Thursday, September 11, 2014

1494. SCRIPT FOR INTERN A Cavalier King Charles has a "blackhead" in his eyelid margin. Suppurative meibomitis

"I press it and pus will come out," the lady told me. "It does not bother him but bothers me very much."

It refers to a swelling and lump on the eyelid margin of this 4-year-old Cavalier King Charles.

"It is suppurative meibomitis and usually the dog tries to rub it away, injuring the cornea and causing tearing," I explained that the eyelid margin has a phospholipid-producing sebacious gland called a meibomian gland. When it is blocked or infected, it swells.

"I don't see him rubbing his eye," the lady told me. "Why don't you just use a scalpel and cut it and let the pus come out?"

"It is not that simple," I replied. "Without anaesthetic, the dog could move a lot and my scalpel may cut into his cornea, blinding him. It is quite a big abscess and need to be excised by surgery and anaesthesia."

"How much?"
"Anaesthesia and surgery will cost around $200," I said. She said Ok.
"Has the dog eaten?"
"Yes," she wanted the surgery to be done today as she was too busy tomorrow.
"It is 10 am now. I will do it at 3 pm when the food has gone past the stomach."

Electro-surgical excision from inside the eyelid conjunctiva. Thick pus flowed out.  There was a bigger lump under the palpebral conjunctiva and the electricity sealed the bleeding blood vessels leaving a black hole of 3 mm x 3 mm.
"Do you need to stitch it?" the lady asked when she came at 3 pm.
"No need to. It will heal."


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