771. How are eye injuries treated at Toa Payoh Vets

HOW ARE EYE INJURIES TREATED AT TOA PAYOH VETS?

Dr Sing Kong Yuen, BVMS (Glasgow).

 1. General examination of the dog and eyes. 

2. 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 in the medical record. 

6. Diagnosis – For example, superficial keratitis, ulcerative keratitis, descemotocoele as shown in images below.

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. Tarsorrhaphy under general anaesthesia. 

7.3 Corneal ulceration surgery. Tarsorrhaphy and 3rd eyelid flap under general anaesthesia.

7.4 Corneal ulceration surgery. Conjunctival graft. Needs 7/0 sutures under general anaesthesia.

8. Digital images before & after treatment preferred or illustration to be recorded in the 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 do so. The "Against Medical Advice" instruction is to be clearly recorded in the medical record to avoid disputes of post-op stitch breakdown. 

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. Eyelid eversion and irrigation must be done.

12. Sub-conjunctival injection of gentamycin may or may not be done, depending on the vet. 

13. Advices: Treat the cause of corneal ulcerations. Traumatic injury caused by the protruding eyeball in the Shih Tzu, Pug, Pekinese ensures that such eye injury cases are common in the three above mentioned breeds in Singapore and elsewhere. Another cause is nasal fold hairs irritating the eyeball and nasal fold excision surgery is recommended. Ectopic cilia is another cause of eye corneal irritation and ulceration. 


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

 

IMAGES OF CASES SEEN AT TOA PAYOH VETS ARE SHOWN BELOW:

SUPERFICIAL ULCERATIVE KERATITIS

DEEP ULCERATIVE KERATITIS

CORNEAL ULCER PERFORATION

DESCEMETOCOELE

TARSORRHAPHY 

CONJUNCTIVAL GRAFT

This blog address:
https://2010vets.blogspot.com/2011/12/771-sop-for-eye-injuries-at-toa-payoh.html

EYE INJURIES

Superficial ulcerative keratitis 

Deep ulcerative keratitis (blood and fluid seen)

Descemetocoele (protrusion of the eye basement membrane)

SURGICAL TREATMENT

Tarsorrhaphy is the joining of part or all of the upper and lower eyelids so as to partially or completely close the eye. Temporary tarsorrhaphies are used to help the cornea heal or to protect the cornea during a short period of exposure or disease. The procedure is done at Toa Payoh Vets. Images of a case study is shown below.

EYELID IRRIGATION

Eyelid eversion is used to expose the superior palpebral conjunctiva and fornix, so that foreign matter can be identified in these areas. Eyelid eversion and irrigation are frequently done together to ensure that both particulate material and chemical irritants are removed from the entire ocular surface. 

SURGICAL TREATMENT
Conjunctival graft. A strip of conjunctiva is freed and rotated so that it covers the ulcer, then stitched into position using very fine dissolvable suture material. The conjunctival graft provides a blood supply and physical support to the ulcer to allow it to heal.

Typically, the cornea will heal in 6 to 8 weeks. A follow-up appointment is necessary to monitor your pet's healing.

A VIDEO ON EYE ULCERS IN THE DOG