Corneal Ulcer
What is a corneal ulcer?
The cornea is the transparent shiny membrane that makes up the front of the eyeball. A corneal ulcer is deep erosion into the third layer of the eye, giving it a cloudy appearance and is painful. The most common cause is trauma. This can result from eyelashes rubbing on the eye (entropion), cat scratch or contact with a sharp object. Most pets will rub the affected eye with a paw or on carpet to attempt to relieve the pain.
Diagnoses methods
Diagnosis is made by direct examination of the eye or in some cases using a special stain.
Treatment options
Some cases can be treated with eye drops/ointment containing antibiotics that will both prevent infection and act as a lubricant, to reduce some of the soreness from the lesion rubbing on the eyelid during blinking. Surgery leads to much shorter healing times generally but comes with some added cost. Pets have an extra eyelid that lies inside the other two lids and is attached to the inside corner of the eye – known as the third eyelid. A third eyelid flap is performed by pulling this structure over the eyeball, and then holding it in place with a suture through the third eyelid and out through the skin lateral to the eye. This surgery is performed under a general anaesthetic.
Recovery and aftercare
Your pet will go home on the day of surgery with a cone in place to prevent trauma that can be caused if your pet tries to rub at the eye with their paw, or tries to rub their face on the floor. The third eyelid flap is usually released around two to four weeks after surgery, depending on the severity of the lesion.
Prolapsed Third Eyelid
What is a prolapsed third eyelid gland?
The third eyelid gland is a gland that sits beneath the third eyelid in dogs. This gland is responsible for a part of the tear film that dogs produce to keep the cornea lubricated. If the gland “prolapses” from underneath the third eyelid, it is seen as roundish pink fleshy mass in the cornea of the eye near the nose.
Treatment options
Prolapse of this gland obstructs the normal movement of the third eyelid across the cornea. The prolapsed gland often tends to become quite inflamed and irritated and can lead to rubbing of this eye and secondary infections.
Procedure method
The gland is normally sutured back into place by creating a pocket in the tissue beneath the third eyelid gland, and closing this pocket, once the gland is back in place, with buried sutures. This keeps it in place permanently. Removal of the gland is even quicker, and whilst not preferred, is still an option.
Recovery and aftercare
Some swelling is normal due to inflammation of the tissues. This settles over the next seven days or so, with the use of eye ointment that the dog goes home with. No suture removal is required.
Meibomian Gland Tumours
What are meibomian gland tumours
These are tumours of the meibomian glands of the eyelids. These are common in older dogs and start as small bumps at the margin of the upper and lower eyelids. Many of these stay small (2 – 3mm) and do not continue to grow further, so there is never any rush to have them removed. Some of these tumours even rub or rest on the eye itself, but if they remain small, they do not appear to cause any irritation. Occasionally the tumours become “active”, and they start to become larger. Once evidence of enlargement is seen then they will only continue to grow until removed.
Treatment options
These tumours are easily removed using a “V” wedge excision of the affected eyelid. We can cut close to these tumours as they do not require large margins, thus preserving most of the eyelid. Most of these require removal of around an 1/8 to 1/4 of the affected eyelid, but even up to a 1/3 of the eyelid can be removed without noticing that surgery has been performed once healed.
Very fine sutures such as 6-0 Prolene are used to close the surgery site or re-oppose the eyelid margins. Placement of the first suture at the eyelid margin is very important. If this is located perfectly then it is often hard to tell that the affected eyelid did indeed have surgery once it has healed.
Recovery and aftercare
Pets go home with an Elizabethan collar to prevent them rubbing at the eyelid that has had surgery. Eye ointment is usually sent home with them as well to help control any conjunctival inflammation as a result of the surgery. Follow up is suture removal two weeks after surgery and we do not charge for this visit.
Entropion
What is entropion?
Entropion is a condition where either the upper or lower eyelids (or both) roll inwards, leading to the eyelashes rubbing on the cornea. Affected animals usually present with wet ‘blinky’ sore eyes.
Commonly affected breeds
Most commonly this condition is seen as rolling-in of the lateral (outer) eyelashes of the lower eyelid of breeds such as Rottweilers, Mastiff breeds, Malamutes and more commonly Shar Pei. This type of entropion is also seen in older cats. With Pugs, we see entropion of the medial (inner or near the nose) area of the lower eyelids. In Shar Pei puppies, we see entropion of the upper eyelids which self corrects as the puppy grows. This can often be managed with the use of anti-inflammatory/antibiotic eye ointments. Occasionally we place sutures to hold the upper eyelids away from the cornea for a couple of months as the puppy grows.
Why surgery is needed
Left untreated this will eventually lead to scarring of the cornea and eventual partial or complete blindness. This condition causes marked discomfort 24 hours a day, every day, until treated.
Treatment method
The procedure is performed under a general anaesthetic, the surgery can take anywhere between 20 – 45 minutes depending on if one or both eyes are affected. Incisions are made along the length of the affected eyelid to ensure the eye is symmetrical given the curvature of the eye. Incisions are made within 2 – 3mm of the eyelid margin, so it is difficult to see a scar long term. We have also found that it is not necessary to shave any of the hair away from around the eyelids to perform this surgery. As a result, owners do not have to wait months and months for the hair to return around the surgical area, leading to a much more rapid and pleasing result to the eye.
Recovery and aftercare
Your pet will go home on the same day as the procedure, with antibiotics, pain relief and eye ointment. Your pet will need to have a cone in place until suture removal, to prevent rubbing of the eyes with a paw or on carpet causing trauma and removal of sutures. The sutures are removed 14 days post-surgery. Your pet’s eyes will take some weeks to heal and usually within a month will be back to normal. Many owners comment when they return they have noticed their pet has changed in behaviour due to the relief of pain and discomfort.
