vigorously till the upper area above the eyelid was a purplish red and the sclera (eye white) was as blood shot as it could ever be.

The lady consulted Vet 1 who had instilled green ophthalmic fluoroescein. This dye showed that > 80% of the eye cornea is ulcerated. She wanted a second quotation and Clara, a dog groomer and friend had referred her to my surgery where charges are apparently lower. Groomers sometimes play a great role in referrals according to the Penang vet I visited in Penang yesterday. The Penang vet showed me the pet shop whose owner regularly sent him cases. Well, I don't have such good connections as pet shop owners in Singapore tend to be promiscuous in veterinary referrals.

"The Shih Tzu has a high fever," I warned the lady of the risk of death on the operating table for an old dog. An old dog with a high fever too aggravated the risk. "However, eye injuries are emergencies and cannot wait another 24 hours." The lady had no choice and left the decision to me.

I gave the anti-fever and painkiller tolfedine and antibiotics baytril injection subcutaneous around 5 minutes before I used Isoflurane gas to anaesthesize the dog. There was no sedation as this would be riskier.

Surgery: Lateral canthoplasty increases the space for this enlarged injured popped out eye. The prolapsed eyeball was too large for a simple stitching up of the eyelids (tarsorraphy).

"But I had a previous Shih Tzu whose eyes popped out bigger and the vet did not do that," the young lady said.

"Each case is different," I said. "If you don't want the side of the eyelid to be cut to enlarge the eye socket to accommodate the eyeball, please don't blame me if the stitching of the upper and lower eyelids break down before 7 days."

The lady consented to leave the technical matters to me. Many owners want to voice their opinions on treatments and in some cases, they are more knowledgeable than he vet who has to treat several thousands of various cases and may not be an expert in a particular condition.

The following is a summary for vet students of what I did.

1. "Clip both eye area and eyelid lashes," I said to Mr Saw as he presented me with the dog. "Take out the 3rd eyelid and wash off any hairs and debris. Also rinse the eyeball thoroughly."
2. I note an embedded foreign body inside the eye-white. I used a scalpel blade cut off.
3. I ensured that all green dye and hairs are washed away.
4. Sub conj gentamycin and prednisolone subconjuctiva.
5. 3rd eyelid flap, use tension tubes and stitch lateral canthus.
6. For old dogs with fever, reduce the fever and stablised the dog first in normal situations. This will take 24 hours. Eye injuries are emergencies and so the vet has to decide whether to operate soon or not.

The beloved Shih Tzu recovered well from anaesthesia as if from a nap. I phoned the worried lady to let her know that her dog was OK. The eyeball should shrink back to normal in 7-14 days. The lady wanted her dog back and took her home the next morning.

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