April 20, 2013 4.26pm NEX public library
Today is a bright sunny Saturday. At 9 am, I reviewed the two surgical cases done by Dr Daniel as he is off on Saturdays. Both will go home today. \
Case 1. Right Perineal hernia in an old male Pom. No more vomiting. The hernia repair tissues were weepy and the stitches were not holding well as the skin was gangrenous. The owner had waited 2 months. The dog had kidney disorder and vomited. The bladder was trapped inside the hernia and the dog could not poop. \
"Ensure the dog drinks at least 200 ml of water twice a day," I reminded the owner and offered to give her a 20-ml syringe. I escorted her to her car parked to the side of the surgery although she said no need to do so. Dr Daniel was not present and normally he would not have done it. Carrying a bigger-sized Pom and opening the car door would be difficult. She had a driver whom I mistook for her husband.
"Hand feed sufficient amount of food. Use clean water to flush away the blood and stools near the wound."
Case 2. This young cat of around one year old had a protruding 3rd eyelid since young. He came in to be neutered. The owner had sent it to another vet earlier. Then the kitten was treated by Dr Daniel for swollen conjunctivitis at the age of one month. The owner asked me what's wrong with the left eye? 3/4 of the eyeball was covered by a brown 3rd eyelid permanently. I could not see 60% of the eyeball and so I could not see the whole pupil.
I had not seen such an eye condition in my over 40 years of practice. "It could be a persistent 3rd eyelid," I said as it reminded me of the condition of "persistent pupillary membrane" in dogs. "During neuter and anaesthesia," a piece could be snipped off.
I discussed the case with Dr Daniel. He said: "This could be Horner's syndrome in the cat. The 3rd eyelid protrudes as the eyeball shrinks or is pulled inwards."
Horner's syndrome is due to brain injury. The upper eyelid droops (the upper eyelid is wet at the margin compared to the right eye). The eyeball does not look shrunken but then this is not so obvious. There should be miosis (constriction of the pupil) but I could not see the whole pupil as it is the eyeball is around 60% covered and only a slit of the pupil could be seen.
Somehow I don't think this is Horner's Syndrome although it has some of the elements. To me, it looks like a developmental defect with the dorsal upper end of the 3rd eyelid stretched out and fixed to the lateral canthus (see images). "The purpose of excising the 3rd eyelid is to let the cat see better," I said to Dr Daniel. He voiced his opinion that it would not work as the cat has a shrunkened eyeball and so the 3rd eyelid would still cover the eyeball due to muscular pull.
"We could test for intra-ocular eye pressure," I decided. "In any case, snip off the triangular piece between the upper and lower corners of the 3rd eyelid so that the cat can see as this area obstructs the vision of his pupil. Dr Daniel neutered the cat and did accordingly yesterday.
This morning, I looked forward to seeing whether this cat can see better. What do you think? I will let the images tell the story.